Journal of the American Geriatrics Society最新文献

{"title":"Advancing Geriatric Nephrology: Evidence for Care at the Intersection of Aging and Kidney Disease","authors":"Rasheeda K. Hall","doi":"10.1111/jgs.70553","DOIUrl":"10.1111/jgs.70553","url":null,"abstract":"<p>Although most older adults in the United States do not have kidney disease, adults aged 65 years and older account for approximately half of all individuals living with chronic kidney disease (CKD) and represent the majority (> 60%) of those with kidney failure [<span>1</span>]. Older adults with kidney disease are a highly heterogeneous group with widely varying degrees of multimorbidity, sensory and cognitive impairment, social support needs, and care preferences. These factors are rarely addressed within disease-centered models of nephrology care, but they are significant contributors to adverse outcomes observed in older adults with kidney disease. These adverse outcomes include disproportionately high healthcare utilization, functional impairment, and diminished quality of life [<span>1-4</span>].</p><p>Importantly, these adverse outcomes are not inevitable consequences of aging with kidney disease. Rather, they reveal gaps in the evidence base needed to improve care at the intersection of aging and kidney disease. An important step toward improving care for this vulnerable population is highlighting geriatric nephrology literature through a new special collection in the Journal of the American Geriatrics Society (JAGS), <i>Advancing Geriatric Nephrology: Evidence for Care at the Intersection of Aging and Kidney Disease</i>. To introduce this special collection, this editorial describes key clinical and research issues in geriatric nephrology.</p><p>Clinical issues in geriatric nephrology can be understood across three interrelated levels of complexity: patient, clinician, and healthcare system. Key patient-level factors that intersect with kidney disease include multimorbidity, geriatric syndromes, and limited social support. Multimorbidity is present in at least 90% of persons with kidney disease [<span>5</span>]; and potential therapies for these conditions often interfere with kidney health (e.g., chronic arthritis treated with NSAIDs) [<span>6</span>]. Multimorbidity also frequently results in inappropriate prescribing cascades, where a medication side effect is interpreted as a new condition or worsening of an existing condition and a subsequent medication is initiated to treat the new or worsening condition. For example, a calcium channel blocker or a gabapentinoid can cause edema, which is managed by initiating diuretics [<span>7, 8</span>]. Kidney disease management can be further complicated by the presence of geriatric syndromes, or multifactorial conditions of aging that reflect vulnerability across multiple physiologic systems [<span>9</span>]. Geriatric syndromes, particularly cognitive impairment and functional limitations, which are present in at least 30% of older adults with kidney disease [<span>10, 11</span>], could lead to problems with medication management, dietary adherence, and may limit patients' ability to travel to and meaningfully engage in routine medical care. Further, geriatric syndromes and multimorbidi","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2491-2494"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260998","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":"Patient and Clinician Perspectives on Chronic Pain Communication in Advanced Kidney Disease","authors":"Jessica E. Ma,&nbsp;Elena Uejo,&nbsp;Stella Quenstedt,&nbsp;Doreet Preiss,&nbsp;Jessica Sperling,&nbsp;Tyffany D. Locklear,&nbsp;Julia Gambino,&nbsp;C. Barrett Bowling,&nbsp;Andrea L. Chadwick,&nbsp;Christopher E. Cox,&nbsp;Karl A. Lorenz,&nbsp;Lynne Matallana,&nbsp;Joseph G. Winger,&nbsp;Hayden B. Bosworth,&nbsp;Karen Steinhauser","doi":"10.1111/jgs.70439","DOIUrl":"10.1111/jgs.70439","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic pain is highly prevalent among older adults with advanced chronic kidney disease (CKD stage 4, stage 5, and end-stage kidney disease [ESKD]). Yet, pain management involves a delicate balance between alleviating symptoms and avoiding harm related to impaired renal drug clearance and the high risk of medication side effects. Because little is known about how patients and clinicians navigate these complex pain management conversations, we examined patient and provider perspectives on communication and decision making in chronic pain and advanced kidney disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative study using semi-structured interviews based on the Ottawa Decision Support Framework. Participants included older adults (age ≥ 65) with both advanced CKD and chronic pain lasting ≥ 3 months and physicians and advanced practice providers from primary care, geriatrics, nephrology, and palliative care. We used thematic analysis to summarize major themes on communication and decision making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 48 participants, including 24 older adults with advanced kidney disease and chronic pain and 24 clinicians, with 6 clinicians from each specialty. Three major themes about barriers to effective communication emerged: (1) treatment complexity and uncertainty; (2) fragmentation of care across specialties and the care team; and (3) divergent treatment preferences between patients and clinicians. Communication strategies to overcome these barriers included: open communication, multidisciplinary care team collaboration, patient advocacy, and relationship- and values-centered decision making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlighted key barriers and potential communication strategies among older adults with chronic pain and advanced kidney disease. These findings can inform the development of targeted interventions that support patients and clinicians in navigating these complex conversations and decisions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2511-2519"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694551","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":"Prolonged Use of Postoperative Gabapentin After Discharge From a Skilled Nursing Facility","authors":"Tasce Bongiovanni,&nbsp;Siqi Gan,&nbsp;Emily Finlayson,&nbsp;W. John Boscardin,&nbsp;Michael A. Steinman,&nbsp;James D. Harrison","doi":"10.1111/jgs.70578","DOIUrl":"10.1111/jgs.70578","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The number of older adults being discharged to a skilled nursing facility (SNF) after surgery continues to rise. Prior studies have shown that gabapentinoid prescribing after surgery is increasing, though this work only studied patients transitioning from hospital to home. Therefore, we aim to describe both use and prolonged use of gabapentinoids for older adults who are discharged to SNF and then home after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis by merging patient data from Medicare Carrier, MedPAR, and Outpatient Files with Medicare Part D for 2013–2020. We included patients ≥ 66 years at time of procedure undergoing one of 14 common surgeries performed in older adults whose discharge was to SNF then home.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total study cohort included 79,417 patients who were discharged to a SNF. Median length of SNF stay was 15 days (IQR 10, 22 days). A total of 3182 (4%) received a new gabapentinoid prescription. Of these, 38% (<i>n</i> = 1219) had prolonged use. On multivariable logistic regression, we found that female sex, gabapentinoid days supply, emergency surgery, non-orthopedic and nonvascular surgery, and higher area deprivation index were associated with prolonged use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Of our cohort, 38% had prolonged use, more than 1.5 times the proportion of prolonged use found in a past study among patients being discharged directly home. Importantly, patients who were sicker and more disadvantaged were more likely to have prolonged use. Our study highlights that additional work needs to focus on understanding and preventing inappropriate prolonged use of gabapentinoids after SNF discharge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2573-2582"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427689","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 Impact of Recorded Music on Postoperative Delirium in Older Adults After Hip Fracture Surgery (IPOD): A Quasi-Experimental Study","authors":"M. E. Jungerling,&nbsp;B. L. van Leeuwen,&nbsp;H. van der Wal-Huisman","doi":"10.1111/jgs.70588","DOIUrl":"10.1111/jgs.70588","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hip fractures often lead to postoperative delirium in older adults, significantly impacting recovery, hospitalization, and nursing workload. While many delirium cases are preventable, implementation of non-pharmacological strategies remains inconsistent. Music has emerged as a safe, effective, and low-cost complementary strategy to prevent delirium by targeting its underlying mechanisms. However, evidence in hip fracture patients remains limited. This study evaluated whether a nurse-led recorded music intervention could reduce the prevalence and influence the course of postoperative delirium, while ensuring practical feasibility. Secondary outcomes included postoperative pain, opioid use, and length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this quasi-experimental study, usual care was compared with the addition of a music intervention comprising twice-daily, 30-min sessions of self-selected music over 5 postoperative days. Cognitively adequate patients aged 65 or older were assessed for postoperative delirium using the Delirium Observation Scale (DOS). Differences in postoperative pain, measured by the Numerical Rating Scale, were analyzed both between groups and within the intervention group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 74 participants were included across control and intervention groups. Statistical power was achieved, and confounders were balanced between groups. Music adherence was 53.13%, with missed sessions approximately equally due to patient refusal and nurse non-administration. DOS scores decreased significantly, especially on postoperative Day 2. Although delirium prevalence was halved in the intervention group, this did not reach statistical significance. No significant differences were found in LOS, opioid use, or postoperative pain between groups, however, a significant decrease in pain was observed within the intervention group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Music influenced the course of postoperative delirium by reducing its intensity and lowered postoperative pain within the intervention group. Future research should build on these findings by implementing a 30-min, once-daily music intervention during the first 3 postoperative days.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2595-2606"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70588","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427600","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":"Burden and Risk Factors of CGM-Detected Hypoglycemia in Older Adults With Type 2 Diabetes","authors":"Michael Fang,&nbsp;Natalie Rula Daya,&nbsp;Yein Jeon,&nbsp;Justin B. Echouffo-Tcheugui,&nbsp;B. Gwen Windham,&nbsp;Scott Zeger,&nbsp;Elizabeth Selvin","doi":"10.1111/jgs.70412","DOIUrl":"10.1111/jgs.70412","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Comprehensive data on the burden of biochemical hypoglycemia in older adults with type 2 diabetes are lacking. We seek to characterize the burden and risk factors for hypoglycemia detected by continuous glucose monitoring (CGM) in older adults with type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional analysis of 315 older adults with type 2 diabetes who attended visit 9 of the Atherosclerosis Risk in Communities Study (2021–2022). We examined rates of Level 1 hypoglycemia (&lt; 70 mg/dL) and percentage meeting recommended targets for hypoglycemia (&lt; 1% of time). We identified risk factors for CGM-detected hypoglycemia by comparing the median time spent in hypoglycemia across subgroups. All analyses were stratified by high-risk medication use (insulin/sulfonylureas vs. not).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 315 participants with type 2 diabetes (mean age 83 years, 55% women, 41% Black adults), 32.4% were using insulin or sulfonylureas. Among individuals using these high-risk medications, the median time spent in hypoglycemia was 3.4%, and ~66% of participants spent more than 1% of the time with CGM glucose &lt; 70 mg/dL. Hypoglycemic episodes typically occurred overnight and lasted a median of ~1.5 h among individuals using insulin or sulfonylureas. CGM-detected hypoglycemia was low in participants not using high-risk medications (median time spent in hypoglycemia: 0.7%). In unadjusted analyses, cardiovascular disease, cognitive impairment, poor physical functioning, and chronic kidney disease were associated with increased time spent in hypoglycemia, regardless of high-risk medication use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There may be a substantial burden of unrecognized CGM-detected hypoglycemia in very old adults with type 2 diabetes using high-risk medications in the general population. Hypoglycemia may also be present among persons not on high-risk medication, but the burden is much lower. Further research is needed to clarify the clinical significance of these hypoglycemic episodes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2530-2537"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597110","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":"Comparing Effectiveness of Antidepressants for Nursing Home Residents With Dementias and Depressive Symptoms","authors":"Shiwei Liang,&nbsp;Kate L. Lapane,&nbsp;Brian R. Ott,&nbsp;Jennifer Tjia,&nbsp;Jonggyu Baek,&nbsp;Yiyang Yuan,&nbsp;Matthew Alcusky","doi":"10.1111/jgs.70582","DOIUrl":"10.1111/jgs.70582","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Alzheimer's disease and related dementias (ADRD) are frequently accompanied by depressive symptoms, which may accelerate cognitive decline and increase mortality. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed, yet comparative effectiveness evidence in nursing home residents with ADRD is scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using linked CMS data (2011–2018) of long-stay nursing home residents aged ≥ 65 years with ADRD and baseline depressive symptoms who newly initiated an SSRI or SNRI. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9; self-report or observed) at baseline and 60–120 days after initiation. Outcomes were the change in PHQ-9 scores (continuous) and clinically meaningful improvement. Analyses used overlap propensity score and inverse probability of censoring weighted linear and log-binomial models with generalized estimating equations to account for clustering of nursing home residents. Intention-to-treat (ITT) analyses, as-treated, and subgroup analyses were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 19,397 SSRI initiators and 2581 SNRI initiators, 66.9% had mild depressive symptoms at baseline. Median time from initiation to follow-up assessment was 85 days. In ITT analyses, mean PHQ-9 change was −2.38 for SSRIs and −2.24 for SNRIs (adjusted difference: −0.15; 95% CI, −0.42 to 0.11); clinically meaningful improvement occurred in 55.2% versus 56.9% (risk difference: −1.57; 95% CI, −3.66 to 0.52). As-treated analyses yielded similar results, and findings were consistent across subgroups defined by baseline depression severity, cognitive function, dementia type, and sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SSRIs and SNRIs were similarly effective for depressive symptoms in nursing home residents with ADRD. Given this and modest improvement rates, antidepressant selection should be individualized, emphasizing safety and resident characteristics. Additional research is needed to inform the decision to treat or not to treat, specific medication selection, and when to stop treatment in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2607-2618"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475004","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":"Building Sustainable Access to Home- and Community-Based Services for Rural Veterans and Older Americans","authors":"Romil R. Parikh","doi":"10.1111/jgs.70584","DOIUrl":"10.1111/jgs.70584","url":null,"abstract":"&lt;p&gt;Over 70% of United States adults aged 50 years or older prefer to remain in their home or community rather than move to residential long-term care settings, as per the American Association of Retired Persons 2024 Home and Community Preferences Survey [&lt;span&gt;1&lt;/span&gt;]. This preference is even more pronounced among adults aged 65 years or older, and among those living in small towns or rural communities [&lt;span&gt;1&lt;/span&gt;]. Mirroring these preferences, states have increasingly rebalanced long-term services and supports (LTSS) spending toward home- and community-based services (HCBS), with HCBS expenditures exceeding expenditures on residential long-term care every year since 2013 [&lt;span&gt;2&lt;/span&gt;]. As the population ages and policymakers increasingly prioritize aging in place over residential care, the central challenge is no longer whether HCBS matters, but whether health systems can ensure sustainable access to them across geography, workforce environments, and fragmented financing structures.&lt;/p&gt;&lt;p&gt;In this issue of the Journal of the American Geriatrics Society, Davila and colleagues provide an important and timely contribution by examining rural–urban differences in HCBS use among more than 6 million Veterans enrolled in the Veterans Health Administration (VHA) [&lt;span&gt;3&lt;/span&gt;]. Their findings highlight a paradox that should command national attention: rural Veterans, despite being older and often carrying greater social and clinical vulnerability, were less likely than urban Veterans to use HCBS. Yet some Veterans Affairs Medical Centers (VAMCs) achieved parity or even higher HCBS use among rural Veterans. This dual message is critical. Geography still matters, but geography is not destiny. Rurality does not imply inevitability of access barriers.&lt;/p&gt;&lt;p&gt;Importantly, HCBS use should not be conflated with HCBS delivery capacity or access. Lower service use among rural Veterans may reflect multiple mechanisms, including reduced availability of services, transportation and workforce barriers, navigation or coordination barriers in a fragmented system, differences in referral or authorization practices, or lower consumer demand and preferences for specific services [&lt;span&gt;4-6&lt;/span&gt;]. Similarly, higher service use does not necessarily imply that HCBS needs are fully met. Prior analyses of the National Core Indicators–Aging and Disability (NCI-AD) survey data show that individuals already using a particular HCBS often report unmet needs for that same service, likely reflecting higher underlying disability burden and support requirements [&lt;span&gt;4, 5&lt;/span&gt;]. Thus, utilization patterns alone cannot fully characterize access adequacy or unmet need.&lt;/p&gt;&lt;p&gt;The authors found that rural Veterans were 8% less likely to use HCBS after adjustment for demographics, comorbidity, neighborhood disadvantage, and facility fixed effects. Particularly striking was the variability across facilities, where adjusted risk ratios ranged from 0.40 to 2.67. Such heterogeneit","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2498-2500"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414396","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":"Rural–Urban Variability in Home and Community-Based Service Use Among Veterans","authors":"Heather Davila,&nbsp;Daniel Hackert,&nbsp;Frank DeVone,&nbsp;Christopher W. Halladay,&nbsp;Michelle A. Mengeling,&nbsp;Samantha L. Solimeo,&nbsp;R. Neal Axon,&nbsp;Mia L. Barron,&nbsp;Casey Buchanan,&nbsp;Tonya Page,&nbsp;Dayna Cooper,&nbsp;Jennifer L. Sullivan,&nbsp;James L. Rudolph","doi":"10.1111/jgs.70500","DOIUrl":"10.1111/jgs.70500","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Home and community-based services (HCBS) are home-based services that enable people to remain in their own environment despite challenges related to disease, disability, or age. In rural areas, service availability may be lower. The purpose of this analysis was to examine rural–urban differences in HCBS use among Veterans enrolled in the Veterans Health Administration (VHA) and identify facility-level variation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study used data from fiscal year 2022 (10/1/21–9/30/22). We incorporated rurality for Veterans (dichotomized as rural/urban based on Rural–Urban Area Commuting Codes) and facilities (proportion of rural Veterans served). VHA payment files identified HCBS use. Regression analyses sequentially adjusted for demographics, comorbidity, Area Deprivation Index (ADI), and facility fixed effects to produce a risk ratio (RR) of HCBS use among rural Veterans (RR &gt; 1.0 indicates higher HCBS use among rural vs. urban Veterans).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of over 6 million enrolled Veterans, 34.1% (<i>n</i> = 2,055,746) were identified as rural. Compared to urban Veterans, rural Veterans were more likely to be older (64.1 ± 16.1 vs. 61.0 ± 17.4 years, <i>p</i> &lt; 0.001), male (92.0% vs. 88.8%, <i>p</i> &lt; 0.001), and white (80.5% vs. 63.7%, <i>p</i> &lt; 0.001). HCBS were used by 5.04% (<i>n</i> = 103,605) of rural Veterans and 5.21% (<i>n</i> = 206,608) of urban Veterans. The unadjusted rural HCBS RR was 0.97 (95% confidence interval (CI) = 0.96–0.97). After adjusting for demographics, comorbidity, ADI, and facility fixed effects, the adjusted RR of HCBS for rural Veterans was 0.92 (95% CI = 0.91–0.93). There was substantial variability across facilities, with rural Veterans ranging from 60% less likely to 167% more likely to use HCBS than urban Veterans (RRs: 0.40–2.67).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While rural Veterans were less likely to use HCBS overall, there was substantial variability across facilities. These findings demonstrate that some VAMCs counteract the overall trend by ensuring rural Veterans receive HCBS at rates comparable to urban Veterans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2546-2555"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70500","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221334","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":"Hospital Drug Burden and Post-Discharge Health Care Utilization in Older Adults Prescribed Central Nervous System-Active Medications","authors":"Juliessa M. Pavon,&nbsp;Richard J. Sloane,&nbsp;Cathleen S. Colón-Emeric,&nbsp;Carl F. Pieper,&nbsp;Kenneth Schmader,&nbsp;David Gallagher,&nbsp;Anna Hung,&nbsp;Susan N. Hastings","doi":"10.1111/jgs.70549","DOIUrl":"10.1111/jgs.70549","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Drug Burden Index (DBI) quantifies cumulative exposure to anticholinergic and sedative medications and can be used to measure medication burden during hospitalization. This study evaluates using automated DBI calculations from electronic health records (EHRs) to track DBI changes during hospitalization, identify high-risk older adults, and assess associations with post-discharge health utilization outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used EHRs of patients aged 65+ from three academic health system hospitals (2018–2020), and prescribed central nervous system (CNS)-acting medications around hospitalization (90 days before and after). Logistic regression assessed the associations between DBI at admission, discharge, and changes in DBI during hospitalization with 30-day readmission and discharge destination. Linear regression assessed the relationship between DBI at these time points and 90-day post-discharge outpatient visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 3450 eligible patients had complete DBI measurements, with 80% having no change during hospitalization. DBI at admission, discharge, or changes during hospitalization was not associated with 30-day readmission. Any change in DBI, compared to no DBI change, was associated with reduced odds of being discharged home (DBI increase [worsening drug burden] OR: 0.29 [0.21, 0.40]); DBI decrease OR: 0.35 [0.28, 0.43]. High DBIs at admission or discharge were linked to more clinical visits post-discharge, while a DBI increase during hospitalization was associated with fewer visits (RR: 0.86 [0.73–1.00]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DBI changes during hospitalization impact discharge disposition and follow-up care needs but not 30-day readmission, highlighting opportunities to optimize medication management during hospitalization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2556-2563"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623445","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":"Perioperative Transfusion Trigger Score Versus Restrictive Transfusion in Older Non-Cardiac Surgery Patients: A Multicenter Randomized Controlled Trial","authors":"Shucong Liang,&nbsp;Lijuan Bai,&nbsp;Guizhen Yang,&nbsp;Zhuo Chen,&nbsp;Yujia Wei,&nbsp;Yanxia Wei,&nbsp;Yuting Lv,&nbsp;Zehan Huang,&nbsp;Yanjuan Huang,&nbsp;Kejian Lu","doi":"10.1111/jgs.70575","DOIUrl":"10.1111/jgs.70575","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Restrictive transfusion (Hb &lt; 7 g/dL) is recommended for most perioperative patients, but the optimal threshold for those with cardiovascular disease or Hb 7–10 g/dL remains uncertain. The Perioperative Transfusion Trigger Score (POTTS), which integrates adrenaline requirement, FiO₂, temperature, and angina history, may standardize decisions and safely reduce transfusions in older non-cardiac surgery patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter RCT in two Chinese hospitals randomized patients ≥ 60 years undergoing non-cardiac surgery 1:1 to POTTS or control. POTTS = 6 plus points for adrenaline, FiO₂ (to maintain SpO₂ ≥ 95%), core temperature, and angina; transfusion when Hb &lt; POTTS. Control followed 2012 AABB guideline (Hb &lt; 7 always transfuse; &gt; 10 not; 7–10 physician discretion). Primary outcome: proportion receiving allogeneic RBC transfusion during perioperative period (ITT population).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>253 patients (mean age 72.3 years; 67.6% women) were randomized (May 2023-Sept 2025). Baseline Hb similar (median 9.60 vs. 9.50 g/dL). In ITT, transfusion required in 24.00% (30/125) of POTTS vs. 35.94% (46/128) of control (<i>p</i> = 0.038). Transfusion volume did not differ significantly (median 2.50 vs. 3.00 units, <i>p</i> = 0.520). Overall complication rates: 12.80% vs. 8.59% (<i>p</i> = 0.279); one death in control group (0.85%). No significant differences in specific complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients ≥ 60 years undergoing non-cardiac surgery, POTTS-guided transfusion significantly reduced the proportion of patients transfused without increasing complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>This study was registered at http://www.chictr.org.cn (#ChiCTR2300071739)</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2564-2572"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70575","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364527","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}