Older Adults' Health
PCORI Answers Critical Questions
Evidence gaps can make it difficult to know which approaches to care will work best given a patient’s specific needs. PCORI funds studies that seek to help older adults and those who care for them answer questions they face when making healthcare choices, such as:
Caregiver: My mom is getting a little frail as she ages. I’ve heard exercise can improve older people’s walking and avoid falls, which would enable her to continue living in her own home. Are some types of exercise classes for older people better than others at accomplishing this?
Clinician: Managing asthma can be hard for patients who have complex challenges such as multiple chronic conditions and functional declines, which are common among older adults. Which evidence-based approaches to self-management can best help older adults, especially African-American and Hispanic individuals, keep their asthma under control?
Patient: Some people say I ought to get my recently diagnosed ductal carcinoma in situ, or DCIS, treated right away. Others say I should just wait and closely monitor it, especially given my age. What’s the right thing to do?
Study Results that Support Better-Informed Decisions
Comparing Surgical Treatments for Cervical Spondylotic Myelopathy
|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.|
Trial Assessed Personalized Approach to Reducing Older Adults’ Risks for Fall-Related Injuries
|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.|
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.
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
This project, supported by a PCORI Engagement Award, created a network of senior patients and family caregivers focused on clinical areas important to older Americans. The project team teaches these stakeholders about patient-centered outcomes research (PCOR) and how to engage with researchers so that senior patients and their caregivers can participate in PCOR projects.
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.
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.