Despite high enthusiasm surrounding the rollout of the COVID-19 vaccine, some older adults continue to remain hesitant about its receipt. There is limited evidence on vaccine hesitancy among community-dwelling older adults. In this study, we examine the prevalence and predictors (particularly the role played by information sources) of vaccine hesitancy in this group. We use the Medicare Current Beneficiary Survey and employ multivariable logistic regression models to explore this. Relative to those relying on regular news, those depending on health care providers (HCPs), social media, other internet/webpages, and family/friends as the main information source on COVID-19 expressed higher negative vaccine intent. The high negative intent with HCPs as the main information source should be interpreted with caution. This could be reflective of the timing of the survey and changing attitude toward the vaccine among HCPs themselves.
Access to recreational and medical marijuana is common in the United States, particularly in states with legalized use. Here, we describe patterns of recreational and medical marijuana use and self-reported health among older persons using a geographically sampled survey in Colorado. The in-person or online survey was offered to community-dwelling older persons aged above 60 years. We assessed past-year marijuana use including recreational, medical, or both; methods of use; marijuana source; reasons for use; sociodemographic and health factors; and self-reported health. Of 274 respondents (mean age = 72.5 years, 65% women), 45% reported past-year marijuana use. Of these, 54% reported using marijuana both medically and recreationally. Using more than one marijuana method or preparation was common. Reasons for use included arthritis, chronic back pain, anxiety, and depression. Past-year marijuana users reported improved overall health, quality of life, day-to-day functioning, and improvement in pain. Odds of past-year marijuana use decreased with each additional year of age. The odds were lower among women and those with higher self-reported health status; odds of use were higher with past-year opioid use. Older persons with access to recreational and medical marijuana described concurrent use of medical and recreational marijuana, use of multiple preparations, and overall positive health impacts.
Objective To identify the patients at greatest odds for SIRS and examine the association between Systemic Inflammatory Response Syndrome (SIRS) and outcomes in patients presenting with intracerebral hemorrhage (ICH). Methods We retrospectively reviewed consecutive patients presenting to a tertiary care center from 2008-2013 with ICH. SIRS was defined according to standard criteria as 2 or more of the following: (1) body temperature < 36°C or >38°C, (2) heart rate > 90 beats per minute, (3) respiratory rate > 20, or (4) white blood cell count < 4000/mm3 or > 12,000/mm3 or > 10% polymorphonuclear leukocytes for >24 hours in the absence of infection. The outcomes of interest, discharge modified-Rankin Scale (mRS 4-6), death, and poor discharge disposition (discharge anywhere but home or inpatient rehab), were assessed using logistic regression. Results A total of 249 ICH patients met inclusion criteria and 53 (21.3%) developed SIRS during their hospital stay. A score was developed (ranging from 0-3) to identify patients at greatest risk for developing SIRS. Adjusting for stroke severity, SIRS was associated with mRS 4-6 (OR 5.25, 95%CI 2.09-13.2) and poor discharge disposition (OR 3.74, 95%CI 1.58-4.83), but was not significantly associated with death (OR 1.75, 95%CI 0.58-5.32). We found that 33% of the effect of ICH score on poor functional outcome at discharge was explained by the development of SIRS in the hospital (Sobel 2.11, p=0.03). Conclusion We observed that approximately 20% of patients with ICH develop SIRS, and that patients with SIRS were at increased risk of having poor functional outcome at discharge.
Cannabis use among older Americans is increasing. Although much of this growth has been attributed to the entry of a more tolerant baby boom cohort into older age, recent evidence suggests the pathways to cannabis are more complex. Some older persons have responded to changing social and legal environments and are increasingly likely to take cannabis recreationally. Other older persons are experiencing age-related health care needs, and some take cannabis for symptom management, as recommended by a medical doctor. Whether these pathways to recreational and medical cannabis are separate or somewhat tangled remains largely unknown. There have been few studies examining cannabis use among the growing population of Americans aged 65 and older. In this essay, we illuminate what is known about the intersection between cannabis and the aging American population. We review trends concerning cannabis use and apply the age-period-cohort paradigm to explicate varied pathways and outcomes. Then, after considering the public health problems posed by those who misuse or abuse cannabis, we turn our attention to how cannabis may be a viable policy alternative in terms of supporting the health and well-being of a substantial number of aging Americans. On the one hand, cannabis may be an effective substitute for prescription opioids and other misused medications; on the other hand, cannabis has emerged as an alternative for the undertreatment of pain at the end of life. As intriguing as these alternatives may be, policy makers must first address the need for empirically driven, representative research to advance the discourse.
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