Effect of Perioperative Tricyclic Antidepressants and First-Generation Antihistamines on Postoperative Delirium in Older Patients Undergoing Arthroplasty or Spine Surgery

Cureus · 2026-03-18

Background Postoperative delirium (POD) is a prevalent condition in older surgical patients, leading to extended hospital stays and increased risk of cognitive and functional decline. We investigated whether in-hospital perioperative administration of tricyclic antidepressants (TCAs) or first-generation antihistamines, both of which have potent anticholinergic activity, was associated with postoperative delirium within the first three postoperative days in older surgical patients undergoing major arthroplasty or spine surgeries. Methods We undertook a secondary data analysis of patients aged 65 or older staying in the hospital for at least two days undergoing hip, knee, or spine surgeries from two prospective studies. Using propensity score matching applied separately for each medication class (TCAs and first-generation antihistamines) to respective control groups. Our primary outcome was the incidence of postoperative delirium within the first three postoperative days, as gauged by the Confusion Assessment Method. Results After propensity score matching, which was applied separately for each medication class, no difference in demographics, geriatric depression scores, cognitive status scores, or surgical details emerged between the medication recipients and non-recipients. The perioperative use of tricyclic antidepressants (OR: 1.82, 95% CI: 0.78-4.16) or first-generation antihistamines (OR: 0.79, 95% CI: 0.48-1.28) was not statistically significantly associated with postoperative delirium. Conclusion In this secondary analysis of older patients undergoing elective major arthroplasty or spine surgery, we did not detect a statistically significant association between perioperative tricyclic antidepressant or first-generation antihistamine use and postoperative delirium within the first three postoperative days. These findings should be interpreted cautiously, given the limited sample size for TCA exposure.

Unilateral Single Joint Arthritis Changes Joint Power in Unaffected Joints

Journal of Orthopaedic Research® · 2025-04-13 · 3 citations

Pain and disability associated with arthritis of the hip, knee, or ankle is well-documented. However, data on joint power and how arthritis in one joint affects power in that joint and in unaffected joints are limited. This study asks if arthritis in any one joint leads to (1) loss of power in that affected joint compared to the contralateral, unaffected joint; (2) loss of total power in the affected limb as compared to the contralateral, unaffected limb; and (3) increased power production in the joints of the ipsilateral limb. Ground reaction forces and joint angles during self-selected speed walking were collected from participants with symptomatic, unilateral ankle (N = 183), hip (N = 63), and knee arthritis (N = 20). Bilateral joint power from the hip, knee, and ankle joints as well as total limb power was calculated for the last third of the stance phase. Arthritis in the hip (p < 0.001), knee (p = 0.008), or ankle (p < 0.001) lead to a loss of power at the affected joint and in the affected limb, though the knee on the affected side does offset some of that loss in participants with hip and ankle arthritis (p < 0.001). The contralateral, unaffected limb (p < 0.001), especially the ankle, produces greater power. Clinical Significance: Isolated lower limb joint arthritis leads to a loss of power on the affected side and compensation by contralateral, unaffected joints. Those joints may be subsequently impacted through repetitive loading and could lead to further degeneration without intervention.

Adverse childhood experiences are associated with development of psychological resilience among older adults

Innovation in Aging · 2025-12-01

Abstract Background A growing body of research suggests that adverse childhood experiences (ACE; e.g. physical abuse) are associated with mental and physical health in young and middle adulthood. However, less is known about how ACEs are linked to psychological resilience in older adults. This study explored the long-term impact of childhood adversity on psychological resilience (PR) trajectories among older adults, drawing on the framework of Cumulative Advantage and Disadvantage (CAD) theory. Method Data include 9,069 respondents aged 65 and above from 2006 to 2020 of the Health and Retirement Study (HRS). We first employed the group-based trajectory modeling to classify heterogeneity in PR’s development over time. Next, a multinomial logistic regression was conducted using four different ACE items including: school retention, physical abuse, parental substance abuse, and trouble with police as the main predictors, with covariates (e.g. age, gender, marital status, and education) controlled in the model. Result The analyses revealed 3 distinct trajectory groups: one group with stable resilience, and two groups with either “sharp” decline or “gradual” decline. In addition, after adjusting for covariates, we found that of the four ACE items, only experiences of physical abuse and parental substance abuse were significantly associated with the reduced likelihood of maintaining a stable trajectory on PR. Conclusion These findings suggest that early adverse experiences may influence trajectories of psychological resilience well into old age. The results underscore the importance of adopting trauma-informed approaches in resilience-based intervention, emphasizing early identification and intervention for individuals with histories of childhood maltreatment.

Identification of Cognitive Superaging and its Predictors Among Older Adults: A Latent Profile Analysis

Innovation in Aging · 2025-12-01

Abstract Older adults demonstrate substantial variability in cognitive functioning, with some maintaining exceptional performance, called Cognitive SuperAging (CSA). This study identified cognitive superagers and other cognitive profiles among individuals ≥ 75 years in 2020 Health and Retirement Study, and examined demographic, health, and behavioral predictors of CSA. The sample included 5,646 individuals with scores on different cognitive domains, including memory, attention, executive functioning (EF), and fluid intelligence-related tasks. Latent Profile Analysis models with 3-6 profiles were compared using fit indices (AIC, BIC, adjusted-BIC, entropy). A four-profile solution best fit the data, comprising: Class 1 Superagers (11.5%), Class 2 Average Memory, Impaired Attention &amp; EF (39.9%), Class 3 Impaired Memory &amp; EF, High Attention (37.2%), and Class 4 Globally Impaired (11.4%). A conditional model using R3STEP indicated sharpest separation between Globally Impaired and Superagers (Entropy = 0.77). The likelihood of not being Superager increased by 27% with age, 15% with each additional chronic condition, and nearly doubled with higher depressive symptoms. Higher physical activity was associated with more than twice the odds of being in Superaging profile (OR = 2.43, 95%CI [2.25, 2.64]). Biological sex showed no significant association, and sleep disturbance was associated with marginal negative effects (OR = 1.033, 95%CI [1.005 – 1.063]) on superaging. The intermediate profiles also showed similar but less pronounced trends. The results have implications for interventions and policies aimed at promoting resilience in cognitive aging. Findings support targeting physical activity, mental health, and chronic disease management to help maintain high cognitive functioning into advanced age.

Variability in Health Behaviors Over 14 Years Predicts Later Cognitive Outcomes

Innovation in Aging · 2025-12-01

Abstract Engaging in healthy behaviors is important for maintaining cognitive functioning throughout the lifespan. We assessed whether variability in physical exercise and hours of sleep over a fourteen year period are associated with subsequent cognitive performance among Health and Retirement Study (HRS) participants aged 50-69 in 2004. We calculated variability in exercise and sleep across 7 biennial assessments by dividing the standard deviation of each participant’s biennial scores by the mean of the participant’s exercise or sleep score over the 14 year interval. Linear Regression analyses of participants aged 50-59 (n = 2370) at baseline revealed that higher initial cognition and educational levels, and female gender were associated with higher cognitive scores 14 years later. Although baseline levels of exercise and mobility were not associated with cognitive scores 14 years later, older age, more chronic conditions at baseline, and higher variability in exercise scores over the 14 years were negatively associated with cognitive scores in 2018. Similar results were found for participants aged 60-69 (n = 2738). We replicated the analyses described above to assess the association between variability in hours of sleep and subsequent cognitive functioning and found very similar findings. Importantly, we also found that the greater variability in biennial assessments of sleep was negatively associated with cognitive functioning 14 years later for those aged 50-59 (n = 743) at baseline, and 60-69 (n = 889) at baseline. The findings reveal the importance of considering variability in health behaviors when assessing their impact on future cognitive functioning and the importance of maintaining health behaviors throughout adulthood.

Understanding the Value of Aging Life Care Managers Through the Eyes of Families and Care Recipients

Innovation in Aging · 2025-12-01

Abstract Aging Life Care Professionals (ALCPs), also known as care managers, play a vital role in supporting families, caregivers, and older adults. With expertise in aging and disability, they help families navigate evolving care needs, including health changes, living transitions, and resource coordination. To assess the value of ALCPs, we conducted 17 virtual interviews with family members and care recipients, exploring reasons for hiring a care manager, services received, satisfaction, and perceived impact. The Aging Life Care Association (ALCA), a nonprofit promoting ALCPs, facilitated participant connections. Interviews were transcribed and thematically coded by the investigators. Families hired care managers for various reasons, including overseeing care, coordinating transitions, acting as intermediaries with medical providers, connecting clients to resources, honoring patient wishes, and supporting caregiver decision-making. Overall, care managers exceeded expectations, demonstrating attentiveness, proactive monitoring, and a strong commitment to care. Participants valued their trustworthiness, transparency, crisis responsiveness, and expertise in managing complex diseases. This study underscores the essential role of ALCPs in enhancing care quality, easing caregiver burden, and ensuring that older adults receive the support they need.

CHANGE IN UNMET NEEDS STATUS FOR DAILY MOBILITY AND SELF-CARE ACTIVITIES

Innovation in Aging · 2024-12-01

Abstract Unmet need occurs when older adults with difficulties completing daily activities cannot complete an activity because no one is available to help. Prior research has not considered whether unmet need status changes over time, nor assessed characteristics of older adults whose unmet needs worsen or resolve. Changes in unmet needs status across three pairs of consecutive annual interviews were assessed using 2011-2014 data from the National Health and Aging Trends Study. Findings revealed that that 57% of older adults who needed help with mobility activities and 62% of older adults who needed help with self-care activities did not experience unmet needs across the three consecutive pairs of occasions. Only 3% who needed help with mobility activities and 1% who needed help with self-care activities consistently reported unmet needs. Worsening of mobility unmet needs occurred for 25% and 16% resolved their mobility unmet needs. Worsening of self-care unmet needs occurred for 25% and 11% resolved their self-care unmet needs. Those who experienced worsening of mobility and/or self-care unmet needs were more likely to be female and have multiple chronic conditions. Those who experienced resolution of mobility unmet needs were more likely to be female and have multiple mobility difficulties and chronic conditions. Those who experienced resolution of self-care unmet needs were more likely to be white race, have zero or one self-care difficulties, and have multiple chronic conditions. The findings inform the need for frequent assessment of unmet needs to identify opportunities to reduce worsening and increase resolution of unmet needs.

Plasma SOMAmer proteomics of postoperative delirium

Brain and Behavior · 2024-02-01 · 4 citations

BACKGROUND: Postoperative delirium is prevalent in older adults and has been shown to increase the risk of long-term cognitive decline. Plasma biomarkers to identify the risk for postoperative delirium and the risk of Alzheimer's disease and related dementias are needed. METHODS: This biomarker discovery case-control study aimed to identify plasma biomarkers associated with postoperative delirium. Patients aged ≥65 years undergoing major elective noncardiac surgery were recruited. The preoperative plasma proteome was interrogated with SOMAmer-based technology targeting 1433 biomarkers. RESULTS: In 40 patients (20 with vs. 20 without postoperative delirium), a preoperative panel of 12 biomarkers discriminated patients with postoperative delirium with an accuracy of 97.5%. The final model of five biomarkers delivered a leave-one-out cross-validation accuracy of 80%. Represented biological pathways included lysosomal and immune response functions. CONCLUSION: In older patients who have undergone major surgery, plasma SOMAmer proteomics may provide a relatively non-invasive benchmark to identify biomarkers associated with postoperative delirium.

UNMET NEEDS AND HEALTHCARE SERVICE UTILIZATION AMONG OLDER ADULTS: A SYSTEMATIC REVIEW

Innovation in Aging · 2024-12-01 · 4 citations

Abstract Unmet needs refer to the absence of necessary assistance for completing Activities of Daily Living (ADLs), and they are associated with severe health consequences, such as hospitalizations, emergency room visits, nursing home placement, and mortality among older adults. The high cost of unmet needs pose challenges at both individual and systemic levels. While the prior literature has focused on immediate consequences of unmet needs (such as going without bathing or toileting), this systematic review consolidates evidence to assess the impact of unmet needs on healthcare utilization and emphasizes the importance of improving community-based care to mitigate (costly) consequences. A comprehensive search of multiple databases, including Scopus, Web of Science, PubMed, and CINAHL, using appropriate keywords (unmet needs, acute healthcare utilization) identified 6,475 studies. After a rigorous screening process, eight studies met the inclusion criteria for analysis, focusing on non-institutionalized older adults in the U.S. with at least one ADL difficulty. Results show that individuals with unmet needs experience double the hospitalization rates compared to those with met needs. Emergency room visits are also 31% higher, especially among those with unmet self-care needs. From the hospital deaths, 74 % report to have experienced unmet needs at end-of-life. Sociodemographic factors, such as older age, being minority race, living alone, and cognitive impairment further exacerbate the risks acute healthcare utilization. Addressing unmet needs is crucial not only for improving quality of life among older adults but also for alleviating the strain on healthcare resources through targeted policy interventions.

Risks and Outcomes of New Onset of Unmet Need for Mobility and Self-Care Daily Activities

The Gerontologist · 2024-10-30 · 1 citations

BACKGROUND AND OBJECTIVES: Among community-living older adults who have limitations in completing activities of daily living (ADLs), unmet need occurs when they cannot complete an ADL task because no one was available to help. Prior research described correlates of existing unmet needs but did not consider which older adults are at risk for new onset of unmet needs. This study assessed health characteristics that increased risk for new onset of unmet needs within a year and subsequent health outcomes. RESEARCH DESIGN AND METHODS: Data are from 2011 to 2019 annual interviews of the National Health and Aging Trends Study. For each pair of 2 consecutive annual interviews, we determined whether new onset of unmet needs occurred between the first and second consecutive interviews. Mixed effects logistic regression models were computed to assess risks for new onset of unmet need across 14,890 paired observations from persons who needed help with mobility tasks and 12,514 paired observations from persons who needed help with self-care tasks. RESULTS: Although demographic characteristics and chronic conditions had modest associations with new onset of unmet need, hospitalization between the 2 consecutive interviews was associated with a twofold increase in risk for new onset of unmet need. New onset of unmet need was associated with hospitalization, nursing home placement, and death in the year following the 2 consecutive annual interviews. DISCUSSION AND IMPLICATIONS: The findings inform the need for frequent assessments of ADL care needs with the goal of preventing new onset of unmet needs, especially after hospitalization.