A5040424385- Blood Pressure and Hypertension Studies
- Pharmaceutical Practices and Patient Outcomes
- Dementia and Cognitive Impairment Research
- Frailty in Older Adults
- Cardiac, Anesthesia and Surgical Outcomes
- Chronic Disease Management Strategies
- Medication Adherence and Compliance
- Health Systems, Economic Evaluations, Quality of Life
- Diabetes Management and Education
- Diabetes Treatment and Management
- Diabetes Management and Research
- Sodium Intake and Health
- Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Global Cancer Incidence and Screening
- Nutrition and Health in Aging
- Colorectal Cancer Screening and Detection
- Heart Failure Treatment and Management
- Primary Care and Health Outcomes
- Palliative Care and End-of-Life Issues
- Aortic aneurysm repair treatments
- Cancer survivorship and care
- Heart Rate Variability and Autonomic Control
- Chronic Kidney Disease and Diabetes
- Health disparities and outcomes
- Pharmacovigilance and Adverse Drug Reactions
University of California, San Francisco
2017-2025
San Francisco VA Medical Center
2017-2025
Northern California Institute for Research and Education
2020-2025
Stanford University
2025
Simon Fraser University
2023
San Francisco VA Health Care System
2021-2023
British Geriatrics Society
2022
Kaiser Permanente
2016
Duke University
2014
Importance Asymptomatic blood pressure (BP) elevations are common in hospitalized older adults, and widespread heterogeneity the clinical management of elevated inpatient BPs exists. Objective To examine association intensive treatment with in-hospital outcomes adults for noncardiac conditions. Design, Setting, Participants This retrospective cohort study examined Veterans Health Administration data between October 1, 2015, December 31, 2017, patients aged 65 years or noncardiovascular...
Antihypertensive medication deprescribing is common among nursing home residents, yet its association with cognitive decline remains uncertain.
Transient elevations of blood pressure (BP) are common in hospitalized older adults and frequently lead practitioners to prescribe more intensive antihypertensive regimens at hospital discharge than the patients were using before hospitalization.To investigate association between intensification clinical outcomes after discharge.In this retrospective cohort study, 65 years with hypertension who Veterans Health Administration national health system facilities from January 1, 2011, December...
More older adults are undergoing major surgery despite the greater risk of postoperative mortality. Although measures, such as functional, cognitive, and psychological status, known to be crucial components health in persons, they not often used assessing adverse outcomes adults.
ABSTRACT Background Deprescribing antihypertensives is of growing interest in geriatric medicine, yet the impact on functional status unknown. We emulated a target trial deprescribing antihypertensive medications compared with continued use measured by activities daily living (ADL) long‐term care population. Methods included 12,238 Veteran Affairs residents age 65+ who had stay ≥ 12 weeks between 2006 and 2019. After 4+ stable medication use, were classified as either deprescribed (reduced 1...
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Abstract Background People with dementia (PWD) take medications that may be unnecessary or harmful. This problem can addressed through deprescribing, but it is unclear if PWD would willing to engage in deprescribing their providers. Our goal was investigate attitudes toward among PWD. Methods a cross‐sectional study of 422 aged ≥65 years who completed the module National Health and Aging Trends Study (NHATS) 2016. Proxies provided responses when participant unable respond due health...
Abstract Objectives To assess how often older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment, and identify markers of appropriateness these intensifications. Design Retrospective cohort study. Setting US Veterans Administration Health System. Participants Patients aged 65 years or over hypertension between 2011 2013. Main outcome measures Intensification defined as receiving a new higher dose agent at discharge...
Abstract Background Older nursing home (NH) residents with glycemic overtreatment are at significant risk of hypoglycemia and other harms may benefit from deintensification. However, little is known about deintensification practices in this setting. Methods We conducted a cohort study January 1, 2013 to December 31, 2019 among Veterans Affairs (VA) NH residents. Participants were VA age ≥65 type 2 diabetes length stay (LOS) ≥ 30 days an HbA1c result during their stay. defined as <6.5 any...
Abstract Background Optimal systolic BP (SBP) control in nursing home residents is uncertain, largely because this population has been excluded from clinical trials. We examined the association of SBP levels with risk cardiovascular (CV) events and mortality Veterans Affairs (VA) on different numbers antihypertensive medications. Methods Our study included 36,634 aged ≥65 years a VA stay ≥90 days October 2006–June 2019. was averaged over first week after admission divided into categories....
Background: It is unclear whether machine learning methods yield more accurate electronic health record (EHR) prediction models compared with traditional regression methods. Objective: The objective of this study was to compare and for 10-year mortality using EHR data. Design: This a cohort study. Setting: Veterans Affairs (VA) Participants: age above 50 primary care visit in 2005, divided into separate training testing cohorts (n= 124,360 each). Measurements Analytic Methods: outcome...
Abstract Background Prescribing cascades are important contributors to polypharmacy. Little is known about which older adults at highest risk of experiencing prescribing cascades. We explored veterans the gabapentinoid (including gabapentin and pregabalin)–loop diuretic (LD) cascade, given dramatic increase in recent years. Methods Using Veterans Affairs Medicare claims data (2010–2019), we performed a prescription sequence symmetry analysis (PSSA) assess loop initiation before after among...
Abstract Background More than one‐fourth of older adults with cognitive impairment (CI) live alone; these individuals often lack support for medication management and face a high risk adverse drug events. We characterized the frequency types high‐risk medications used by CI living alone and, context, compared patterns those in others. Methods This was cross‐sectional study National Health Aging Trends Study (NHATS) data Medicare claims (2015–2017). ascertained status from NHATS use Part D...
This retrospective cohort study examines whether patients with type 2 diabetes on hospice are assessed for dysglycemia, receive insulin or oral hypoglycemic medications, experience hypoglycemia and hyperglycemia in the nursing home setting.
Abstract Background Persons with dementia (PWD) have high rates of polypharmacy. While previous studies examined specific types problematic medication use in PWD, we sought to characterize a broad spectrum misuse and overuse among community‐dwelling PWD. Methods We included adults aged ≥66 the Health Retirement Study from 2008 2018 linked Medicare classified as having using validated algorithm. Medication usage was ascertained over 1‐year prior an HRS interview date. Potentially medications...
Pharmacy dispensing data are frequently used to identify prevalent medication use as a predictor or covariate in observational research studies. Although several methods have been proposed for using pharmacy use, little is known about their comparative performance.
Abstract Background Guidelines discourage sliding scale insulin (SSI) use after the first week of a nursing home (NH) admission. We sought to determine prevalence SSI and identify factors associated with stopping or transitioning another short‐acting regimen. Methods In an observational study from October 1, 2013, June 30, 2017 non‐hospice Veterans Affairs NH residents type 2 diabetes admission over 1 week, we compared weekly versus two other regimens – fixed dose (FDI) correction (CDI,...
Abstract Background Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high adverse events. Multimorbidity indices such as Charlson Elixhauser scores have important limitations. We sought to create a better method of measuring using by incorporating geriatric conditions, markers disease severity, disease‐disease interactions, tailoring measures different outcomes. Methods Health conditions were assessed Medicare inpatient outpatient from...
<h3>Importance</h3> Elevated blood glucose levels are common in hospitalized older adults and may lead clinicians to intensify outpatient diabetes medications at discharge, risking potential overtreatment when patients return home. <h3>Objective</h3> To assess how often discharged with intensified the likelihood of benefit associated these intensifications. <h3>Design, Setting, Participants</h3> This retrospective cohort study examined aged 65 years not previously requiring insulin. The...
Abstract Background Inadequate treatment of high blood pressure (BP) can lead to preventable adverse events in nursing home residents, while excessive associated harms. Methods Data were extracted from the VA electronic health record and Bar Code Medication Administration system on 40,079 long‐term care residents aged ≥65 years October 2006 through September 2018 (FY2007‐2018). Hypertension prevalence at admission was identified by ICD code(s) year prior, antihypertensive medication use...