Journal of the American Geriatrics Society最新文献

{"title":"Gaps in the coordination of care for people living with dementia","authors":"Lisa M. Kern MD, MPH,&nbsp;Catherine Riffin PhD,&nbsp;Veerawat Phongtankuel MD, MS,&nbsp;Joselyne E. Aucapina,&nbsp;Samprit Banerjee PhD,&nbsp;Joanna B. Ringel MPH,&nbsp;Jonathan N. Tobin PhD,&nbsp;Semhar Fisseha MPH,&nbsp;Helena Meiri RN, MA,&nbsp;Sigall K. Bell MD,&nbsp;Paul N. Casale MD, MPH","doi":"10.1111/jgs.19105","DOIUrl":"10.1111/jgs.19105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>One-third of people living with dementia (PLWD) have highly fragmented care (i.e., care spread across many ambulatory providers without a dominant provider). It is unclear whether PLWD with fragmented care and their caregivers perceive gaps in communication among the providers involved and whether any such gaps are perceived as benign inconveniences or as clinically meaningful, leading to adverse events. We sought to determine the frequency of perceived gaps in communication (coordination) among providers and the frequency of self-reported adverse events attributed to poor coordination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study in the context of a Medicare accountable care organization (ACO) in New York in 2022–2023. We included PLWD who were attributed to the ACO, had fragmented care in the past year by claims (reversed Bice-Boxerman Index ≥0.86), and were in a pragmatic clinical trial on care management. We used an existing survey instrument to determine perceptions of care coordination and perceptions of four adverse events (repeat tests, drug–drug interactions, emergency department visits, and hospital admissions). ACO care managers collected data by telephone, using clinical judgment to determine whether each survey respondent was the patient or a caregiver. We used descriptive statistics to summarize results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 167 eligible PLWD, surveys were completed for 97 (58.1%). Of those, 88 (90.7%) reported having &gt;1 ambulatory visit and &gt;1 ambulatory provider and were thus at risk for gaps in care coordination and included in the analysis. Of those, 23 respondents were patients (26.1%) and 64 were caregivers (72.7%), with one respondent's role missing. Overall, 57% of respondents reported a problem (or “gap”) in the coordination of care and, separately, 18% reported an adverse event that they attributed to poor care coordination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gaps in coordination of care for PLWD are reported to be very common and often perceived as hazardous.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3119-3128"},"PeriodicalIF":4.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790671","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":"Site-initiated adaptations in the implementation of an evidence-based inpatient walking program","authors":"Jaime M. Hughes PhD, MPH, MSW,&nbsp;Ashley L. Choate MPH,&nbsp;Cassie Meyer BS,&nbsp;Caitlin B. Kappler MSW,&nbsp;Virginia Wang PhD,&nbsp;Kelli D. Allen PhD,&nbsp;Courtney H. Van Houtven PhD,&nbsp;S. Nicole Hastings MD,&nbsp;Leah L. Zullig PhD, MPH","doi":"10.1111/jgs.19044","DOIUrl":"10.1111/jgs.19044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site-initiated adaptations to STRIDE, a hospital-based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>STRIDE was implemented at eight hospitals in a stepped-wedge cluster randomized trial. During the pre-implementation phase, sites were encouraged to adapt program characteristics to optimize implementation and align with their hospital's resources, needs, and culture. Recommended adaptations included those related to staffing models, marketing, and documentation. To assess the number and types of adaptations, multiple data sources were reviewed, including implementation support notes from site-level support calls and group-based learning collaborative sessions. Adaptations were classified based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), including attention to what was adapted, when, why, and by whom. We reviewed the number and types of adaptations across sites that did and did not sustain STRIDE, defined as continued program delivery during the post-implementation period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 25 adaptations were reported and classified across seven of the eight sites. Adaptations were reported across five areas: program documentation (<i>n</i> = 13), patient eligibility criteria (<i>n</i> = 5), program enhancements (<i>n</i> = 3), staffing model (<i>n</i> = 2), and marketing and recruitment (<i>n</i> = 2). More than one-half of adaptations were planned. Adaptations were common in both sustaining and non-sustaining sites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adaptations were common within a program designed with flexible implementation in mind. Identifying common areas of planned and unplanned adaptations within a flexible program such as STRIDE may contribute to more efficient and effective national scaling. Future research should evaluate the relationship between adaptations and program implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3210-3218"},"PeriodicalIF":4.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790673","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":"Selective serotonin/serotonin-norepinephrine reuptake inhibitor serum concentrations' association with delirium duration","authors":"James O. Jordano MD,&nbsp;Eduard E. Vasilevskis MD, MPH,&nbsp;Sandra F. Simmons PhD,&nbsp;Warren D. Taylor MD, MHSc,&nbsp;Andrew A. Monte MD, PhD,&nbsp;Maria C. Duggan MD, MPH,&nbsp;Jin H. Han MD, MSc","doi":"10.1111/jgs.19107","DOIUrl":"10.1111/jgs.19107","url":null,"abstract":"&lt;p&gt;Delirium is a form of acute brain failure that commonly afflicts older hospitalized patients.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The association between delirium and benzodiazepines is well-documented,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; but the association with other psychotropic medication classes is less clear. Using a novel liquid chromatography-mass spectrometry (LC-MS) assay, we observed supratherapeutic psychotropic drug levels (SPDLs) occurred in 17% of delirium cases and were associated with prolonged delirium episodes. Over half of SPDLs were secondary to selective and serotonin-norepinephrine reuptake inhibitors (SSRI/SNRIs),&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; which are not considered deliriogenic.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Most studies examining SSRI/SNRIs and delirium relied on medication lists, which do not account for SPDLs.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; They also did not account for preexisting dementia, which may increase vulnerability to developing delirium, even at nontoxic, therapeutic drug concentrations.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; We sought to determine if serum SSRI/SNRI concentrations were associated with prolonged delirium duration in older hospitalized adults and examined if this association was modified by preexisting dementia.&lt;/p&gt;&lt;p&gt;This was an exploratory analysis of a prospective cohort study.&lt;span&gt;&lt;sup&gt;3, 6&lt;/sup&gt;&lt;/span&gt; Patients ≥65 years old who were admitted to the hospital, had serum available for LC-MS measurements, and enrolled within 4 h of emergency department presentation were included. All delirious and a random selection (~17%) of non-delirious patients were enrolled between March 2012 and November 2014.&lt;/p&gt;&lt;p&gt;Delirium was assessed daily using the modified Brief Confusion Assessment Method (bCAM), which is 82% sensitive and 96% specific for delirium.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Serum SSRI/SNRI drug levels were measured using a LC-MS assay that measured 30+ psychotropic medications (Precera Bioscience, Inc., Franklin, TN). Standardized serum SSRI/SNRI concentrations were calculated by dividing each measurement by the upper limit of normal published in the literature. To establish the validity of our standardization approach, we analyzed standardized serum benzodiazepine concentrations. A patient was considered to have pre-illness dementia if they had: (i) a pre-illness dementia assessment (IQCODE) greater than 3.38,&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; (ii) documented dementia diagnosis in the medical record, or (iii) prescribed cholinesterase inhibitors prior to admission.&lt;/p&gt;&lt;p&gt;To determine if standardized serum concentrations of SSRI/SNRIs or benzodiazepines were associated with delirium duration, proportional odds logistic regression was performed adjusting for age, pre-illness dementia, functional status, and depression, comorbidity burden, pre-illness severity, kidney/liver dysfunction, and central nervous system diagnosis.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; A standardized serum concentration*pre-illness dementia interaction was incorporated; effect modif","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3594-3597"},"PeriodicalIF":4.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790672","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":"Nursing Home Compare star ratings before versus after a change in nursing home ownership","authors":"Kira L. Ryskina MD, MSHP,&nbsp;Emily Tu MS,&nbsp;Junning Liang MS,&nbsp;Seiyoun Kim PhD,&nbsp;Rachel M. Werner MD, PhD","doi":"10.1111/jgs.19104","DOIUrl":"10.1111/jgs.19104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Efforts to increase transparency and accountability of nursing homes, and thus improve quality, now include information about changes in nursing home ownership. However, little is known about how change in ownership affects nursing home quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of 15,471 U.S. nursing homes between January 2016 and December 2022, identifying all changes in ownership during that period. We used logistic regression to measure the association between nursing home characteristics and the odds of a change in ownership. A difference-in-differences model with multiple time periods was used to examine the impact of a change in ownership on the Medicare Nursing Home Compare 5-star ratings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One in five (23%) facilities changed ownership between 2016 and 2022. Nursing homes that were urban, for-profit, part of a chain, located in the South, had &gt;50 beds, lower occupancy, higher percentage of stays covered by Medicaid, higher percentage of residents with non-white race, or a 1-star (poor) rating were more likely to undergo a change in ownership. There was a small statistically significant decrease in 5-star ratings after a change in ownership (−0.09 points on a 5-point scale; 95% CI −0.13 to −0.04; <i>p</i> &lt; 0.001), driven primarily by a decrease in staffing ratings (−0.19 points; 95% CI −0.24 to −0.14; <i>p</i> &lt; 0.001), and health inspections ratings (−0.07 points; 95% CI −0.11 to −0.03; <i>p</i> = 0.001). This was mitigated by an increase in quality measure ratings (0.15 points; 95% CI 0.10–0.20; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3078-3088"},"PeriodicalIF":4.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794445","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 Medicare annual wellness visit: An opportunity to improve health system identification of hearing loss?","authors":"Danielle S. Powell AuD, PhD,&nbsp;Mingche M. J. Wu MSPH,&nbsp;Stephanie Nothelle MD,&nbsp;Jamie M. Smith RN PhD,&nbsp;Kelly Gleason PN, PhD,&nbsp;Esther S. Oh MD, PhD,&nbsp;Hillary D. Lum MD, PhD,&nbsp;Nicholas S. Reed AuD,&nbsp;Jennifer L. Wolff PhD","doi":"10.1111/jgs.19111","DOIUrl":"10.1111/jgs.19111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hearing loss is prevalent and consequential but under-diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient-reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We use 5 years of electronic medical record (EMR) data (2017–2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (<i>n</i> = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, <i>p</i> = 0.01; 68.9% vs. 37.5%, <i>p</i> &lt; 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3089-3097"},"PeriodicalIF":4.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763650","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":"“I make myself get busy”: Resilience and social connection among low-income older adults living in subsidized housing","authors":"Marcela D. Blinka PhD,&nbsp;Suzanne M. Grieb PhD, MSPH,&nbsp;Tsai-Tong Lee MPH,&nbsp;Samantha Hogg MPH,&nbsp;Katherine L. Runge MA,&nbsp;Andre Nogueira PhD,&nbsp;Nicole Williams MS,&nbsp;Laura Prichett PhD, MHS,&nbsp;Carl A. Latkin PhD,&nbsp;Joseph J. Gallo MD, MPH,&nbsp;Cynthia M. Boyd MD, MPH,&nbsp;Thomas K. M. Cudjoe MD, MPH, MA","doi":"10.1111/jgs.19069","DOIUrl":"10.1111/jgs.19069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Social isolation and loneliness are pervasive issues among older adults in the United States, carrying significant health risks. Low-income older adults are particularly vulnerable to these challenges compared with their higher-income counterparts due to their limited access to resources and social networks. Many low-income older adults live in subsidized housing, which has the potential to offer unique support tailored to their needs. The intersection of aging and the unique social circumstances faced by low-income older adults significantly influences how they navigate crises.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews with 24 older adults aged 63–86 residing in subsidized housing communities in the United States. The data were collected from August 2021 to November 2022 and subsequently analyzed using a thematic constant comparison analysis approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Many participants felt connected to their housing community. Participants reported that their lives changed substantially due to the pandemic: communal activities ceased leading to isolation and feelings of loneliness. Amid this challenge, participants were resourceful and found creative ways to manage. Many emphasized the crucial role of technology in maintaining emotional support despite physical separation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Participants in subsidized housing shared their experiences before and during this unique crisis highlighting the challenges they face, as well as their resilience and adaptability when facing challenges. Our findings underscore the significance of community activation, demonstrating that activities motivated older adults to improve their well-being. Additionally, the role of technology in maintaining connections proved to be crucial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3188-3199"},"PeriodicalIF":4.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763646","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":"Discontinuation versus continuation of statins: A systematic review","authors":"Cayden Peixoto MSc,&nbsp;Yasmeen Choudhri MSc,&nbsp;Sara Francoeur ADN,&nbsp;Lisa M. McCarthy PharmD, MSc,&nbsp;Celeste Fung MD,&nbsp;Dar Dowlatshahi MD, PhD,&nbsp;Geneviève Lemay MD, MSc,&nbsp;Arden Barry PharmD,&nbsp;Parag Goyal MD, MSc,&nbsp;Jeffrey Pan PharmD,&nbsp;Lise M. Bjerre MDCM, PhD,&nbsp;Wade Thompson PharmD, PhD","doi":"10.1111/jgs.19093","DOIUrl":"10.1111/jgs.19093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinicians and patients often face a decision to continue or discontinue statins. We examined the impact of discontinuation of statins compared with continuation on clinical outcomes (all-cause mortality, cardiovascular [CV] mortality, CV events, and quality of life).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review. Randomized controlled trials (RCTs), cohort studies, case–control studies, and quasi-randomized studies among people ≥18 years were eligible. We searched MEDLINE, Embase, and Cochrane Central Registry (inception to August 2023). Two independent reviewers performed screening and extracted data. Quality assessment was performed by one author and verified by another. We summarized results narratively, performed meta-analysis for a subset of studies, and used GRADE to assess certainty of evidence. We summarized findings in the subgroup of persons ≥75 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We retrieved 8369 titles/abstracts; 37 reports from 36 studies were eligible. This comprised 35 non-randomized studies (<i>n</i> = 1,708,684) and 1 RCT (<i>n</i> = 381). The 1 RCT was conducted among persons with life expectancy &lt;1 year and showed there is probably no difference in 60-day mortality (risk difference = 3.5%, 90% CI −3.5 to 10.5) for statin discontinuation compared with continuation. Non-randomized studies varied in terms of population and setting, but consistently suggested that statin discontinuation might be associated with a relative increased risk of mortality (hazard ratio (HR) 1.92, 95% CI 1.52 to 2.44, nine studies), CV mortality (HR 1.63, 95% CI 1.27 to 2.10, five reports), and CV events (HR 1.31, 95% CI 1.23 to 1.39, eight reports). Findings in people ≥75 years were consistent with main results. There was a high degree of uncertainty in findings from non-randomized studies due to methodological limitations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Statin discontinuation does not appear to affect short-term mortality near end-of-life based on one RCT. Outside of this population, findings from non-randomized studies consistently suggested statin discontinuation may be associated with worse outcomes, though this is uncertain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3567-3587"},"PeriodicalIF":4.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763647","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":"The association between clinically evaluated cognitive function and oral health in Norwegian older adults: The HUNT Study","authors":"Marion Denos PhD,&nbsp;Ernest Obeng Asante MSc,&nbsp;Rannveig Sakshaug Eldholm MD, PhD,&nbsp;Geir Selbæk MD, PhD,&nbsp;Håvard Kjesbu Skjellegrind MD, PhD,&nbsp;Xiao-Mei Mai MD, PhD,&nbsp;Yue Chen MD, PhD,&nbsp;Yi-Qian Sun MD, PhD","doi":"10.1111/jgs.19103","DOIUrl":"10.1111/jgs.19103","url":null,"abstract":"&lt;p&gt;Poor oral health and neurocognitive disorders (NCDs) are both important public health challenges in the general older population.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Older adults with NCDs may have poorer oral health due to decline in self-care, medication side effects, and lower dietary quality.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Yet, the association between cognitive function and oral health is unclear.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Wu et al. advocated a standardized assessment of oral health and cognitive states to better evaluate their potential associations.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The aim of this cross-sectional study was to explore the relationship between cognitive function and oral health, both thoroughly assessed by clinical experts, in a home-dwelling Norwegian older adult population.&lt;/p&gt;&lt;p&gt;Our study population, derived from the Trøndelag Health Study Survey 4 (HUNT4), included 633 participants aged 70 years or older who attended both the HUNT4 Oral Health Study and HUNT4 70+.&lt;span&gt;&lt;sup&gt;5-7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Clinical experts assessed the cognitive function of HUNT4 70+ participants after a comprehensive clinical evaluation, following the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In the current study, mild cognitive impairment (MCI) and dementia were diagnosed and collectively categorized as NCDs.&lt;/p&gt;&lt;p&gt;Participants in the HUNT4 Oral Health Study underwent clinical and radiographic examinations conducted by trained and calibrated dentists. Decayed, missing, and filled teeth (DMFT) were calculated using the clinical and radiographic caries registration of dental status.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Decayed teeth were caries lesions confined in dentine (grades 3–5), secondary caries in dentine, and root caries with cavitation. Severe periodontitis was defined as periodontal Stage 3 or 4 based on radiographic bone loss and periodontal stage assessments.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The relationships between cognitive function and the number of decayed teeth, DMFT or natural teeth were assessed using negative binomial regression models, computing ratios of means (RMs) with 95% confidence intervals (CIs). The relationship between cognitive function and the prevalence of severe periodontitis was estimated using Poisson regression with robust error variance, providing prevalence ratios (PRs) with 95% CIs. Covariates such as age, sex, education, marital status, body mass index (BMI), smoking status, and alcohol consumption were considered potential confounders based on the literature.&lt;span&gt;&lt;sup&gt;4, 8, 9&lt;/sup&gt;&lt;/span&gt; All statistical analyses were performed with STATA/MP 18.&lt;/p&gt;&lt;p&gt;Table 1 describes the baseline characteristics of the study population overall and by cognitive function (normal and NCDs). As shown in Figure 1A, the mean number of decayed teeth was higher for participants with NCDs compared to those with normal cognitive function (1.8 vs. 1.5). NCDs were associated with a 19% inc","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3590-3593"},"PeriodicalIF":4.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763649","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":"The effect of anxiety on all-cause dementia: A longitudinal analysis from the Hunter Community Study","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.19078","DOIUrl":"10.1111/jgs.19078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anxiety is common, however, the effect of chronicity of anxiety on dementia has not been explored. This study aims to assess the longitudinal relationship between chronic versus resolved versus new onset anxiety, and all-cause dementia risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 2132 participants with mean age 76 years from the Hunter Community Study were recruited. Anxiety was measured using Kessler Psychological Distress Scale (K10). Dementia was defined as per International Classification of Disease—10 codes. The Fine–Gray subdistribution hazard model was computed to assess dementia risk, while adjusting for the competing risk of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Chronic anxiety and new onset anxiety at follow-up were associated with all-cause dementia risk (HR 2.80, 95% CI 1.35–5.72 and HR 3.20, 95% CI 1.40–7.45 respectively) with an average time to dementia diagnosis of 10 years (SD = 1.7) whereas resolved anxiety was not. In subgroup analyses, these results were driven particularly by chronic and new anxiety among participants below the age of 70 years (HR 4.58, 95% CI 01.12–18.81 and HR 7.21, 95%CI 1.86–28.02 respectively). Sensitivity analyses imputing missing data and addressing reverse causation gave very similar results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Chronic and new anxiety were associated with increased risk of all-cause dementia, and this association was significant in those 70 years and younger. However, the resolved anxiety at follow-up reduced the risk, similar to that of the non-exposed group. These results suggest that timely management of anxiety may be a viable strategy in reducing the risk of dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3327-3334"},"PeriodicalIF":4.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753710","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":"The structure and process of physiotherapy services for nursing home residents with dementia in the Netherlands","authors":"Dennis Boer MSc,&nbsp;Shanty Sterke PhD,&nbsp;Charlotte Schmidt PhD,&nbsp;Thea Vliet Vlieland PhD","doi":"10.1111/jgs.19084","DOIUrl":"10.1111/jgs.19084","url":null,"abstract":"&lt;p&gt;In addition to memory loss, dementia poses significant healthcare challenges, including diminished physical function and increased care dependency.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; As care dependency grows, the transition from residential to nursing home care may become inevitable.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Physiotherapy services are frequently employed to maintain or improve the physical functioning of nursing home residents with dementia.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Although physiotherapy is a prevalent therapeutic modality, previous literature indicates significant variation in its employment.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; This variation can potentially result in suboptimal treatment. To reduce this variation, calls for guidelines on physiotherapy for nursing home residents with dementia have been made.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; Before guidelines can be developed, more knowledge about factors that cause variation is necessary. The aim of this study was therefore to explore the presence of practice variation in physiotherapy services for nursing home residents with dementia in the Netherlands.&lt;/p&gt;&lt;p&gt;We used a cross-sectional study design utilizing an online survey to collect data from physiotherapists working with nursing home residents with dementia. We aimed to include 10% of the approximately 830 Dutch nursing homes which have facilities for people with dementia, with one responding physiotherapist per nursing home. In the Netherlands, nursing home care is integrated into the national insurance scheme. The costs associated with physiotherapy treatment are encompassed within standardized care packages, which are uniform across care providers in the country. Physiotherapists were recruited from November 2022 to March 2023. To prevent repetitive submissions from the same nursing home, the four digits from the postal code were gathered. In case of repetitive submissions, either the survey with the largest number of completed questions, or in case completion was similar, the last received survey was included.&lt;/p&gt;&lt;p&gt;The survey was based on the healthcare framework by Donabedian,&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; describing the quality of care by its “structure,” “process,” and “outcome”, and was created by two authors (DB, SS) experienced in physiotherapy for nursing home residents with dementia. Survey data output was analyzed in SPSS version 25 (Armonk, NY: IBM Corp.). Descriptive statistics were calculated for all variables. The practice variation thresholds were set in a consensus meeting at &gt;75% and &lt;25% for data presented in percentages. For data expressed as mean and standard deviation the coefficient of variation was calculated, and the thresholds COV &gt;0.8 as variation, COV &gt;0.5 and ≤0.8 as possible variation, and &lt;0.5 as no variation was used.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;A total of 109 physiotherapists representing 109 nursing homes participated with a median age of 36 years (range 30–53) and a median working experience 10 years (range","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3265-3270"},"PeriodicalIF":4.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753711","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}