Background/Objectives Polypharmacy is receiving increased attention as a potential problem for older persons, who frequently have multiple chronic conditions. The purpose of this study was to summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications,among older community-dwelling persons. Design Systematic review of MEDLINE (OvidSP 1946 to May Week 3 2014). Setting Community Participants Observational studies examining health outcomes according to the number of prescription medications taken. Measurements Association of number of medications with health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding. Results Of the total of 50 studies identified, the majority studies that were rated as “good” in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls/fall outcomes/fall risk factors; adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of those studies rated as “fair” or “poor.” Conclusions Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes among community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more definitive evidence regarding this relationship.

Objective The purpose of this study was to develop a vulvovaginal symptoms questionnaire (VSQ) to study symptoms, emotions, life-impact, and sexual-impact of vulvovaginal symptoms in postmenopausal women. Methods We developed questionnaire focused on vulvovaginal symptoms based on modifications to the Skindex-16, a validated questionnaire to measure the impact of skin disease. We then recruited postmenopausal women seeking routine gynecologic care to test the psychometric properties of the VSQ. Test-retest reliability was assessed 2 to 4 weeks after their initial recruitment and measured utilizing intra-class coefficients. Four distinct a priori scales of the VSQ were developed: symptoms, emotions, life-impact, and sexual-impact. Confirmatory factor analysis was performed to verify the four a priori scales by evaluating the goodness-of-fit of a final confirmatory factor analysis model. The internal consistency of the scales was assessed through the calculation of Cronbach’s α coefficient. Results The VSQ is a 21-item written questionnaire with four scales, symptoms, emotions, life-impact, and sexual impact. One hundred twenty postmenopausal women participated in the psychometric validation of the VSQ. The test-retest reliability the four scales measured by intra-class coefficients were 0.75, 0.60, 0.55, and 0.65 for symptoms, emotions, life-impact and sexual-impact. The goodness-of –fit of the confirmatory factor response model was confirmed. Cronbach’s α coefficients were 0.76, 0.87, 0.83, and 0.82 for the scales. Conclusion The VSQ is a reliable and internal consistent instrument to measure vulvovaginal symptoms in postmenopausal women.

Objective To describe the association between social isolation and urinary incontinence (UI) and fecal incontinence (FI) in older women. Methods We conducted a secondary database analysis of the National Social Life, Health and Aging Project (NSHAP) for women aged 57 to 85 years old. Our primary outcome was self-report of often feeling isolated. We explored self-report of daily UI and weekly FI. Two logistic regression analyses were performed to assess the association between often feeling isolated and 1) daily UI and 2) weekly fecal incontinence. Results A total of 1,412 women were included in our analysis. Daily UI was reported by 12.5% (177/1,412) of community-dwelling older women. More women with daily UI reported often feeling isolated (6.6%, 95% CI [1.3–11.9] vs. 2.6%, 95% [1.7–3.5], p=.04) compared with women without daily UI. Women with daily UI had 3.0 (95% CI 1.1, 7.6) increased odds of often feeling isolated after adjusting for depressive symptoms, age, race, education, and overall health. Weekly FI was reported by 2.9% (41/1,412) of women. Weekly FI and often feeling isolated were associated on univariable analysis (Crude Odds Ratio(OR) = 4.6 (95% CI 1.4, 15.1). However after adjusting for depressive symptoms, age, race, education, and overall health the association between weekly FI and often feeling isolated was not significant (Adjusted OR=0.65 (95% CI 0.1, 5.3, p=0.65)). Conclusion After adjusting for confounders, daily UI was significantly associated with often feeling isolated. Weekly FI was not found to be associated with often feeling isolated on multivariable logistic regression.

The aims of this study were to estimate the occurrence of postoperative surgical site infections (SSIs) after different routes of hysterectomy and to identify associated risk factors. The investigators conducted a secondary cross-sectional analysis of the 2005Y2009 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to examine data files of women undergoing hysterectomies. The primary hysterectomy routes compared were laparotomy and the vaginal approach. The main study outcome was the occurrence of 30-day superficial SSI (cellulitis) after hysterectomy; secondary outcomes were the occurrence of deep and organ-space SSI. Logistic regression models were used to examine associations of risk factors after hysterectomy. The final analysis included 13,822 women who had undergone hysterectomy.The occurrence of cellulitis after hysterectomy was 1.6% (221/13,822). Multivariate analysis showed that the following risk factors were associated with 30-day postoperative cellulitis: route of hysterectomy (adjusted odds ratio [aOR], 3.74; 95% confidence interval [CI], 2.26Y6.22 for laparotomy compared with the vaginal approach), operative time greater than 75th percentile (aOR,1.84; 95% CI, 1.40Y2.44), American Society of Anesthesia Class 3 or greater (aOR, 1.79; 95% CI, 1.31Y2.43), morbid obesity (body mass index Q40 kg/m 2 ) (aOR, 2.65; 95% CI, 1.85Y3.80), and diabetes mellitus (aOR, 1.54; 95% CI, 1.06Y2.24). The occurrence of deep and organ-space SSI after hysterectomy was 1.1% (154/13,822).These data show decreased occurrence of superficial SSI after use of the vaginal approach for hysterectomy and reaffirm the role for vaginal hysterectomy as the route of choice for hysterectomy.

Objective Our objective was to estimate the occurrence of surgical site infections (SSI) after hysterectomy and associated risk factors. Study Design We conducted a cross-sectional analysis of the 2005-09 American College of Surgeons National Surgical Quality Improvement Program participant use data files to analyze hysterectomies. Different routes of hysterectomy were compared. The primary outcome was to identify the occurrence of 30-day superficial SSI (cellulitis) after hysterectomy. Secondary outcomes were the occurrence of deep and organ-space SSI after hysterectomy. Logistic regression models were conducted to further explore the associations of risks factors with SSI after hysterectomy. Results A total of 13,822 women were included in our final analysis. The occurrence of postoperative cellulitis after hysterectomy was 1.6% (n= 221). Risk factors associated with cellulitis were route of hysterectomy with an adjusted odds ratio (AOR) of 3.74 (95% CI 2.26-6.22) for laparotomy compared with the vaginal approach, operative time > 75th percentile (AOR = 1.84, 95% CI 1.40-2.44), American Society of Anesthesia Class ≥ 3 (AOR 1.79, 95% CI 1.31-2.43), body mass index ≥ 40kg/m2 (AOR 2.65, 95% CI 1.85-3.80), and diabetes mellitus (AOR 1.54, 95% CI 1.06-2.24) The occurrence of deep and organ-space SSI was 1.1% (n= 154) after hysterectomy. Conclusion Our finding of the decreased occurrence of superficial SSI after vaginal approach for hysterectomy reaffirms the role for vaginal hysterectomy as the route of choice for hysterectomy.