Faculty Bibliography

BACKGROUND:This study evaluated the impact of aging on the frequency and prevalent symptoms of Long COVID, also termed post-acute sequelae of SARS-CoV-2, using a previously developed Long COVID research index (LCRI) of 41 self-reported symptoms in which those with 12 or more points were classified as likely to have Long COVID. METHODS:We analyzed community-dwelling participants ≥ 60 years old (2662 with prior infection, 461 controls) compared to participants 18-59 years (7549 infected, 728 controls) in the Researching COVID to Enhance Recovery adult (RECOVER-Adult) cohort ≥ 135 days post-onset. RESULTS:Compared to the Age 18-39 group, the adjusted odds of LCRI ≥ 12 were higher for the Age 40-49 group (odds ratio [OR] = 1.40, 95% confidence intervals [CI] = 1.21-1.61, p < 0.001) and 50-59 group (OR = 1.31, CI = 1.14-1.51, p < 0.001), similar for the Age 60-69 group (OR = 1.09, CI = 0.93-1.27, p = 0.299), and lower for the ≥ 70 group (OR = 0.68, CI = 0.54-0.85, p < 0.001). Participants ≥ 70 years had smaller adjusted differences between infected and uninfected symptom prevalence rates than those aged 18-39 for the following symptoms: hearing loss, fatigue, pain (including joint, back, chest pain and headache), post-exertional malaise, sleep disturbance, hair loss, palpitations, and sexual desire/capacity, making these symptoms less discriminating for Long COVID in older adults than in younger. Symptom clustering, as described in Thaweethai et al. (JAMA 2023) also exhibited age-related shifts: clusters 1 (anosmia and ageusia) and 2 (gastrointestinal, chronic cough and palpitations, without anosmia, ageusia or brain fog) were more likely, and clusters 3 (brain fog, but no loss of smell or taste) and 4 (a mix of symptoms) less likely to be found in older adults (relative risk ratios for clusters 3-4 ranging from 0.10-0.34, p < 0.001 vs. 18-39 year-olds). CONCLUSIONS:Within the limits of this observational study, we conclude that in community-dwelling older adults, aging alters the prevalence and pattern of reported Long COVID.

The authors created Geriatrics Connect (GeriConnect), a program for first-year medical students at NYU Grossman School of Medicine to learn about healthy aging by developing a 7-month long telephonic relationship with an older adult living in the community. Background and Objectives: Early exposure to geriatrics and older adults is instrumental to preparing future physicians to care for the aging population. The objective of this study was to evaluate how the GeriConnect program affected students' attitudes on aging and ageism. Design: Paired students conducted monthly telephone or video calls with a geriatric patient recruited from the NYU Internal Medicine outpatient practice and wrote required reflections on ageism. Participants: 99 first-year medical students at NYU Grossman School of Medicine. Measurements: Student reflection essays were descriptively coded by five independent reviewers. Results: Thematic analysis revealed that many students had limited exposure to older adults prior to starting medical school, and suggested that the longitudinal relationships developed in the program improved students' understanding of aging and ageism. Conclusion: Establishing longitudinal telephonic relationships with older adults may be an effective method of enhancing student exposure to geriatrics and fostering more positive attitudes toward older adults.

Localized breast amyloidosis is often found incidentally on mammography or ultrasound, as amyloid deposits can be calcified and mimic malignancy. Although rare, breast amyloidosis should be considered a possible etiology of abnormal mammography findings in older women.

BACKGROUND:Although studies to date have broadly shown that cardiovascular disease (CVD) increases cognitive and physical impairment risk, there is still limited understanding of the magnitude of this risk among relevant CVD subtypes or age cohorts. METHODS:We analyzed longitudinal data from 16 679 U.S. Health and Retirement Study participants who were aged ≥65 years at study entry. Primary endpoints were physical impairment (activities of daily living impairment) or cognitive impairment (Langa-Weir Classification of dementia). We compared these endpoints among participants who developed incident CVD versus those who were CVD free, both in the short term (<2-year postdiagnosis) and long term (>5 years), controlling for sociodemographic and health characteristics. We then analyzed the effects by CVD subtype (atrial fibrillation, congestive heart failure, ischemic heart disease, and stroke) and age-at-diagnosis (65-74, 75-84, and ≥85). RESULTS:Over a median follow-up of 10 years, 8 750 participants (52%) developed incident CVD. Incident CVD was associated with significantly higher adjusted odds (aOR) of short-term and long-term physical and cognitive impairment. The oldest (≥85) age-at-diagnosis subgroup had the highest risk of short-term physical (aOR 3.01, 95% confidence interval [CI]: 2.40-3.77) and cognitive impairment (aOR 1.96, 95% CI: 1.55-2.48), as well as long-term impairment. All CVD subtypes were associated with higher odds of physical and cognitive impairment, with the highest risk for patients with incident stroke. CONCLUSIONS:Incident CVD was associated with an increased risk of physical and cognitive impairment across CVD subtypes. Impairment risk after CVD was highest among the oldest patients (≥85 years) who should therefore remain a target for prevention efforts.

Given the growth of the older adult population in the United States, there is a greater need for tools to enable students, trainees, and clinicians to master the comprehensive geriatric assessment. Our goal was to develop a mobile phone application (app) to assist in performing this assessment. We performed a market survey of 45 apps that related to geriatrics and health screening. We evaluated for usability, target audience, and instruments used. Deficiencies included: (1) focusing on a single domain; (2) being time-intensive; and (3) having components behind a paywall. We then designed an app that incorporates instruments that are well-validated, available at no cost, and brief in length. GeriKit includes eight domains: cognition, depression, function, strength, medications, falls, and advance care planning. Each instrument requires fewer than 5 minutes, and once it is completed and scored, the user can access relevant educational materials. GeriKit was launched for Apple users in December 2020, and for Android in August 2021. There have been over 3,400 downloads to date. The GeriKit app makes the comprehensive geriatric assessment accessible to a wide audience, improving the ability to for learners to perform geriatric assessments.

Background: As the number of older adults in the US grows, there is a pressing need to teach medical trainees how to conduct geriatric assessments. GeriKit, a free mobile health (mHealth) app (available for iOS and Android) was designed to guide learners in conducting these assessments. The aim of this study was to understand the app's usability in early adopters.
Method(s): A 9-question validated survey of mHealth app usability was embedded within GeriKit and, through a 7-point Likert scale for each question, measured features of the user experience. A 10th question invited users to offer feedback. All users were eligible to take the survey anonymously. Survey data was analyzed from 12/2020-11/2021.
Result(s): 56 survey responses were received, which were categorized as positive (strongly agree/agree/somewhat agree; like a great deal/like a moderate amount/like a little) and negative/neutral (neither agree nor disagree/somewhat disagree/disagree/strongly disagree; neither like nor dislike/dislike a little/dislike a moderate amount/ dislike a great deal). Notably 53/56 (95%) would use the app again, 55/56 (98%) thought the app was easy to use, and 53/56 (95%) liked the interface (Figure). As feedback, respondents suggested adding a screening tool for medications on the Beer's List and an e-mail feature for assessment results.
Conclusion(s): Data from early adopters of GeriKit demonstrate that that the app was effective in assisting users with performing geriatric assessments