Journal of the American Geriatrics Society最新文献

{"title":"Feasibility of an electronic health record web-based application to optimize medication-related communication between skilled home healthcare clinicians and primary care providers","authors":"Jonathan D. Norton BS, Kimberly Carl BSN, RN, Adeola Alowonle MS, Bruce Leff MD, Orla C. Sheehan MD, PhD, Cynthia M. Boyd MD, MPH","doi":"10.1111/jgs.19273","DOIUrl":"10.1111/jgs.19273","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"958-961"},"PeriodicalIF":4.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670173","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 art of aging gracefully","authors":"Antonio Yaghy MD","doi":"10.1111/jgs.19274","DOIUrl":"10.1111/jgs.19274","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"277-278"},"PeriodicalIF":4.3,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645310","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":"Do I need to go to a skilled nursing facility? Hospital discharges to SNF during and after the COVID-19 pandemic","authors":"Marianne Tschoe MD, Charles Olvera MA, MS, Anna Liggett MD, Jennifer Woodward MD, Vanessa Ramirez-Zohfeld MPH, Lee A. Lindquist MD, MPH, MBA","doi":"10.1111/jgs.19267","DOIUrl":"10.1111/jgs.19267","url":null,"abstract":"<p>Hospitalized patients who need rehabilitation or continued medical care are often discharged to skilled nursing facilities (SNF) for ongoing treatment. During the early years of the COVID-19 pandemic, overburdened hospitals were heavily strained, so the Centers for Medicare and Medicaid Services (CMS) waived its 3-day rule to obtain SNF care, effective March 1, 2020.<span><sup>1</sup></span> Patients no longer had to meet inpatient criteria or remain hospitalized for 3 days to transfer to SNFs. We sought to characterize trends in hospital discharges to SNF during the COVID-19 pandemic waiver.</p><p>As part of a discharge to SNF metric at an urban academic medical center, a database was created utilizing a retrospective cohort of Medicare beneficiaries who used hospital inpatient services, specifically examining those patients who were discharged to a SNF for additional care. Variables (age, concurrent depression diagnosis, length of stay, and ICU admission) were chosen to gauge severity of illness. Secondary data analysis was conducted, parsing the information into 3 years: March 2020–February 2021 (COVID Year 1), March 2021–February 2022 (Year 2), and March 2022–February 2023 (Year 3) and analyzed using univariate and chi-square analyses.</p><p>We examined 674 discharges to SNF across 607 individuals (Figure 1). Approximately 11% (<i>n</i> = 73) of discharges occurred in Year 1, 24% (<i>n</i> = 164) in Year 2, and 65% (<i>n</i> = 437) in Year 3. The mean preceding hospital stay in Years 1 and 2 was 12.0 versus 10.1 days in Year 3 (<i>p</i> < 0.05). In Year 1, no individual was held for fewer than 3 days before discharge to an SNF. Approximately 41% of discharges to SNF were preceded by an ICU stay in Year 1 versus 20% in Year 2 and 19% in Year 3, representing a significant decrease in the proportion of ICU stays between COVID Years (<i>p</i> < 0.0001). Mean age at discharge declined across years 1–3, from 84.84 in Y1, to 84.29 in Y2, to 83.54 in Yr3. The age decline between Years 2 and 3, from 84 in Year 2 to 79 in Year 3 was significant (<i>p</i> < 0.001). The proportion of patients discharged to SNF who had a depression diagnosis lessened significantly between years: 26% in Year 1 versus 12% in Year 2 versus 16% in Year 3 (<i>p</i> < 0.03).</p><p>This study is the first to examine hospital discharges to SNF over the three-year course of the COVID-19 pandemic. Hospital discharges to SNF were the lowest during the first year of the pandemic when severity of illness was the highest. Absence of a vaccine and facility visitor restrictions could have prompted patients and their families to choose discharge to home rather than SNF. Residents in long-term care facilities accounted for 37.7% of COVID-19 deaths in the United States by the end of 2020,<span><sup>2</sup></span> when the vaccine first became available. Visitor restrictions during the pandemic have been associated with increased emotional distress among patients and their fam","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"651-653"},"PeriodicalIF":4.3,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649801","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":"Factors associated with language concordant cognitive testing among linguistically diverse older adults","authors":"Victoria L. Chuen MD, Alison J. Wu BSc, Shabbir M. H. Alibhai MD, MSc, Shail Rawal MD, MPH, Xiang Y. Ye MSc, Christina Reppas-Rindlisbacher MD","doi":"10.1111/jgs.19258","DOIUrl":"10.1111/jgs.19258","url":null,"abstract":"<p>Quality standards recommend cognitive assessments be completed in patients' preferred languages,<span><sup>1</sup></span> but rates of language-concordant or interpreter-mediated cognitive testing for patients who do not speak the dominant societal language are unknown.</p><p>We conducted a retrospective cohort study of patients aged 65 years and older presenting to an academic geriatric oncology clinic in Toronto, Canada who underwent cognitive testing during a comprehensive geriatric assessment between July 2015 and December 2022. A sample of 1800 patient charts was reviewed for self-reported language preference, a variable previously validated at our institution.<span><sup>2</sup></span> Demographic characteristics, patient diagnoses, reason for referral, and interpretation use were collected from the electronic medical record.</p><p>We evaluated the proportion of older patients who received language-concordant or interpreter-mediated cognitive testing, ad hoc interpretation, or no interpretation and used descriptive statistics to compare patient characteristics across two groups (language-concordant or interpreter-mediated vs. ad hoc interpretation or no interpretation). We used univariate and multivariable logistic regression to identify factors associated with cognitive testing in patients' preferred language. Statistical analyses were performed using SAS (SAS institute Inc., NC; version 9.4) and a two-sided <i>p</i>-value of <0.05 was considered statistically significant. The University Health Network's Research Ethics Board approved the study (see Supplemental File S1).</p><p>Of 1800 charts screened, 253 patients reported a non-English preferred language (mean age 81.2 [SD 6.4] years, 54.5% female, Table 1). The most common preferred languages were Chinese (21.3%), Portuguese (14.6%), and Italian (15.0%). Cognitive testing was language-concordant or interpreter-mediated in 45 cases (17.8%) with 49% in person, 16% by telephone, 29% unknown, and 7% documented as patient-physician shared language. For the remaining patients, 19.0% (<i>n</i> = 48) had ad hoc interpretation and 63.2% (<i>n</i> = 160) received no interpretation (Figure 1).</p><p>Patients referred for cognition (adjusted odds ratio [aOR] 8.90, 95% confidence interval [CI]: 1.76–45.09), with a curative treatment intent (aOR 3.19, 95% CI: 1.25–8.19), and who preferred a Chinese language (aOR 2.75, 95% CI: 1.02–7.36) had increased odds of language-concordant or interpreter-mediated cognitive testing, whereas patients with higher comorbidity (Charlson Comorbidity Index ≥2 vs. 0 aOR 0.17, 95% CI: 0.06–0.47), and who resided longer in Canada (aOR 0.97 per year, 95% CI: 0.95–1.00) had reduced odds (see Supplemental Table S1).</p><p>Among patients with a non-English preferred language presenting to a geriatric oncology clinic, only 17.9% received interpreter-mediated or language-concordant cognitive testing. Factors associated with increased odds of interpreter-mediated or languag","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"647-650"},"PeriodicalIF":4.3,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635192","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":"Denosumab for osteoporosis in older adults in long-term care: A randomized trial","authors":"Susan L. Greenspan MD,&nbsp;Subashan Perera PhD,&nbsp;Nami Safai Haeri MD,&nbsp;David A. Nace MD,&nbsp;Neil M. Resnick MD","doi":"10.1111/jgs.19260","DOIUrl":"10.1111/jgs.19260","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In long-term care (LTC), the incidence of hip or vertebral fractures are eight times that in the community. Despite the wide availability of osteoporosis therapy, LTC residents are omitted from pivotal trials and not treated. Denosumab is a relatively new, monoclonal antibody therapy for osteoporosis treatment. Via a randomized trial, we sought to determine the safety and efficacy of denosumab in LTC residents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a 2-year, double-blind, placebo-controlled, randomized clinical trial in 201 osteoporotic men and women aged ≥ 65 years, living in LTC communities. Participants with multimorbidity, dysmobility, and cognitive impairment were not excluded. The intervention was denosumab 60 mg subcutaneous every 6 months or placebo. Our primary outcome measures were hip and spine bone mineral density (BMD) improvement at 24 months. Secondary outcomes included BMD at other skeletal sites, function, and safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 123 women and 78 men with a mean ± standard error age of 81.5 ± 0.6. Overall, 83% and 71% completed 12 and 24 months, respectively. Compared with placebo, the women receiving denosumab had a greater 24-month percent increase in spine (7.41 ± 0.93 vs. 2.15 + 0.56; <i>p</i> = 0.014), and total hip BMD (4.62 ± 0.62 vs. −0.19 ± 0.79; <i>p</i> = 0.007); and men in spine (7.91 ± 0.96 vs. 1.12 ± 1.13; <i>p</i> = 0.002) and total hip (3.74 ± 0.55 vs. 0.48 ± 0.74; <i>p</i> = 0.018). There were no significant differences in safety metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Denosumab was a safe and effective therapy for improving BMD in osteoporotic older men and women with multiple comorbidities in LTC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"445-457"},"PeriodicalIF":4.3,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635190","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":"Change in frailty among older COVID-19 survivors","authors":"Benjamin Seligman MD, PhD,&nbsp;Katherine D. Wysham MD,&nbsp;Troy Shahoumian MPH, PhD,&nbsp;Ariela R. Orkaby MD, MPH,&nbsp;Matthew Bidwell Goetz MD,&nbsp;Thomas F. Osborne MD,&nbsp;Valerie A. Smith DrPH,&nbsp;Matthew L. Maciejewski PhD,&nbsp;Denise M. Hynes MPH, PhD, RN,&nbsp;Edward J. Boyko MD, MPH,&nbsp;George N. Ioannou MD, MS","doi":"10.1111/jgs.19255","DOIUrl":"10.1111/jgs.19255","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>COVID-19 survivors are at greater risk for new medical conditions. Among older adults, where multimorbidity and functional impairment are common, frailty measurement provides a tool for understanding how infection impacts future health beyond a one-disease-at-a-time approach. We investigated whether COVID-19 was associated with change in frailty among older Veterans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were from the Veterans Affairs (VA) COVID-19 Observational Research Collaboratory, which extracted VA medical record data. We included Veterans who had COVID-19 from March 1, 2020, to April 30, 2021 and matched uninfected controls. We excluded those &lt;50 years at index or did not survive 12 months after. Frailty was assessed at the index date and 12 months using the VA Frailty Index (VA-FI).</p>\u0000 \u0000 <p>We assessed the number of new VA-FI deficits over 12 months. Analysis was done by negative binomial regression adjusted for age, gender, race, ethnicity, and BMI. Coefficients are given as the ratio of the mean number of new deficits in COVID-19 cases versus controls during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 91,338 COVID-19-infected Veterans and an equal number of matched controls. Median (IQR) age was 68.9 years (60.3–74.2), 5% were female, 71% were White, and baseline VA-FI was 0.16 (0.10, 0.26). Median (IQR) number of new deficits at 1 year was 1 (0–2) for infected and 0 (0–1) for uninfected controls. After adjustment, those with COVID-19 accrued 1.54 (95% CI 1.52–1.56) times more deficits than those who did not. The five most common new deficits were fatigue (9.7%), anemia (6.8%), muscle atrophy (6.5%), gait abnormality (6.2%), and arthritis (5.8%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We found a greater increase in frailty among older Veterans with COVID-19 compared with matched uninfected controls, suggesting that COVID-19 infection has long-term implications for vulnerability and disability among older adults. Functional impairments such as fatigue, impaired mobility, and joint pain may warrant specific attention in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3800-3809"},"PeriodicalIF":4.3,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635185","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":"Stress tests and biomarkers of resilience: Proceedings of the second state of resilience science conference","authors":"Cathleen Colón-Emeric MD, MHS,&nbsp;Jeremy Walston MD,&nbsp;Alessandro Bartolomucci PhD,&nbsp;Judith Carroll PhD,&nbsp;Martin Picard PhD,&nbsp;Adam Salmon PhD,&nbsp;Shakira Suglia MS, ScD,&nbsp;Heather Whitson MD, MHS,&nbsp;Peter Abadir MD","doi":"10.1111/jgs.19246","DOIUrl":"10.1111/jgs.19246","url":null,"abstract":"<p>The “Stress Tests and Biomarkers of Resilience” conference, hosted by the American Geriatrics Society and the National Institute on Aging, marks the second in a series aimed at advancing the field of resilience science. Held on March 4–5, 2024, in Bethesda, Maryland, this conference built upon the foundational work from the first conference, which focused on defining resilience across various domains—physical, cognitive, and psychosocial. This year's gathering centered around three factors: the biology that underlies resilient outcomes; the social, environmental, genetic, and psychosocial factors that impact that resilience biology; and the biomarker testing and imaging that predicts resilient outcomes for older adults. The presentations and discussions around these topics were underscored by considerations around the many impacts of social determinants of health on resiliency interventions, and by advances in the modern training and research methodologies that influence data collection and experiment design.</p><p>See related article by Umoh et al. in this issue.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1017-1028"},"PeriodicalIF":4.3,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635210","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":"Census growth and challenges of a novel Hospital at Home program: A retrospective cohort study","authors":"Stephen T. Biederman MD,&nbsp;Julia S. Breton MD,&nbsp;Gordon M. Pace MD,&nbsp;Alan W. Dow MD","doi":"10.1111/jgs.19259","DOIUrl":"10.1111/jgs.19259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital at Home (HaH) is a growing care model requiring significant investments. Critical to starting a program is estimating census and enrollments. The objective of this study was to compare expected versus actual consults, enrollments, and barriers in a novel HaH program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an observational, retrospective cohort study at a single urban academic medical center. Adult inpatients considered for enrollment to HaH were included. Demographic data, diagnoses and outcomes data were extracted for HaH patients. Volume and outcomes of HaH consults were recorded, including reasons for ineligibility or a patient declining to enroll.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over the first year of implementation, 248 patients enrolled. The average daily census (ADC) grew over months 1–6, then plateaued at a mean of 4.4 patients during month 10, with an overall ADC range from 0 to 7 patients. From months 7 to 12, there were 724 consults for a home hospital assessment, of which 22.5% (163/724) of patients were enrolled, 21.8% (158/724) declined to enroll, 29.3% (212/724) were ineligible for the program, and 26.4% (191/724) had consults that were deferred until the time of discharge and never explicitly consented or refused. The most common reasons for program ineligibility were complex care needs, insurance status, and not meeting inpatient status. The most common reasons patients declined to enroll were a preference to remain in the brick-and-mortar hospital and home conditions not suitable for HaH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This retrospective, cohort study defines the challenges of enrolling patients in an HaH program and provides areas for other programs to examine as they start or grow a program.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"881-886"},"PeriodicalIF":4.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607229","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":"Kay Khaing MMed,&nbsp;Xenia Dolja-Gore PhD,&nbsp;Balakrishnan R. Nair MD,&nbsp;Julie Byles PhD,&nbsp;John Attia PhD","doi":"10.1111/jgs.17875","DOIUrl":"https://doi.org/10.1111/jgs.17875","url":null,"abstract":"<p><b>Cover caption</b>: Anxiety and increased risk of dementia. See the related article by Khaing et al., pages 3327–3334.\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":"72 11","pages":"C1"},"PeriodicalIF":4.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.17875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142664650","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":"Clinician contributions to central nervous system-active polypharmacy among older adults with dementia in the United States","authors":"Sarah E. Vordenberg PharmD, MPH,&nbsp;Rachel C. Davis MS,&nbsp;Julie Strominger MS,&nbsp;Steven C. Marcus PhD,&nbsp;Hyungjin Myra Kim ScD,&nbsp;Frederic C. Blow PhD,&nbsp;Lauren P. Wallner PhD, MPH,&nbsp;Tanner Caverly MD, MPH,&nbsp;Sarah Krein PhD, RN,&nbsp;Donovan T. Maust MD, MS","doi":"10.1111/jgs.19256","DOIUrl":"10.1111/jgs.19256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Exposure to central nervous system (CNS)-active polypharmacy—overlapping exposure to three or more CNS-active medications—is potentially harmful yet common among persons living with dementia (PLWD). The extent to which these medications are prescribed to community-dwelling PLWD by individual clinicians versus distributed across multiple prescribers is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified community-dwelling Medicare beneficiaries with a dementia diagnosis and Medicare Parts A, B, and D coverage for at least one month in 2019. Using fill date and days' supply for prescriptions filled between January 1, 2019 and December 31, 2019, we identified beneficiaries exposed to CNS-active polypharmacy (i.e., &gt;30 days of overlapping exposure to three or more antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, nonbenzodiazepine benzodiazepine receptor agonists, or skeletal muscle relaxant medications). We examined the number and type of clinicians who contributed to polypharmacy person-days among PLWD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included 955,074 PLWD who were primarily female (64.0%), were White (78.5%), and had a mean age of 83.4 years (standard deviation 8.0). Notably, 14.3% were exposed to CNS-active polypharmacy. At the person level, 24.6% of PLWD experienced polypharmacy prescribed by a single clinician. Considering total days of exposure, 45.3% of polypharmacy person-days were prescribed by a single clinician. Primary care physicians prescribed 63.0% of polypharmacy person-days and accounted for the plurality of days for all seven medication classes, followed by psychiatrists for antipsychotics and benzodiazepines and primary care advanced practice providers (APPs) for antidepressants and antiseizure medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this cross-sectional analysis of Medicare claims data, primary care clinicians (both physicians and APPs) prescribed the majority of medications that contributed to CNS-active polypharmacy for PLWD. Future research is needed to identify strategies to support primary care clinicians in appropriate prescribing of CNS-active medications to PLWD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"422-430"},"PeriodicalIF":4.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19256","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584126","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}