BOSTON – With half of all women and a quarter of all men over fifty expected to suffer a fracture in the years ahead, the number of such injuries exceeds the incidence of heart attack, stroke, and breast cancer combined. By discouraging the use of medications that can cause dizziness or loss of balance and prescribing medications known to prevent bone loss, clinicians can help patients lower their risk of falls and fractures.

In a commentary published today in JAMA Internal Medicine, gerontologists at Beth Israel Deaconess Medical Center and Hebrew SeniorLife Institute for Aging Research underscore the importance of reviewing patients’ prescription medications in the wake of a fracture. Appearing alongside original research by Munson et al that finds few changes are made to patients’ prescription medications in the four months following a fracture, the commentary is a call for clinicians to coordinate care among orthopedics, rehabilitation services and primary care to reevaluate patients’ medication use.

“The findings of Munson et al suggests that far too often clinicians fail to perform a thoughtful medication review for patients with a fracture,” said corresponding author Sarah D. Berry, MD, MPH, assistant professor of medicine in the Division of Gerontology in the Department of Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School (HMS), as well as assistant scientist II at the Hebrew SeniorLife Institute for Aging Research. “It’s imperative that researchers and clinicians work together to narrow this treatment gap and reduce secondary fractures and their devastating consequences.”

More than 20 percent of older people who break a hip die within a year – a death rate two- to four-times higher than that among uninjured people the same age and sex. Other complications of broken bones among the elderly include pain, depression, infection, functional decline and subsequent fractures.

Berry and co-author Douglas P. Kiel, MD, MPH, professor of medicine in the Department of Medicine at BIDMC and HMS, and senior scientist and director of the Musculoskeletal Research Center at the Hebrew SeniorLife Institute of Aging Research, suggest a two-prong approach for clinicians considering patient medications after a fall or fracture.

First, clinicians should consider reducing or discontinuing the use of drugs linked to increased risk of falls or fractures – especially psychotropic medications such as sleep aids, sedatives and antidepressants that can cause dizziness or loss of balance. But when Munson et al looked at prescription drug use in the four months before and after a hip, forearm or wrist fracture in a group of older, community-dwelling Medicare beneficiaries, they found that more than 85 percent of them were taking one or more of the drugs known to increase fracture risk after their injury.

“Given the robust evidence linking psychotropic medications with falls and fractures, the lack of decline in the use of these medications after a fracture is alarming,” Berry and Kiel wrote.

Clinicians may avoid broaching the topic of reducing use of this class of medications based on a perception that patients may be dependent on them, the authors suggest. However, they cite previous research indicating that after patients were given a simple pamphlet describing the risks associated with the sedative benzodiazepine, 38 percent of study participants voluntarily discontinued using it, compared to just 11 percent of the control group.

Second, clinicians should prioritize prescribing drugs known to prevent the likelihood of fractures among this high-risk group, the authors wrote. The National Osteoporosis Foundation recommends osteoporosis medication for all adults over 50 who have fractured a hip. Yet Munson et al found that less than a quarter of hip fracture patients received a common osteoporosis medication known to reduce the risk of fracture. Another recent study using commercial insurance claims saw even lower numbers, around 15 percent.

Berry and Kiel suggest that multiple care teams working across various medical settings can make it unclear which provider should conduct this post-fracture medication review. Primary care physicians are generally not involved in the immediate care of fractures, the authors wrote, but orthopedic specialists may not have the long-term relationship necessary to help make risk/benefit decisions about certain sleep or mood medications.

“Most clinicians wouldn’t dispute the importance of medication review for patients following a fracture but the question is who should do it,” Berry said. “We challenge all clinicians to work together to reduce the use of drugs linked to falls and fractures and to treat patients with drugs that can prevent subsequent fractures. We also encourage patients who have experienced a fall or fracture to initiate a discussion with their doctors about the risks and benefits of medications associated with falls and bone loss.

BOSTON - Vitalize 360SM has been awarded a $100,000 grant to improve its software to promote healthy aging from Aging in America®, a not-for-profit that supports companies that offer technology solutions to help older adults maintain independence in the community. Vitalize 360 is a joint venture between two national senior services leaders Hebrew SeniorLife and Kendal.

“We are honored by the grant from Aging in America,” said Diana Cox, Executive Director of Vitalize 360. “It will jump-start development efforts for on-demand reporting about program outcomes, improve software navigation and usability, facilitate new ad hoc and report writing capacity, and offer residents/members access to their case files from their computer or smartphone.”

Vitalize 360 combines an innovative, person-directed approach to wellness coaching and leverages information derived from a scientifically-grounded assessment system to engage, challenge and inspire older adults. There are currently 33 senior living communities, continuing care at home, and subsidized housing programs in 13 states participating in Vitalize 360.

Vitalize 360 members often comment on the impact the program has on their lives. One commented, “When I look around and I'm feeling a little down, and I see these women and they’re working out in these classes and I say, ‘If they can do it, why shouldn't I be doing it?’” Another participant commented on the wellness coaching and said, “I think most people set goals when they're young and married and have small children. Now I see myself coming back to a lot of those things that I said, 'Well, I'm never going to do that at this age,' but I find I want to.”

“Aging in America’s mission is to inspire innovation that empowers, guides, educates and supports those individuals and organizations faced with the challenges and opportunities of aging,” said William T. Smith, Ph.D., President/CEO. “This is our first significant grant to another not-for-profit and it is designed to help expand this important work to a new level.”

With Vitalize 360, organizations can be more strategic and predictive around health and wellness operations and utilization. For senior living communities, Vitalize 360 can help residents live vibrantly and independently longer, potentially freeing health center beds and services for individuals in the community-at-large. The program gives care coordinators for continuing care at home programs additional tools to support healthy aging and reduce costs.

Hebrew SeniorLife and Kendal have long recognized the importance of measuring and influencing healthy aging outcomes for their respective organizations, and for the aging services field. Vitalize 360 is designed to develop engaged cultures that embrace well-being, person-directed care and quality services, and continuous learning.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the nonprofit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

About Kendal

Kendal is a not-for-profit organization headquartered in Kennett Square, Pennsylvania, where ground was broken for the first Kendal community in 1971. Kendal provides advice, leadership and support to the communities and services in eight states that make up the Kendal System, primarily by helping to develop and disseminate model practices, facilitate economies of scale and advance responsible growth. As a system of not-for-profit communities, programs and services founded on the principles of the Religious Society of Friends (Quakers), Kendal aspires to transform the experience of aging, guided by Kendal’s Values and Practices.

About Vitalize 360

Vitalize 360SM combines an innovative, person-directed approach to wellness coaching and the power of information derived from a scientifically-grounded assessment system. The program offers senior living communities, continuing care at home, and subsidized housing programs the tools to engage, challenge and inspire older adults. Currently there are 33 communities in 13 states participating in Vitalize 360SM. More information about Vitalize 360 is available from: Neil Beresin National Program Manager Vitalize 360 info@vitalize360.org 610.335.1283

A routine osteoporosis screening bone density test can tell if you are at increased risk for a heart attack because of the presence of calcium in the aorta.  

Now, this calcification test score can be calculated quickly by using machine learning, without the need for a person to grade the scans. 

“This development paves the way for use in routine clinical settings with little or no time to generate the useful calcification score that predicts heart attacks,” said Douglas P. Kiel, M.D., MPH, director of the Musculoskeletal Research Center at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research and professor of medicine at Harvard Medical School.

This finding is documented in the article “Machine Learning for Abdominal Aortic Calcification Assessment from Bone Density Machine-Derived Lateral Spine Images,” published in the journal eBiomedicine.  The joint first author is Naeha Sharif of the Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Centre for AI&ML, School of Science, Edith Cowan University, Perth, Australia; and the Department of Computer Science and Software Engineering, The University of Western Australia, Perth, Australia.

“During DXA scans obtained for bone mineral density testing, vascular calcification of the aorta can be seen and quantified.  This study developed a machine learning algorithm to automatically determine the severity of the calcification that corresponds closely with the manual reading that is far more time consuming to perform,” said Sharif.

The scoring of abdominal aortic calcification scores from bone density machine images is laborious and requires careful training. As a result, AAC scoring is not routinely performed when these images are acquired in clinical practice.  This study developed, validated and tested machine learning algorithms for AAC assessment called ML-AAC-24, and evaluated it in a real-world setting using a registry study of 8,565 older men and women. Greater ML-AAC-24 scores were associated with substantially higher cardiovascular disease risk and poorer long-term prognosis.

Collaborating institutions are:

• Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia
• Centre for AI&ML, School of Science, Edith Cowan University, Perth, Australia
• Department of Computer Science and Software Engineering, The University of Western Australia, Perth, Australia
• Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, Canada
• INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
• Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
• George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
• Medical School, The University of Western Australia, Perth, Australia
• Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
• MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
• NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
• Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, USA
• Division of Health Policy and Management, University of Minnesota, Minneapolis, USA
• Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Canada
• Centre for Kidney Research, Children’s Hospital at Westmead School of Public Health, Sydney Medical School, the University of Sydney, Sydney, Australia.

Funding information or grantor requirements:

• Dr. Kiel’s time was supported by a grant from the National Institute of Arthritis, Musculoskeletal and Skin Diseases (R01 AR 41398). 

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of nearly $85 million, making it the largest gerontological research facility in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.
 

BOSTON - Alan Alda, Emmy and Golden Globe Award-winning actor, writer and science advocate, and this year's choice for the Lifetime Achievement Award by the Screen Actors Guild, will have star billing at EngAGE 2018, Hebrew SeniorLife's signature philanthropic event, on November 8 at the Revere Hotel Boston Common. Headliners also include Marilyn Maye, the Grammy-nominated cabaret singer, and Rose Styron, poet, journalist, translator, and international human rights activist. ABC News' Senior Medical Contributor, Timothy Johnson, M.D., will lead a fireside chat with Alda and Lewis Lipsitz, M.D., Director, Institute for Aging Research and Chief Academic Officer at Hebrew SeniorLife.

Hebrew SeniorLife, a nonprofit organization committed to improving the lives of older adults in the Greater Boston area and around the world, has hosted the successful EngAGE event for five years. In announcing the line-up, Lou Woolf, President and CEO, said, “Aging is a journey, not a destination. It is an opportunity for seniors and their caregivers to embrace the next stage of their lives, through pursuit of their passions, goals, and community spirit.

“EngAGE has become the go-to event that honors the rich tapestry of life experience that seniors bring to our communities and celebrates the innovations and advancements that will help all of us lead deeper, fuller senior lives, ” Woolf continued.

Tickets are selling quickly for EngAGE 2018, which features a mixed-media program and small dinner parties. All proceeds power Hebrew SeniorLife’s health care, communities, research, and teaching that transform the experience of aging. Last year’s event raised $1.25 million.

Co-chairs for EngAGE 2018 are Jennifer and Jeffrey Drucker and Hinda and Arthur Marcus, all of Chestnut Hill (MA). For more information about EngAGE, visit www.hslengage.org.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Founded in Boston in 1903, the nonprofit, non-sectarian organization today provides communities and health care for seniors, research into aging, and education for geriatric care providers. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.