Journal of the American Geriatrics Society最新文献

{"title":"Long-Term Outcomes Associated With Peripheral Nerve Blocks for Hip Fracture Surgery: A Retrospective Comparison of Medicare Data","authors":"Arissa M. Torrie,&nbsp;Nathan N. O'Hara,&nbsp;Kathleen A. Ryan,&nbsp;Tedric Henneghan,&nbsp;Vineesh Mathur,&nbsp;Robert V. O'Toole,&nbsp;Gerard P. Slobogean,&nbsp;Jason Falvey","doi":"10.1111/jgs.70340","DOIUrl":"10.1111/jgs.70340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Peripheral nerve blocks (PNBs) are increasingly recommended as analgesia for hip fractures. Their association with outcomes beyond the immediate pharmacological effects remains unclear. This study examined the association between the use of PNBs and the number of days alive and at home after hip fracture surgery among Medicare beneficiaries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To examine the association between PNBs and long-term outcomes in older adults undergoing surgical fixation for hip fractures, we analyzed Medicare data from 2010 to 2018. Patients who received PNBs (exposure group) (<i>n</i> = 5701) were compared to those who did not receive a PNB (comparator group) using 1:1 propensity score matching, creating 5700 matched pairs. The primary outcome was days alive and at home within 120 days of admission. Secondary outcomes included days alive and at home within 365 days and 1-year mortality. A subgroup analysis of propensity score matched patients from 2018 examined outcomes when techniques had improved and use had increased.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the primary analysis (2010–2018), no significant differences were observed between groups for days alive and at home within 120 days (68.1 vs. 68.4 days; <i>p</i> = 0.64), days alive and at home within 365 days (244.5 vs. 240.7 days; <i>p</i> = 0.12), or 1-year mortality (21% vs. 22%; <i>p</i> = 0.22). In 2017 and 2018, when peripheral nerve block use increased, patients who received PNBs spent more days alive and at home within 365 days than patients who did not receive peripheral nerve blocks (248.6 vs. 241.6 days; <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PNBs showed no association with improved outcomes across the 2010–2018 study period. Analysis of 2017 and 2018 revealed more days alive and at home within 365 days and a trend toward reduced mortality among patients who received PNBs. PNBs may provide benefits beyond their immediate analgesic effects, potentially improving long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"1025-1032"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198346","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":"Perennial Challenges With More-Than-Modest Deprescribing","authors":"Stephen M. Thielke","doi":"10.1111/jgs.70374","DOIUrl":"10.1111/jgs.70374","url":null,"abstract":"&lt;p&gt;The term “polypharmacy” dates from before the mid-1800s. A treatise of 1857 described it as “that complex, cumbrous, unwieldy system of mixing all sorts of drugs”, and even more elegantly as “complicated drugging” [&lt;span&gt;1&lt;/span&gt;]. Since that time, polypharmacy has received general censure, and various efforts have sought to combat it. These have, however, lacked a common name in English until the coining of “deprescribing” in 2003 [&lt;span&gt;2&lt;/span&gt;]. This word appeared little in print until around 2012, after which its use has increased consistently along with research about it, to the point that it has allowed bibliometric analysis [&lt;span&gt;3&lt;/span&gt;] and structured reviews [&lt;span&gt;4, 5&lt;/span&gt;]. Not everyone has backed the movement. An insightful commentator caricatured it as “fashion accessory or fig leaf” [&lt;span&gt;6&lt;/span&gt;] and professed that “deprescribing makes me weep” [&lt;span&gt;7&lt;/span&gt;]. Carrión-Madroñal et al.'s research [&lt;span&gt;8&lt;/span&gt;] offers an opportunity to reflect on what more than a decade of research about deprescribing has shown.&lt;/p&gt;&lt;p&gt;Carrión-Madroñal et al.'s cohort study of an intervention to reduce potentially inappropriate medications in Spain, LESS-CHRON, adds to the literature suggesting that structured programs can reduce the number of medications prescribed to older adults. Among 229 outpatients and 231 institutionalized patients, a multidisciplinary team applying the LESS-CHRON deprescribing tool identified 960 potentially inappropriate medications, of which 542 were stopped. (As context, this represented about 5600 starting medications, so about one in ten was stopped). Of the 542, 70 medications were reintroduced by 3 months. The authors interpret the intervention as successful, insofar as it did stop the vast majority of medications targeted for discontinuation. But it merits reconsidering the context and outcomes of deprescribing and reflecting on the future of the field. I will note a few outstanding and unresolved challenges.&lt;/p&gt;&lt;p&gt;The subjects in the study started with an average of about 12 chronic medications. Medication lists of this length have become so commonplace that the number does not generate shock, but it does defy reason. Do older adults really require a dozen medications in order to remain healthy? How have we come to accept this degree of prescription as a norm? How could anyone ascertain the differential and combined effects of so many pills? Deprescribing efforts, by chipping away at a small part of the list, skirt these larger questions.&lt;/p&gt;&lt;p&gt;Off the cuff, one might propose that a deprescribing program which removed half or more of the average dozen prescribed medications would yield a major effect (although six medications is still a lot). LESS-CHRON and other similar interventions have, in relatively controlled conditions, stopped about one medication per patient. Perhaps that one pill was causing many problems, but 11 remain. Beyond issues of statistical significance, you have to wonder how much e","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"951-953"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70374","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438680","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":"Practice Variability in the SHARING Choices Pragmatic Trial of Primary Care Advance Care Planning","authors":"Sydney M. Dy,&nbsp;Danny Scerpella,&nbsp;Jennifer L. Wolff,&nbsp;Martha Abshire Saylor,&nbsp;Erin R. Giovannetti,&nbsp;Valecia Hanna,&nbsp;Jessica L. Colburn,&nbsp;David L. Roth","doi":"10.1111/jgs.70341","DOIUrl":"10.1111/jgs.70341","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Barriers to advance care planning intervention implementation and impact on outcomes at the patient, clinician, and health system levels are well-documented. Understanding practice-level variation in implementation and outcomes could elucidate relevant contextual factors and potential strategies for improving future implementation. We therefore examined practice variation and associations between processes and outcomes in the pragmatic trial of SHARING Choices, a primary care advance care planning (ACP) and communication intervention for older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an explanatory sequential mixed-methods analysis of quantitative variation among intervention practices in trial processes and outcomes, and qualitative interview analysis of ACP facilitators' perceptions of variation in implementation. We evaluated variation in key processes: (1) reach (phone contact between ACP facilitator and patient/family) and (2) uptake (facilitator-led ACP conversations) and outcomes: (1) new electronic health record (EHR)-documented advance directives (ADs) at 12 months and (2) receipt of potentially burdensome care within 6 months of death for Maryland residents with serious illness who died. We examined practice-level correlations among processes and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Variation among practices was substantial for key processes (ACP facilitator reach and uptake) and outcomes (new EHR AD documentation and potentially burdensome care at end of life; all <i>p</i> &lt; 0.01). Processes of reach and uptake were significantly correlated with the outcome of new EHR AD documentation but not with potentially burdensome care at end of life. ACP facilitators perceived variation in practice engagement with the intervention related to practice relationships and teams, relative priority of ACP, and resources such as space.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Practice variation in processes and mixed associations with outcomes highlight pragmatic trial implementation challenges and the impact and complexity of ACP. Future ACP trials should consider accounting for and evaluating practice variation in study design, implementation, and analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"1033-1040"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145292","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":"Longitudinal Associations Between Neurodegenerative Biomarkers and Cognitive Decline in Older Adults: Insights From the LASI-DAD Study","authors":"Abhijith R. Rao,&nbsp;Rashmita Pradhan,&nbsp;Masroor Anwar,&nbsp;Abhishek Gupta,&nbsp;Manjusha Bhagwasia,&nbsp;Emma Nichols,&nbsp;Alden L. Gross,&nbsp;Bharat Thyagarajan,&nbsp;Peifeng Hu,&nbsp;Eileen M. Crimmins,&nbsp;Aparajit Ballav Dey,&nbsp;Jinkook Lee,&nbsp;Sharmistha Dey","doi":"10.1111/jgs.70336","DOIUrl":"10.1111/jgs.70336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Longitudinal Aging Study in India—Diagnostic Assessment of Dementia (LASI-DAD) is a nationally representative study of cognitive aging and dementia in older adults. This study aims to investigate the longitudinal relationship between neurodegenerative biomarkers such as amyloid-beta (Aβ) 42/40 ratio, glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), phosphorylated tau (pTau), and total tau, and cognitive decline among older adults in India.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 1181 participants (aged ≥ 60 years) who completed both Wave 1 (2017–2019) and Wave 2 (2022–2024) of LASI-DAD with biomarker data were analyzed. General cognitive factor score was used as a comprehensive measure of cognitive performance, and biomarkers including NFL, Aβ42/Aβ40 ratio, GFAP, pTau, and total Tau were measured using Simoa technology. Generalized Estimating Equations (GEE) were used to analyze the association between change in cognition and biomarkers, adjusting for demographic covariates and comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age at Wave 1 was 66 years (IQR: 63–71), with 51.9% female participants and 64.4% from rural areas. In Model 3, adjusted for age, sex, education, habitat, and comorbidities, higher GFAP levels (<i>β</i> = −1.68 × 10⁻³, <i>p</i> = 0.005) and higher NfL (<i>β</i> = −1.94 × 10⁻³, <i>p</i> = 0.002) were associated with greater cognitive decline over time. Domain-specific analysis showed GFAP and NfL were linked to language and memory decline; Aβ42/Aβ40 ratio was associated with language decline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that biomarkers, including GFAP and NfL, are associated with cognitive decline over time in older adults in India. These biomarkers may serve as important indicators for monitoring cognitive aging and dementia risk in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"1041-1050"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159897","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":"A Pragmatic Framework for Shared Decision Making in Older Adults: Cardiac Amyloidosis as a Prototype","authors":"Monika Do,&nbsp;Sandesh Dev,&nbsp;Pranav Pillai,&nbsp;Ambar Andrade,&nbsp;Jeffrey Schmeckpeper,&nbsp;Megan Branda,&nbsp;Lori Herges,&nbsp;Sandeep Pagali,&nbsp;Nimit Agarwal","doi":"10.1111/jgs.70299","DOIUrl":"10.1111/jgs.70299","url":null,"abstract":"<div>\u0000 \u0000 <p>Advanced chronic diseases, or multicomplexity in older adults presents unique challenges. Transthyretin cardiac amyloidosis (ATTR-CA) is one such scenario where heart failure is a common presentation, and management remains challenging. We describe the challenges involved in the diagnosis of ATTR-CA in older adults, which has implications on treatment options. We discuss the application of comprehensive geriatric assessment (CGA) and shared decision making (SDM) in the context of these challenges. Based on geriatric medicine principles, an innovative framework for applying SDM in ATTR-CA patients is proposed, including consideration of the patient priorities care approach. The proposed framework emphasizes assessing functionality, frailty, and life expectancy to help categorize risk. This framework can be applied in various advanced chronic diseases or multicomplexity. Based on risk categorization, treatment burden, and alignment with values and preferences, management pathways are suggested for each risk category. Incorporating CGA and SDM, the proposed framework supports patient-centered care, ensuring that clinical recommendations are tailored to each older adult's unique needs and goals. In ATTR-CA, a collaboration between cardiology and geriatric medicine provides significant value in managing older adults. The need to prevent age-related bias in clinical decision-making exists across all health conditions, and the proposed framework allows for a thorough evaluation of multimorbidity, frailty, disability, and patient preferences. While ATTR-CA is used as a prototype, this integrated approach can be applied across all health conditions and is essential for delivering holistic care, improving communication, and aligning treatment plans with patient values.</p>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"954-963"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992440","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":"Predictors of Readiness to Engage in Advance Care Planning Among Older Adults With Serious Illness: Baseline Findings From the EQUAL ACP Study","authors":"Deborah Ejem,&nbsp;Alyssa Platt,&nbsp;Ramona L. Rhodes,&nbsp;Anupama Gangavati,&nbsp;Nadine Barrett,&nbsp;Marie Bakitas,&nbsp;Marisette Hasan,&nbsp;Ronit Elk,&nbsp;Raegan W. Durant,&nbsp;Maren Olsen,&nbsp;Kenisha Bethea,&nbsp;Tammie Quest,&nbsp;Kimberly S. Johnson","doi":"10.1111/jgs.70331","DOIUrl":"10.1111/jgs.70331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Advance care planning (ACP) supports seriously ill individuals in identifying and communicating their values and preferences for future care. However, disparities in ACP engagement persist, particularly among African American older adults. This study examined racial differences and predictors of readiness to engage in ACP among seriously ill African American and White older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional analysis used baseline data from the EQUAL ACP cluster randomized trial testing two ACP interventions. Participants included 792 community-dwelling, non-Hispanic African American (<i>n</i> = 428) and White (<i>n</i> = 364) adults aged 65 and older with serious illness or multimorbidity, recruited from 10 primary care clinics across five Southern U.S. states. Readiness to engage in ACP was measured using a four-item scale assessing willingness to discuss and document care preferences. Predictor variables included religiosity, beliefs about death and dying, perceived discrimination and trust, provider communication, treatment preferences, and self-rated health. Mixed-effects regression models were used to examine predictors of ACP readiness in the overall sample and racial subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall ACP readiness did not significantly differ by race. Across racial groups, greater comfort discussing death was associated with greater ACP readiness. Among African American participants, frequent religious service attendance was associated with higher ACP readiness (mean difference = 0.28; 95% CI: 0.08–0.47). Among White participants, a preference for pain relief over life extension in their current health status was associated with higher readiness (mean difference = 0.25; 95% CI: 0.05–0.45). Trust in providers, experiences of discrimination, and ratings of provider communication were not significantly associated with ACP readiness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although mean readiness scores were similar, predictors varied by race. Religious attendance may facilitate ACP readiness among African American patients, while comfort-focused treatment preferences appear more influential among White patients. Culturally tailored strategies are needed to equitably support ACP engagement among older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"1012-1024"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183925","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":"Quality of Medicare Skilled Home Health for People Living With Dementia in the US: National Patterns and Implications","authors":"Jennifer M. Reckrey,&nbsp;Bian Liu,&nbsp;Arushi Arora,&nbsp;Christine Ritchie,&nbsp;Bruce Leff,&nbsp;Abraham A. Brody,&nbsp;Julia G. Burgdorf,&nbsp;Katherine A. Ornstein","doi":"10.1111/jgs.70345","DOIUrl":"10.1111/jgs.70345","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People living with dementia frequently use Medicare skilled home health care and have unique usage patterns as compared to people without dementia, but little is known about variation in measured quality of home health care received by this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using 2021 Medicare Fee-for-Service Claims data, we examined receipt of high-quality home health (i.e., care from an agency with a star rating &gt; 3.5) as determined by two publicly available measures: the Quality of Patient Care Star Rating (based on standardized clinical status measures) and the Patient Survey Star Rating (based on satisfaction with care reported by patients or caregivers). For each quality measure, we mapped the county-level high-quality-home health agency utilization rate among people living with dementia and compared differences in utilization of high-quality home health agencies by dementia status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found significant county-level variability in utilization of high-quality home health. When quality was operationalized based on <i>clinical status measures</i> (i.e., Quality of Patient Care Star Rating), dementia patients did not receive care from lower quality agencies. However, when quality was operationalized based on <i>satisfaction with care</i> (i.e., Patient Survey Star Ratings), people living with dementia were less likely than those without dementia to receive care from high-quality home health agencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings highlight variability in receipt of high-quality home health care among people living with dementia nationally and suggest a need for further investigation as to what constitutes high-quality home health care in this population. To ensure home health meets the unique care needs of people living with dementia, policy makers should work to ensure quality measures are better aligned with the needs of people living with dementia, incentivize access to high-quality home health care where services are limited, and promote systems to improve family caregiver identification and engagement with home health care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"1080-1088"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273770","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":"Outpatient Cardiac Rehabilitation and Long-Term Clinical Outcomes After Transcatheter Aortic Valve Replacement","authors":"Koki Takegawa,&nbsp;Yoshitaka Iwanaga,&nbsp;Koshiro Kanaoka,&nbsp;Shoko Chishaki-Kawabata,&nbsp;Haruka Matsuura,&nbsp;Tetsuo Sasano,&nbsp;Yuichi Nishioka,&nbsp;Tomoya Myojin,&nbsp;Tatsuya Noda,&nbsp;Tomoaki Imamura,&nbsp;Yoshihiro Miyamoto","doi":"10.1111/jgs.70356","DOIUrl":"10.1111/jgs.70356","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transcatheter aortic valve replacement (TAVR) has become the standard treatment for severe aortic stenosis, particularly among very old adults, and long-term comprehensive management post-TAVR is becoming increasingly important. Although cardiac rehabilitation (CR) is strongly recommended for patients with heart failure (HF) or post-cardiac surgery, cohort studies evaluating the long-term efficacy of CR in patients who have undergone TAVR are scarce. This study aimed to examine the association between outpatient CR and long-term clinical outcomes post-TAVR utilizing a nationwide administrative claims database in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 46,885 patients who underwent TAVR between April 2014 and March 2021, 34,165 patients who participated in inpatient CR and were discharged alive were included. Patients were categorized by outpatient CR participation. After propensity score matching, the primary outcome, a composite of all-cause mortality and HF hospitalization, was compared over a 3-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the eligible patients, 29,552 (86.5%) were aged ≥ 80 years, and 22,805 (66.7%) were female. The participation rate in outpatient CR was 10.2%, with no observed increasing trend over the years. Advanced age, female sex, dementia, and multiple comorbidities were associated with non-participation in CR. The outpatient CR group exhibited reduced risk for the primary outcome (hazard ratio: 0.87, 95% confidence interval: 0.79–0.96) with a median follow-up of 734 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The participation rate in outpatient CR after TAVR remains low, with identifiable barriers in Japan. Participation was associated with improved outcomes, suggesting a beneficial management strategy for older patients post-TAVR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"1071-1079"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230342","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 Palliative Care Paradox: Investigating Unexpected Outcomes in Dementia Care","authors":"W. James Deardorff,&nbsp;Ashwin Kotwal","doi":"10.1111/jgs.70347","DOIUrl":"10.1111/jgs.70347","url":null,"abstract":"&lt;p&gt;Community-dwelling persons with dementia experience a high prevalence of neuropsychiatric symptoms (e.g., depression, apathy), clinical symptoms (e.g., pain, insomnia), and unmet care needs (e.g., assistance with activities of daily living) [&lt;span&gt;1, 2&lt;/span&gt;]. They also frequently receive burdensome treatments near the end of life, including hospitalizations and intensive care unit (ICU) admissions [&lt;span&gt;3&lt;/span&gt;]. Palliative care for individuals with dementia may therefore play a key role in ensuring that individuals receive care that optimizes quality of life, supports family and care partners, and facilitates goal-concordant care, which may entail avoiding certain aggressive medical interventions [&lt;span&gt;4&lt;/span&gt;]. However, palliative care services are a limited resource in health systems worldwide. As a result, identifying the optimal timing for initiating palliative care among community-dwelling persons with dementia to meet clinical needs and reduce burdensome acute care utilization is critical [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt;, Quinn and colleagues used a unique cohort of 50,961 community-dwelling older adults with advanced dementia in Ontario, Canada to investigate this question of optimal timing of palliative care initiation; specifically, during a window of time when these individuals have both limited life expectancy &lt;i&gt;and&lt;/i&gt; increased care needs as indicated by a referral for home care services [&lt;span&gt;6&lt;/span&gt;]. They hypothesized that palliative care initiation within 30 days of this window would reduce acute care utilization (e.g., emergency department use, hospitalizations, and ICU admissions), which may not align with the values and goals of this population.&lt;/p&gt;&lt;p&gt;Their analytic approach used propensity-score overlap weighting to minimize confounding by indication, given that sicker patients are more likely to receive palliative care. Overlap weighting is a relatively novel method that lends greater emphasis to individuals who could have easily ended up in either group (palliative care vs. no palliative care) by assigning larger weights to those with a likelihood of being in either group close to approximately 50% [&lt;span&gt;7&lt;/span&gt;]. Overlap weighting produces an estimate of the average treatment effect in the overlap population, answering the question, “Among those who could realistically receive palliative care, does initiation of palliative care actually lead to reduced acute care utilization?”&lt;/p&gt;&lt;p&gt;Unexpectedly, in the overlap-weighted analysis, the authors found that palliative care was associated with an increased hazard of hospitalization within the first 90 days (HR 1.43 at 30 days, 95% CI = 1.25–1.64). Importantly, this increased hazard of hospitalization was observed up to 180 days for hospitalizations with palliative intent (HR 1.45, 95% CI = 1.13–1.87), but not hospitalizations with non-palliative intent (HR 0.94, 95% CI = 0.79–1.13). The classification o","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"947-950"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70347","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208553","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":"Social Engagement and Epigenetic Age Acceleration in the Health and Retirement Study","authors":"Zhao Hu,&nbsp;Yue Xu,&nbsp;Qi Liu,&nbsp;Qianqian Ji,&nbsp;Jiale Li,&nbsp;Yaxian Meng,&nbsp;Liuqing Li,&nbsp;Lu Tang,&nbsp;Yunzhang Wang,&nbsp;Jieli Zhang,&nbsp;Shan Xu,&nbsp;Ruoqing Chen,&nbsp;Enxiang Tao,&nbsp;Yiqiang Zhan","doi":"10.1111/jgs.70350","DOIUrl":"10.1111/jgs.70350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study investigated the relationship between social engagement and epigenetic age acceleration (EAA) in older adults in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were selected from the Health and Retirement Study (HRS). Social engagement was assessed using the 15-item social engagement scale. Thirteen epigenetic clocks based on DNA methylation data were obtained from the 2016 HRS Venous Blood Study. EAA was calculated for each clock by regressing the residual clock values on chronological age. The association between various social activities and 13 EAA was analyzed using multiple linear regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average age of participants was 69.9 years, with 41.5% being male. In the fully adjusted model, more frequent engagement in social activities was linked to slower EAA in the Zhang, GrimAge, Weidner, and VidalBralo clocks. Specifically, more frequent community activities were significantly associated with slower EAA in the GrimAge clock after FDR correction. Unexpectedly, more cognitive activities were significantly associated with faster DunedinPoAm38. More physical activities were associated with slower EAA in the Zhang, PhenoAge, GrimAge, and DunedinPoAm38 clocks after FDR correction. Participants with consistent nonparticipation in overall social activities were associated with faster EAA in the Zhang clock.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings indicate that active engagement in social activities, encompassing community, cognitive, home-based creative, and physical activities, is associated with slower EAA, marked by several clocks in older adults, providing evidence for the benefit of social activities for health and offering valuable insights for promoting “Active Aging” initiatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 4","pages":"1110-1120"},"PeriodicalIF":4.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208456","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}