Older Adults' Health
The Median Life Expectancy (Centers for Disease Control)
Medicare spent on health care for older individuals and people with disabilities in 2018
Average amount people 65 and over spend on out-of-pocket health costs in 2016, a 38% increase since 2006
Study Results that Support Better-Informed Decisions
Every year, many of the 250,000 people who have surgery for hip fracture in the United States receive general anesthesia, but the use of regional anesthesia injected into the spine is rapidly increasing. A PCORI-funded randomized trial led by researchers at the University of Pennsylvania found that the two approaches are equally safe and effective. Published in the New England Journal of Medicine, the study of 1,600 patients 50 and older at 46 hospitals across the United States and Canada found rates of survival, ability to walk, and post-operative delirium were similar for patients who had either anesthesia. The results could facilitate decision making about which option best fits a patient’s preferences.
Cervical spondylotic myelopathy, or CSM, occurs when the spinal cord becomes compressed as people age and is the most common cause of spinal cord dysfunction worldwide. A PCORI-funded study -- conducted by a team at the Lahey Clinic in Massachusetts -- examined patient-reported outcomes one year after surgery among patients who received any of the three common surgical treatments for CSM. As reported in JAMA, compared with the other two types of surgery, patients with dorsal laminoplasty had better physical function and fewer problems from surgery. They were also less likely to report using opioids for pain, having imaging tests, and having ongoing physical therapy.
As reported in Depression and Anxiety, a research team at Wake Forest University found that cognitive behavioral therapy (CBT) and yoga were both effective at reducing worry and anxiety in older adults, while CBT improved sleep more than yoga. In the study, the team -- led by Gretchen Brenes, PhD -- assigned half of the older adults to CBT or yoga by chance; the other half chose between CBT and yoga. These results held regardless of whether the participants chose their treatment or were assigned treatment at random.
Age-related challenges—including memory loss, limited caregiver availability, or chronic conditions—can affect how older adults respond to treatment for cancer, but physicians sometimes aren’t aware of them. The COACH Study wanted to see if a report about issues related to a patient’s age would improve care-planning communication among the patient, caregiver, and doctor. As reported in JAMA Oncology, compared with patients without a report, patients who had one were engaged in and more satisfied with conversations with their physician.
In a paper in the New England Journal of Medicine, the PCORI- and National Institutes of Health-funded STRIDE Study reported that having nurses tailor and administer fall-prevention plans for older adults at high risk resulted in about an 8 percent to 10 percent reduction in serious fall injuries, but this effect was not statistically significant. The paper discusses potential barriers to care and other factors that could account for why a more significant reduction in serious fall injuries was not seen when risk-reduction strategies shown to be effective in previous studies were deployed this way in real-world circumstances and settings.
The first phase of this PCORI-funded study asked older adult patients and family caregivers which outcomes of transitions in care between different settings matter most to them, a question that previous research has not thoroughly explored. The study identified three outcomes: feeling prepared to implement their care plans, accountability from care settings, and feeling their healthcare providers care about them. These early findings are part of a larger, ongoing study.
The PCORI-funded PROSPER study compared outcomes of older adults who have atrial fibrillation and have had a stroke. In a new paper published in JAMA Neurology, the research team reports that patients who were prescribed direct oral anticoagulants when discharged from the hospital following a stroke had relatively better outcomes—including more days at home and fewer adverse events—than patients prescribed the blood thinner warfarin. This reinforces findings from prior research on the subject.
Spotlights on Ongoing Studies and Projects
Hip fractures send more than 300,000 older adults to hospitals each year, and the vast majority of patients must undergo surgery that requires anesthesia. Previous research suggests that spinal anesthesia may help patients get better faster and with less pain than general anesthesia. This study is comparing short- and long-term patient outcomes of general versus localized anesthesia for hip fracture surgery.
Every year, roughly one in three adults over age 65 falls. These falls can lead to serious injury, disability, and even death. This project, a joint initiative with the NIH National Institute on Aging, is comparing two approaches that aim to reduce falls among older adults who live at home alone. In one arm of the study, patients receive general information about preventing falls, and in the other arm, patients work with a nurse who is a fall-care manager to develop and follow a plan to prevent falls, taking into consideration the individual patient’s risk factors.
NIH Study Targeting Older Adults Will Leverage PCORnet Data Resource
A $90 million National Institutes of Health-funded study assessing statins’ abilities to prevent dementia and other disabilities in older adults will take advantage of PCORnet®, the National Patient-Centered Clinical Research Network. This exciting study is the strongest demonstration yet that PCORnet has evolved into a valuable national resource that will help research get done faster and more efficiently.