Journal of the American Geriatrics Society最新文献

{"title":"Cover","authors":"Paula A. Rochon MD, MPH,&nbsp;Joyce Li MSc,&nbsp;Haley Warren MHSC,&nbsp;Razan Rawdat MHSC,&nbsp;Surbhi Kalia MSc","doi":"10.1111/jgs.18436","DOIUrl":"https://doi.org/10.1111/jgs.18436","url":null,"abstract":"<p><b>Cover caption</b>: Examples of Conditions that Affect Women Uniquely, Disproportionately, or Differently. See the related article by Rochon et al., pages 1645-1647.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18436","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Geriatrics Society 2025 Annual Scientific Meeting","authors":"","doi":"10.1111/jgs.19450","DOIUrl":"https://doi.org/10.1111/jgs.19450","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 S1","pages":"S1-S450"},"PeriodicalIF":4.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover","authors":"Dana E. Bisson MSN,&nbsp;Shannon C. Clancy Burgess MSN,&nbsp;Michelle E. Gamache BSN,&nbsp;Maureen P. Dunn MLIS,&nbsp;Aimee B. Valeras PhD, LICSW,&nbsp;Lyn S. Lindpaintner BSN, MD","doi":"10.1111/jgs.18434","DOIUrl":"https://doi.org/10.1111/jgs.18434","url":null,"abstract":"<p><b>Cover caption</b>: Examples of the Attention and Awareness Through Movement intervention for delirium in hospitalized older patients, depicting exaggerated and sustained sensory and motor touch and sustained positional movement. See the related article by Bisson et al., pages 1008-1016.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"C1"},"PeriodicalIF":4.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crippling Cryptococcus: The Complexity of Unraveling Cryptococcal Meningitis in Recurrent Falls","authors":"Xavier Kai Yang Tay,&nbsp;Ling Ling Beatrix Wong","doi":"10.1111/jgs.19459","DOIUrl":"10.1111/jgs.19459","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1656-1658"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Safety of Short-Acting Opioid Dose Escalation and Long-Acting Opioid Initiation in Nursing Home Residents","authors":"Anthony P. Nunes,&nbsp;Heeyoon Jung,&nbsp;Yiyang Yuan,&nbsp;Jonggyu Baek,&nbsp;Jayne Pawasauskas,&nbsp;Anne L. Hume,&nbsp;Shao-Hsien Liu,&nbsp;Kate L. Lapane","doi":"10.1111/jgs.19417","DOIUrl":"10.1111/jgs.19417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>For patients with continued pain while receiving an initial course of a short-acting opioid (SAO), clinicians may intensify the opioid regimen by escalating the SAO dose or initiating a long-acting opioid (LAO). The objective of this study was to assess the comparative safety of opioid intensification regimens in nursing home residents with nonmalignant pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort analysis of US long-stay nursing home residents identified from the national Minimum Data Set (MDS) 3.0 and linked Medicare data, 2011–2016. Opioid regimen changes were assessed using Part D claims to identify dose escalation of SAO, adding LAO to SAO, or a switch from SAO to LAO. The outcomes of interest were hospitalized falls/fractures and delirium identified in the MDS or hospitalization. Resident attributes were described by opioid regimen. Hazard ratios of study outcomes were quantified using as-treated (primary analysis) and intent-to-treat (secondary analysis) doubly robust inverse probability of treatment (IPT) weighted Fine &amp; Gray regression models with a competing risk of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the as-treated analysis, relative to residents in the SAO escalation cohort, the hazard of delirium was elevated in the LAO cohorts (aHR [LAO switch]: 2.05, 95% CI: 1.57–2.67; aHR [LAO add-on]: 1.55, 95% CI: 1.23–1.96). Results for falls and fractures were inconclusive. We did not observe evidence of an association with falls and fractures in the primary as-treated analysis; however, the intent-to-treat analysis observed increased hazards in the LAO switch cohort relative to the SAO escalation cohort (aHR 2.86, 95% CI:1.64–4.99).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is limited evidence to inform the clinical judgment between escalating the SAO dose or incorporating a LAO. Our study suggests increased risks of delirium in nursing home residents with nonmalignant pain when switching or adding an LAO to the opioid regimen relative to increasing the dose of SAOs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1517-1527"},"PeriodicalIF":4.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Influenza Vaccination on Hospitalization and Mortality Among People With Dementia","authors":"Andreas Moses Appel,&nbsp;Christina Jensen-Dahm,&nbsp;Thomas Munk Laursen,&nbsp;Gunhild Waldemar,&nbsp;Janet Janbek","doi":"10.1111/jgs.19392","DOIUrl":"10.1111/jgs.19392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People with dementia have an increased risk for infection-related complications, which may be mitigated by common vaccinations. The aim was to investigate the association between influenza vaccination and the rates of all-cause and influenza-related hospitalizations and deaths among older adults with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We followed all Danish residents with dementia aged 65 and above from September 1, 2002, to August 31, 2018. Dementia was defined from records in the Danish national registries (positive predictive value 85.8%). People with dementia were identified on September 1 of each year. On this date, vaccination status was also reset, and the status of covariates was assessed. We used proportional hazard Cox regression to compare rates of all-cause hospitalization, hospitalization with a respiratory infection, hospitalization with influenza or pneumonia, and all-cause mortality for vaccinated and unvaccinated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across the entire study period, we included 134,002 people with dementia. Rates of hospitalization were 9%–10% lower, and the mortality rate 9% lower, for vaccinated compared to unvaccinated among people with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Influenza vaccination was associated with lower rates of hospitalization and mortality among people with dementia. Further exploration of the preventive potential of influenza vaccination among people with dementia is important for shaping interventions in this vulnerable group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1498-1505"},"PeriodicalIF":4.3,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Reporting and Enforcing: Innovating for Higher Medical Director Engagement","authors":"Arif Nazir","doi":"10.1111/jgs.19424","DOIUrl":"10.1111/jgs.19424","url":null,"abstract":"&lt;p&gt;A recent study published in JAGS by Goldwein et al. [&lt;span&gt;1&lt;/span&gt;], along with an accompanying editorial [&lt;span&gt;2&lt;/span&gt;], once again highlights the gaps associated with the role of medical directors in skilled nursing facilities (SNFs). The study underscores key aspects such as the reporting of administrative tasks, the distinction between administrative and clinical responsibilities, and, at best, minimal influence of compliance and regulatory standards. Despite ongoing discourse on this subject, significant gaps remain, particularly concerning the impact of the medical director role, and the critical question persists: will this renewed attention catalyze actionable stakeholders into some action?&lt;/p&gt;&lt;p&gt;As a geriatrician, medical director, fractional chief medical officer for three NH chains, and co-founder of a technology platform designed to operationalize the medical director role across hundreds of SNFs, I offer unique insights, data, and potential solutions to advance this discussion constructively.&lt;/p&gt;&lt;p&gt;Operationalization of the medical director role requires a systematic approach involving strategic recruitment, well-defined contracts delineating expectations, continuous communication and training for medical directors and facility teams, and performance-based data sharing. A digital platform, centered on self-reporting of administrative (non-clinical) tasks by medical directors in accordance with Center for Medicare and Medicaid Services and Post-Acute and Long-term Care Medical Association (PALTmed) recommendations, offers a comprehensive mechanism to visualize and assess medical director engagement. When juxtaposed with the data reported by Goldwein et al., such insights could provide a more nuanced understanding of medical director contributions.&lt;/p&gt;&lt;p&gt;Data collected from our platform in 2024, encompassing 389 NHs across 22 states (Figure 1), indicates that most NHs report more than 10 h per month of administrative time for their medical directors. Review of the tasks illustrated the frequency of reported administrative tasks, with monitoring of clinical quality and metrics emerging as the most frequently cited activity (22%), followed by leadership meetings (14%). Notably, none of the surveyed NHs reported zero medical director hours for the year—a stark contrast to the 36.1% figure reported in PBJ data by Goldwein et al. This discrepancy underscores the pressing need for more accurate and standardized mechanisms for capturing and reporting medical director contributions.&lt;/p&gt;&lt;p&gt;Before addressing solutions for improved reporting and enforcement, a broader discussion on the medical director role itself is warranted. As Goldwein et al. emphasize, this role demands a clear and distinct definition. Unlike attending physicians or nurse practitioners, medical directors are entrusted with systemic responsibilities, including clinical governance, policy oversight, and quality improvement. Without clearly delineating these duties, their","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1338-1340"},"PeriodicalIF":4.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Disparities Based on Race or Ethnicity Require Interventions at Multiple Levels of the Healthcare System","authors":"David K. Conn","doi":"10.1111/jgs.19439","DOIUrl":"10.1111/jgs.19439","url":null,"abstract":"&lt;p&gt;Health disparities have been defined by the Institute of Medicine (IOM) as “differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention” [&lt;span&gt;1&lt;/span&gt;]. The World Health Organization (WHO) describe health inequities as “differences in health status, or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age” [&lt;span&gt;2&lt;/span&gt;]. The WHO emphasizes that health inequities are a global issue which is “unfair and could be reduced by the right mix of government policies” [&lt;span&gt;2&lt;/span&gt;]. Health disparities often lead to negative health outcomes such as increased morbidity and disability, higher mortality rates and reduced quality of life for groups that experience reduced quality of healthcare and treatment. In 2000, the Department of Health and Human Services launched a comprehensive nationwide, health promotion and disease prevention agenda in the United States [&lt;span&gt;3&lt;/span&gt;]. The report called for the elimination of all health disparities, including differences that occur due to ethnicity, sex, education, income, disability, geographic location, or sexual orientation. The Institute of Medicine published a report in 2003 entitled &lt;i&gt;Unequal treatment: confronting racial and ethnic disparities in healthcare&lt;/i&gt; [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Hall-Lipsy and Chisholm-Burns carried out a systematic review of “pharmacotherapeutic disparities” in medication treatment [&lt;span&gt;4&lt;/span&gt;]. A total of 311 research articles were identified that investigated whether race, ethnicity, or sex was associated with disparities in medication treatment. Seventy-seven percent of the included articles revealed significant disparities in drug treatment across race, ethnicity, and sex. The most frequent disparity found in almost three-quarters of the articles studied was differences in the receipt of prescription drugs. Documented disparities also occurred related to differences in the drugs prescribed, drug dosing administration, and wait time to receipt of a drug. Documented outcomes associated with these disparities included increased rates of hospitalization, decreased rates of therapeutic goal attainment, and decreased rates of survival. Clinical content areas included treatment for asthma, cardiovascular disease, diabetes mellitus, HIV infection, mental health, oncology, osteoporosis, pain control/palliative care, and Parkinson's disease. The top three in terms of number of publications were mental health, cardiovascular disease, and pain control/palliative care.&lt;/p&gt;&lt;p&gt;In this edition of the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt; (JAGS), Cassara et al. report on a study related to the use and discontinuation rates of long-acting injectable (LAI) antipsychotic medications among older adults, with a focus on differences based on race/ethnicity [&lt;span&gt;5&lt;/span&gt;]. The ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1341-1343"},"PeriodicalIF":4.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover","authors":"Mahip Acharya PhD,&nbsp;Corey J. Hayes PharmD, PhD, MPH,&nbsp;Cari A. Bogulski PhD,&nbsp;Mir M. Ali PhD,&nbsp;Hari Eswaran PhD","doi":"10.1111/jgs.18432","DOIUrl":"https://doi.org/10.1111/jgs.18432","url":null,"abstract":"<p><b>Cover caption</b>: Trend and Trajectories of Remote Patient Monitoring (RPM) Use for Hypertension Management in Medicare Fee-For-Service Data (2018–2021). For full details, see “Attrition of remote patient monitoring use for hypertension management in Medicare fee-for-service beneficiaries (2018–2021)” on page 966.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"C1"},"PeriodicalIF":4.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulling Back the Curtain on Deprescribing Interventions","authors":"Jerry H. Gurwitz","doi":"10.1111/jgs.19408","DOIUrl":"10.1111/jgs.19408","url":null,"abstract":"&lt;p&gt;Older adults living with dementia commonly experience polypharmacy and exposure to high-risk medications [&lt;span&gt;1, 2&lt;/span&gt;]. According to findings from the National Health and Aging Trends Study, among people with dementia, 1 in 5 believe that they may be taking one or more medicines they no longer need, nearly 9 in 10 are willing to stop one or more of their medications, and half are uncomfortable taking five or more medications [&lt;span&gt;3&lt;/span&gt;]. This underscores the need for tailored medication optimization strategies, including carefully designed, evidence-based deprescribing interventions.&lt;/p&gt;&lt;p&gt;ALIGN (Aligning Medications with What Matters Most) was a pragmatic, pharmacist-led telehealth deprescribing pilot study to support primary care providers in addressing polypharmacy in people living with dementia, who were age ≥ 65 and who were prescribed &gt; 7 medications [&lt;span&gt;4, 5&lt;/span&gt;]. The intervention consisted of a deprescribing educational brochure, a telehealth visit by a pharmacist with the patient-care partner dyad to discuss the patient's medications in the context of their goals and preferences, and deprescribing recommendations from the pharmacist conveyed to the primary care provider via the electronic health record. The primary goal of the intervention was to reduce total medication burden and regimen complexity by focusing on what matters most to patients and care partners. With the primary care provider's approval, the pharmacist was able to implement recommended medication changes. The intervention pharmacists held PharmD degrees with board certification in Geriatric Pharmacy. Pharmacist recommendations could include both stopping medications and starting medications; 73% of patients received a recommendation to stop a medication, or reduce the dose or frequency, while 42% received a recommendation to start a medication, or increase the dose or frequency.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt;, Green and colleagues complement the findings of the ALIGN study by reporting on an analysis of audio-recorded conversations between the intervention pharmacists and the patient-care partner dyads [&lt;span&gt;5&lt;/span&gt;]. By characterizing these conversations, the authors aimed to provide new insights to guide the future development of deprescribing interventions. This qualitative study specifically focused on how elicitation of medication-related priorities from people with dementia and their care partners shaped discussions with the pharmacists.&lt;/p&gt;&lt;p&gt;Importantly, the investigator team has described what actually happened during the telehealth visits with patients and their care partners, including the actual language used by the pharmacists to explain their recommendations. This is a refreshing step forward beyond the usual “sterile” results reported out from most deprescribing intervention trials, which rarely ever extend beyond tables and figures summarizing mean total numbers of medications in the i","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1002-1004"},"PeriodicalIF":4.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}