UNASSIGNED: Our goal was to quantify the ability of various PSA values in predicting the likelihood of developing metastatic or fatal prostate cancer in older men.
UNASSIGNED: We used a random sample of patients in the US Veterans Health Administration to identify 80,706 men who had received PSA testing between ages 70 to 75. Our primary end point was time to development of either metastatic prostate cancer or death from prostate cancer. We used cumulative/dynamic modeling to account for competing events (death from non-prostate cancer causes) in studying both the discriminative ability of PSA as well as for positive predictive value and negative predictive value at 3 time points.
UNASSIGNED: PSA demonstrated time-dependent predictive discrimination, with receiver operating characteristic AUC at 5, 10, and 14 years decreasing from 0.83 to 0.77 to 0.73, respectively, but without statistically significant difference when stratified by race. At PSA thresholds between 1 and 8 ng/mL, the positive predictive value of developing advanced prostate cancer was significantly greater in Black than White patients. For instance, at a PSA > 3, at 5, 10, and 14 years, White patients had 2.4%, 2.9%, and 3.7% risk of an event, whereas Black patients had 4.3%, 6.5%, and 8.3% risk.
UNASSIGNED: In men aged 70 to 75 deciding whether to cease PSA testing with borderline-elevated PSA values, the risk of developing metastatic or fatal prostate cancer is quantifiable and relatively low. Risk assessment in this setting must account for the higher incidence of prostate cancer in Black men.

OBJECTIVE: Assisted living (AL) is a significant and growing congregate care option for vulnerable older adults designed to reduce the use of nursing homes (NHs). However, work on excess mortality in congregate care during the COVID-19 pandemic has primarily focused on NHs with only a few US studies examining AL. The objective of this study was to assess excess mortality among AL and NH residents with and without dementia or significant cognitive impairment in Alberta, Canada, during the first 2 years of the COVID-19 pandemic, relative to the 3 years before.
METHODS: Population-based, retrospective cohort study.
METHODS: Residents who lived in an AL or NH facility operated or contracted by the Provincial health care system to provide publicly funded care in Alberta between January 1, 2017, and December 31, 2021.
METHODS: We used administrative health care data, including Resident Assessment Instrument - Home Care (RAI-HC, AL) and Minimum Data Set 2.0 (RAI-MDS 2.0, NHs) records, linked with data on residents\' vital statistics, COVID-19 testing, emergency room registrations, and hospital stays. The outcome was excess deaths during COVID-19 (ie, the number of deaths beyond that expected based on pre-pandemic data), estimated, using overdispersed Poisson generalized linear models.
RESULTS: Overall, the risk of excess mortality [adjusted incidence rate ratio (95% confidence interval)] was higher in ALs than in NHs [1.20 (1.14-1.26) vs 1.10 (1.07-1.13)]. Weekly peaks in excess deaths coincided with COVID-19 pandemic waves and were higher among those with diagnosed dementia or significant cognitive impairment in both, AL and NHs.
CONCLUSIONS: Finding excess mortality within both AL and NH facilities should lead to greater focus on infection prevention and control measures across all forms of congregate housing for vulnerable older adults. The specific needs of residents with dementia in particular will have to be addressed.

Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents\' QoL.
Cross-sectional study (July to December 2021).
We purposefully selected 9 NHs in Alberta, Canada, based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). We included data for 689 residents from 18 care units.
We used the DEMQOL-CH to assess resident QoL through video-based care aide interviews. Independent variables included a COVID-19 outbreak in the NH in the past 2 weeks (health authority records), care unit-levels of care aide burnout (9-item short-form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit (validated surveys), and resident covariates (Resident Assessment Instrument-Minimum Data Set 2.0).
Recent COVID-19 outbreaks (β = 0.189; 95% CI: 0.058-0.320), higher proportions of emotionally exhausted care aides on a care unit (β = 0.681; 95% CI: 0.246-1.115), and lack of access to geriatric professionals (β = 0.216; 95% CI: 0.003-0.428) were significantly associated with poorer resident QoL.
Policies aimed at reducing infection outbreaks, better supporting staff, and increasing access to specialist providers may help to mitigate how COVID-19 has negatively affected NH resident QoL.

Aging care is critical. Projections for 2020 indicate that India\'s older population will comprise 6.57% of the overall population. The best-known newly developed technologies must be provided to the older population. Non-governmental organizations and private institutions are increasingly providing more door-to-door guidance and help. This study evaluated the impact of the National Programme for Health Care of the Elderly (NPHCE) in India and analyzed its achievements and challenges. The program\'s key strategies include providing preventive and promotional care and sickness management, empowering geriatric services, and guaranteeing optimal rehabilitation. The NPHCE is an excellent project for caring for a rapidly aging population. This study described the existing programs and schemes related to older people in India, with a focus on the NPHCE and an analysis of the program\'s achievements and challenges.

BACKGROUND: Hospitalization can be hazardous for older people, but most hospitals in Europe are not prepared to meet the unique needs of older adult inpatients. Adaptations of the physical environment, care processes, and staff knowledge and skills in geriatric care are essential to improve the quality of care for older people. An assessment of baseline organizational approaches to older adult care is an important first step toward recognizing the challenges organizations face when delivering acute care services to older adults and attempting to improve them. The Geriatric Institutional Assessment Profile could be a promising tool for this endeavor.
OBJECTIVE: To describe a systematic process implemented across seven countries and languages that sought to develop valid and culturally-appropriate translations of the Geriatric Institutional Assessment Profile.
METHODS: Cross-cultural instrument translation and content validation study.
METHODS: Expert review panels comprised of 68 practicing nurses from seven European or EU associated countries (Austria (German), Belgium (Dutch), Denmark (Danish), Israel (Hebrew), Poland (Polish), Switzerland (German, French), and Turkey (Turkish)) evaluated cross-cultural relevance, including translation, of the Geriatric Institutional Assessment Profile.
METHODS: A systematic approach to translating and validating a cross-cultural survey instrument, including back-to-back translation, adaptation, and evaluation of content validity using content validity indexing (CVI) techniques for each country and language, assessing translation and relevance content validity separately. The item, subscale and domain content validity index scores were calculated and adjusted for chance agreement among raters for all parts of the Geriatric Institutional Assessment Profile: the four subscales of geriatric care environment, the general knowledge about older adults subscale, and the clinical geriatric knowledge subscale. Consensus discussions among the raters then finalized translations.
RESULTS: CVI scores for relevance and translation were all in the \"good\" to \"excellent\" range. The geriatric care environment scale\'s CVI scores were 0.84 to 0.94 for relevance and 0.82 to 0.98 for translation. The clinical geriatric knowledge subscale\'s CVI scores were 0.83 to 0.97 for relevance and 0.94 to 0.98 for translation. The general knowledge about older adults subscale received high translation agreement (0.93 to 0.99) but slightly lower scores for relevance, ranging from 0.46 to 0.94.
CONCLUSIONS: Study results provided preliminary evidence of the applicability and validity of a multi-factor measure of age-friendly care in diverse health care systems, in German, Dutch, Danish, Hebrew, Polish, French, and Turkish languages.

Nurses\' knowledge, attitudes, and their professional responsibility regarding elderly people are vital determinants in delivery of quality care for older people. Thus, this study aimed to identify the perception and attitude of nurses toward elderly care and their correlation with professional responsibility in nurses working in emergency departments. This descriptive-correlational study was conducted on 252 nurses working in the emergency departments of five general hospitals located in the province of Ardabil, Iran. Data was collected a demographic questionnaire and standard questionnaire of nursing care for the elderly of Persoon et al. The majority of nurses reported a positive knowledge and attitude towards elderly care. Only half of the nurses had a desirable professional responsibility towards elderly care. Based on the results of multivariate regression model, the variables of knowledge, attitude, age, work experience, and previous care of older client had a significant relationship with nurses \'professional responsibility for elderly care (p < 0.01). Knowledge, attitude, age, and previous history of elderly care are significant determinants for professional responsibility towards elderly care; therefore, periodical evaluation of elderly care and its related factors can help the hospital managers to construct the basics of healthcare delivery for older people in emergency departments.

OBJECTIVE: To analyze potentially inappropriate prescribing (PIP), its prevalence and patient conditions associated with this phenomenon, in a cohort of older adults receiving outpatient care in Mexico.
METHODS: Data from 1252 adults ≥ 60 years of age, from primary care centers were analyzed. Information included sociodemographic data, medications, chronic diseases, polypharmacy (≥ 5 medications), functional dependence, cognitive impairment and frailty. Three logistic regression models were employed to identify associations between PIP (according to the Beers criteria) and different variable combinations.
RESULTS: A total of 41.8% of participants had at least one PIP. The most frequently identified PIPs involved nonsteroidal anti-inflammatory drugs (NSAIDs) and glibenclamide; clonazepam in patients with cognitive impairment; and interactions of warfarin with NSAIDs. In the multivariate analyses, Model 1 showed that frailty and polypharmacy were associated with PIP. In Model 2, only polypharmacy was associated with PIP. For Model 3, lower educational levels, taking hypoglycemics, nervous system disease drugs, antiasthmatics, gastrointestinal disease drugs and anti-inflammatories-antirheumatics and analgesics, were associated with PIP.
CONCLUSIONS: PIP is common in outpatient treatment of health care services in Mexico. Its association with medical and nonmedical factors highlights the need to improve drug treatment quality focused on implementation of effective strategies, such as educative interventions, electronic medication safety alerts, and inclusion of pharmacists in the health team.

Sharing data offers opportunities to make research into older person care more efficient. However, this is not yet common practice in the Netherlands. To optimally utilize the potential of data sharing, insight into factors that promote the implementation of data sharing in older person care research is important. In the TOPICS-MDS project, research data from the National Program for Older Person Care (NPO) was collected, managed and reused on a large scale. The experiences of stakeholders involved in this project can teach us more about the needs researchers have when sharing their data. For this study, we interviewed 23 people involved in different ways in data sharing in TOPICS-MDS about their experiences in the data sharing process. Thematic analysis yielded four overarching themes, which we converted into the following lessons: those who want to promote data sharing must ensure 1) visibility of the added value of data sharing, 2) trust in the database, 3) transparency of the process and 4) communication. These lessons complement the results of previous research with concrete advice. Optimizing data sharing in older person research is both promising and challenging. It requires dedication and involvement from both the researcher and the research participant, and appreciation for both.
Data delen biedt mogelijkheden om onderzoek naar ouderenzorg efficiënter te maken. Toch is dit in Nederland nog geen gangbare praktijk. Inzicht in factoren die implementatie van data delen in het ouderenzorgonderzoek bevorderen, is van belang om de potentie van data delen optimaal te benutten. In het TOPICS-MDS-project werd onderzoeksdata uit het Nationaal Programma Ouderenzorg (NPO) grootschalig verzameld, beheerd en hergebruikt. De ervaringen van betrokkenen in dit project kunnen ons meer leren over de behoeften die onderzoekers hebben bij het delen van hun data. Voor deze studie werden 23 mensen, die op verschillende manieren betrokken waren bij data delen in TOPICS-MDS, geïnterviewd over hun ervaringen in het proces van data delen. Thematische analyse leverde vier overkoepelende thema’s op die we hebben omgezet in de volgende lessen: diegenen die data delen willen bevorderen, moeten zorgen voor 1) zichtbaarheid van de meerwaarde van data delen, 2) vertrouwen in de database, 3) transparantie van het proces en 4) communicatie. Deze lessen vullen de resultaten uit eerder onderzoek aan met concrete adviezen. Het optimaliseren van data delen in ouderenonderzoek is veelbelovend én uitdagend. Het vraagt om toewijding en betrokkenheid van onderzoeker én onderzoeksparticipant, en waardering voor beiden.

OBJECTIVE: Undesirable events, such as falls, aspiration, and pressure ulcers, are associated with functional decline and lower quality of life among older adults. This study describes the frequency of such events among residents of geriatric care facilities and assesses the effect of training care managers in a multidisciplinary plan-do-check-adjust cycle on preventing such events.
METHODS: This was a Japan-based, non-randomized cluster intervention study. The intervention group comprised geriatric care facilities from which care managers had attended a training course, while the control group comprised facilities with care managers who did not receive this training. Six-month pre-admission and 3-month post-admission incidences of undesirable events were collected from both groups, and the two groups were compared.
RESULTS: Valid data were collected from 862 residents (416 and 446 from the intervention and control groups, respectively) from 130 facilities (60 and 70, respectively). Three-month post-admission incidences were 27.8%, 20.0%, and 11.3% for falls, fever, and pressure ulcers, respectively. There was no difference between the groups regarding post-admission incidence for any event type. Training care managers reduced the post-admission incidence of pressure ulcers among residents with a history of such ulcers.
CONCLUSIONS: The training of care managers in a multidisciplinary risk-management cycle was not effective for preventing falls, fever, or pressure ulcers. Results underscore the difficulty of preventing risk events in geriatric care facility residents even with organizational training efforts. The authors believe it is important to share such risks with residents and their families. Geriatr Gerontol Int 2021; 21: 842-848.

While the importance of primary care becomes more imminent for older adults to manage multi-morbidities, the perception of primary care among this group is not well examined.
To evaluate the primary care experience among older adults in the United States (US).
We conducted a retrospective cross-sectional study examining four domains of primary care: first contact, longitudinality, comprehensiveness, and coordination. Using survey responses from Medical Expenditure Panel Survey (MEPS), we used propensity score matching method to compare the percentage of geriatric (≥65 years old) and non-geriatric (< 65 years old) who answered favorably to questions that supported each domain from 2014 to 2016. Using multivariate regression, we also assessed the impact of each domain on various demographic and perceived need for care features of older adults.
A total of 12,982 surveys were analyzed for geriatric, compared to 62,694 surveys for non-geriatric. Overall, older adults answered more favorably than younger adults for all four domains. However, uninsured older adults, Black older adults and older adults with limitation in activities, cognitive impairments, and multiple comorbidities were more likely to have difficulties in accessing their usual source of care (USC). Additionally, Black, Hispanic, and Asian older adults and cognitively impaired adults perceived less contribution in their own treatment management.
Older adults in the US generally experience good quality of primary care, compared to younger adults. However, establishing and maintaining access (first contact) and being involved in disease management (coordination) were perceived as poor by several cohorts of older adults.