Journal of the American Geriatrics Society最新文献

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

{"title":"Towards a Balanced View of Benefits and Harms in Deprescribing Trials","authors":"Kenneth Lam, Tyson Garfield, Timothy S. Anderson","doi":"10.1111/jgs.19473","DOIUrl":"10.1111/jgs.19473","url":null,"abstract":"<p>A friend's nonagenarian mother recently experienced a probable adverse drug withdrawal event (ADWE). She had increasing weakness, exhaustion, and falls. Her new geriatrician, following a “less is more” philosophy, raised concerns about hypotension and frailty and enthusiastically stopped several medications because of concerns polypharmacy was causing her symptoms. The geriatrician deprescribed several antihypertensives and a diuretic. She also deprescribed dronedarone—an anti-arrhythmic used for rhythm control in atrial fibrillation. Within weeks, the friend's mother became weaker and more tired rather than less. She developed a rapid heart rate, leg swelling, and shortness of breath. She was readmitted to the hospital in atrial fibrillation and decompensated heart failure, and after unsuccessful attempts at diuresis as an inpatient, she unfortunately died.</p><p>ADWEs are (i) physiological withdrawal reactions (e.g., flu-like symptoms when stopping serotonergic antidepressants) or (ii) the re-emergence of symptoms of underlying disease (e.g., depressive symptoms) when discontinuing or reducing the dose of a drug [<span>1</span>]. In this issue of <i>JAGS</i>, Lee et al. [<span>2</span>] raise concerns that we are inadequately monitoring for ADWEs in deprescribing research. In their systematic review of 139 randomized controlled trials (RCTs) of deprescribing interventions, they found less than 1 in 10 reported on ADWEs. Of the few studies reporting ADWEs, they found ADWEs were slightly more likely to occur in participants receiving a deprescribing intervention. Their results suggest we may be systematically overlooking and underestimating the harms of deprescribing.</p><p>Why this oversight in research and, in our case, clinical practice? One possibility is the natural bias to believe that what we do helps. This also happens in drug initiation trials, where it is well documented that researchers neglect harms too [<span>3</span>]. This bias motivated recommendations by the CONSORT group (Consolidated Standards of Reporting Trials) in 2004 for reporting harms in clinical trials [<span>4</span>]. They suggested researchers explicitly declare if they are studying (i) benefits <i>and</i> harms or (ii) benefits <i>only</i>. If studying harms, researchers should explicitly describe how data on harms are collected, define and classify expected versus unexpected harms by severity, and consider whether a study is powered to detect a meaningful difference. The statement also recommended researchers try to determine if participants left the study because of adverse events (AEs); for deprescribing trials, this would mean collecting data on whether participants restarted medications and why. In other words, proof that deprescribing is safe requires that researchers consider, collect, and analyze data about possible harms with the same rigor as they treat possible benefits.</p><p>Yet another explanation for this oversight is that we lack clarity in how we","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1671-1673"},"PeriodicalIF":4.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19473","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035116","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":"Managing Hypercholesterolemia in Adults Older Than 75 years Without a History of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From the National Lipid Association and the American Geriatrics Society","authors":"Vera Bittner,&nbsp;Sunny A. Linnebur,&nbsp;Dave L. Dixon,&nbsp;Daniel E. Forman,&nbsp;Ariel R. Green,&nbsp;Terry A. Jacobson,&nbsp;Ariela R. Orkaby,&nbsp;Joseph J. Saseen,&nbsp;Salim S. Virani","doi":"10.1111/jgs.19398","DOIUrl":"10.1111/jgs.19398","url":null,"abstract":"<p>The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated LDL-cholesterol and non-HDL-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75 years and do not adjust for co-morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL-cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available data suggest that statin therapy in older primary prevention patients may reduce atherosclerotic cardiovascular events and that benefits from lipid-lowering with statins outweigh potential risks such as statin-associated muscle symptoms and incident Type 2 diabetes mellitus. While some evidence suggests the possibility that statins may be associated with incident cognitive impairment in older adults, a preponderance of literature indicates neutral or even protective statin-related cognitive effects. Shared decision-making which is recommended for all patients when considering statin therapy is particularly important in older patients. Randomized clinical trial data evaluating the use of non-statin lipid-lowering therapy in older patients are sparse. Deprescribing of lipid-lowering agents may be appropriate for select patients older than 75 years with life-limiting diseases. Finally, a patient-centered approach should be taken when considering primary prevention strategies for older adults.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1674-1696"},"PeriodicalIF":4.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19398","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029859","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":"Editorial for “Managing Hypercholesterolemia in Adults Older Than 75 Years Without a History of Atherosclerotic Cardiovascular Disease. An Expert Clinical Consensus From the National Lipid Association and American Geriatrics Society”","authors":"Sunny A. Linnebur,&nbsp;Vera Bittner","doi":"10.1111/jgs.19452","DOIUrl":"10.1111/jgs.19452","url":null,"abstract":"&lt;p&gt;Since the first statin was approved by the Food and Drug Administration in 1987, low-density lipoprotein cholesterol (LDL-C)-lowering drugs have been some of the most highly prescribed drugs in the US. In 2018, 25.2 million Medicare beneficiaries were taking LDL-C-lowering therapies, with the associated Medicare expenditure at $3.3 billion [&lt;span&gt;1&lt;/span&gt;]. Randomized controlled trials of statin therapy demonstrate reductions in atherosclerotic cardiovascular disease (ASCVD) in a broad population of individuals ranging from intermediate risk to very high risk individuals in both primary and secondary prevention and across a broad range of baseline low-density lipoprotein cholesterol levels [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;However, the management of hypercholesterolemia in adults over 75 years of age presents unique challenges, particularly in the absence of established ASCVD. The Expert Clinical Consensus statement, a collaborative effort from the National Lipid Association (NLA) and the American Geriatrics Society (AGS), addresses these complexities by combining expertise from leading professionals in clinical lipidology, geriatrics, cardiology, and pharmacology [&lt;span&gt;3&lt;/span&gt;]. The NLA, a prominent authority on lipid and cardiovascular health, and the AGS, an organization dedicated to improving the health and quality of life for older adults, have aligned their efforts to ensure that lipid management for adults over 75 years of age is personalized, evidence-based, and mindful of the diverse needs of our aging population.&lt;/p&gt;&lt;p&gt;This consensus is of significant importance to clinicians involved in the care of older adults, as it provides evidence-based guidance tailored specifically to those over 75 years without ASCVD. Such patients face unique physiological and clinical considerations, including frailty, comorbidities, and varying life expectancies. Given the paucity of randomized controlled trials specifically in adults over 75 years without ASCVD [&lt;span&gt;4&lt;/span&gt;], assessment of cardiovascular risk and treatment of hypercholesterolemia may not be straightforward for clinicians. This consensus document emphasizes a patient-centered approach, weighing the benefits of lipid-lowering therapies against possible adverse effects and aligning treatment decisions with individual patient goals and values.&lt;/p&gt;&lt;p&gt;Clinicians will find practical insights on assessing ASCVD risk in older adults, incorporating tools like coronary artery calcium (CAC) scoring to refine treatment decisions. Consistent with the principles outlined by the AGS for managing older adults with multimorbidity, the document stresses the importance of considering patients' individual preferences, comorbidities, and overall life context in guiding treatment [&lt;span&gt;5&lt;/span&gt;]. Recommendations focus mostly on the initiation of statins, given less evidence for non-statin lipid lowering options in this population, along with monitoring for potential statin-associated risks and consideration for de","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1663-1664"},"PeriodicalIF":4.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19452","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055306","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":"Incidence of Frailty, Dementia, and Disability Among Community-Living Older Americans According to County-Level Disadvantage","authors":"Yi Wang,&nbsp;Emma X. Zang,&nbsp;Kendra Davis-Plourde,&nbsp;Brent Vander Wyk,&nbsp;Thomas M. Gill,&nbsp;Robert D. Becher","doi":"10.1111/jgs.19465","DOIUrl":"10.1111/jgs.19465","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>County-level contextual disadvantage is a novel social determinant of health (SDOH) for older persons. No prior study has evaluated the national incidence of geriatric conditions according to county-level contextual disadvantage among older persons. Our objective was to estimate the incidence of frailty, probable dementia, and disability over a 5-year period on the basis of county-level contextual disadvantage among community-living older Americans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, nationally representative longitudinal study used data from the 2015 cohort of the National Health and Aging Trends Study (NHATS), linked to various publicly available, geographically based contextual datasets. County-level disadvantage was assessed using the Geriatric Index of County-Level Multi-Dimensional Contextual Disadvantage (GERi-County), which included nine contextual indicators from these linked datasets. Data on frailty, probable dementia, and activities of daily living (ADL) disability were obtained from the NHATS annual assessments (2015–2020).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Totally 7499 participants were included in the analysis, representing 40,728,543 community-living older Americans. The 5-year incidence rates per 1000 person-years were significantly higher in the disadvantaged compared to the non-disadvantaged counties: 52.8 (95% confidence interval (CI), 41.6–64.0) versus 40.3 (95% CI, 37.2–43.3) for frailty; 29.9 (95% CI, 25.4–34.3) versus 21.2 (95% CI, 19.0–23.4) for probable dementia; and 78.1 (95% CI, 70.2–86.0) versus 62.5 (95% CI, 58.2–66.8) for ADL disability. For participants who lived versus did not live in disadvantaged counties, the age- and sex-adjusted HRs were 1.38 (95% CI, 1.08–1.75) for frailty, 1.53 (95% CI, 1.25–1.86) for probable dementia, and 1.30 (95% CI, 1.13–1.49) for ADL disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Community-living older Americans who reside in disadvantaged counties have a higher incidence of frailty, probable dementia, and ADL disability over a 5-year follow-up period compared to their non-disadvantaged counterparts. Findings underscore the vital, underappreciated role that county-level social contextual disadvantage plays on clinically meaningful outcomes in older persons in the U.S.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1847-1856"},"PeriodicalIF":4.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

{"title":"Home-Based Rehabilitation After Transcatheter Aortic Valve Replacement (REHAB-TAVR): A Pilot Randomized Controlled Trial","authors":"Sandra M. Shi,&nbsp;Faith-Anne Rapley,&nbsp;Heather Margulis,&nbsp;Roger J. Laham,&nbsp;Kimberly Guibone,&nbsp;Edward Percy,&nbsp;Tsuyoshi Kaneko,&nbsp;Kuan-Yuan Wang,&nbsp;Dae Hyun Kim","doi":"10.1111/jgs.19456","DOIUrl":"10.1111/jgs.19456","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The benefit of early cardiac rehabilitation after transcatheter aortic valve replacement (TAVR) is not well established. This pilot study evaluated the feasibility and short-term effects of a home-based exercise program, with or without cognitive-behavioral intervention (CBI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We randomized 51 patients (mean age, 83.9 years; 19 women) to a home-based exercise program with CBI (Group A; <i>n</i> = 18) or without CBI (Group B; <i>n</i> = 15), or telephone-based education control (Group C; <i>n</i> = 18). The exercise program focusing on balance, flexibility, strength, and endurance began within 7 days post-discharge and was delivered once weekly by a physical therapist for 8 weeks. CBI included discussions on exercise benefits and barriers, goal setting, detailed exercise planning, and a weekly cash adherence incentive. The primary outcome was a disability score (range: 0–22; higher scores indicate greater disability) at 8 weeks. Secondary outcomes included the Short Physical Performance Battery (SPPB) (range: 0–12; higher scores indicate better function), self-efficacy, and outcome expectation scores. Feasibility outcomes included adherence and drop-out rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen participants (83.3%) in Group A, 10 (58.8%) in Group B, and 10 (52.6%) in Group C completed ≥ 5 of the eight assigned weekly sessions (<i>p</i> = 0.196). Two participants in each group were lost to follow-up. At 8 weeks, the home-based exercise groups (Group A and B combined) demonstrated lower disability scores (mean [SE]: 2.6 [0.3] vs. 4.5 [0.5]; <i>p</i> = 0.042) and higher SPPB scores (9.5 [0.6] vs. 6.5 [0.8]; <i>p</i> = 0.003) compared with the education group (Group C). Group A had lower disability scores than Group B (2.1 [0.4] vs. 3.4 [0.5]; <i>p</i> = 0.047), with no differences in self-efficacy and outcome expectation scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An early, home-based, multi-domain exercise program appears feasible and may prevent disability and improve physical function in older adults after TAVR. Adding CBI, including a modest cash incentive, showed trends toward improved adherence and reduced disability.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> NCT02805309</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1836-1846"},"PeriodicalIF":4.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766203","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":"Impact of Discontinuation of Fall-Risk-Increasing Drugs on Falls in Multimorbid Older Patients With Polypharmacy","authors":"Namiko A. Goto,&nbsp;Dayna A. M. van Heel,&nbsp;Lauren Dautzenberg,&nbsp;François-Xavier Sibille,&nbsp;Emma Jennings,&nbsp;Douglas C. Bauer,&nbsp;Carole E. Aubert,&nbsp;Anne Spinewine,&nbsp;Nicolas Rodondi,&nbsp;Huiberdina L. Koek,&nbsp;Mariëlle H. Emmelot-Vonk,&nbsp;Wilma Knol","doi":"10.1111/jgs.19460","DOIUrl":"10.1111/jgs.19460","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Falls are a major concern in the older population. An important cause of falls is fall-risk-increasing drugs (FRID). However, it is not known if the discontinuation of FRID leads to a reduction of falls. Therefore, the aim of this study was to assess the association between discontinuation of FRID and the occurrence of falls and recurrent falls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included adults aged ≥ 70 years with multimorbidity and polypharmacy who were enrolled in a cluster randomized controlled trial assessing hospital pharmacotherapy optimization (OPERAM). Participants who were using FRID at baseline, were alive after 2 months of follow-up, and provided data on fall occurrence were included. FRID discontinuation was defined as discontinuation of ≥ 1 FRID within 2 months after inclusion, including the following groups: antidepressants, antiepileptics, antihistamines, antipsychotics, benzodiazepines and z-drugs, diuretics, opioids, and alpha-blockers. Multivariable cox regression analysis, using inverse probability weighting, was performed to assess the association between FRID discontinuation and the occurrence of falls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our analysis included 1546 participants, with a median age of 79 years (IQR 74–84) and 45% female. After 2 months of follow-up, FRID were discontinued in 878 (57%) participants. Among all participants, 378 (24%) experienced a fall within 1 year of follow-up, with 137 (9%) of the participants experiencing two or more falls, and 199 (13%) participants experiencing a serious fall. No association was found between FRID discontinuation and the occurrence of falls. In a subgroup of participants with a previous fall, discontinuation of antipsychotics was associated with a lower occurrence of falls (HR 0.32 [CI 0.12–0.84], <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In multimorbid older patients using FRID, falls are highly prevalent. No association was found between discontinuation of FRID and the risk of falls, except for the discontinuation of antipsychotics in patients who experienced a previous fall.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1827-1835"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19460","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

{"title":"Criteria to Report Adverse Drug Withdrawal Events in Clinical Trials: A Systematic Review","authors":"Jimin J. Lee,&nbsp;Émilie Bortolussi-Courval,&nbsp;Eva Filosa,&nbsp;Soham Rej,&nbsp;Claire Godard-Sebillote,&nbsp;Robyn Tamblyn,&nbsp;Todd C. Lee,&nbsp;Emily G. McDonald","doi":"10.1111/jgs.19457","DOIUrl":"10.1111/jgs.19457","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Polypharmacy is a major risk factor for adverse drug events (ADEs), which are a common cause of hospitalization, especially among older adults. Deprescribing is a promising strategy to prevent ADEs; however, clinicians may hesitate to deprescribe for fear of causing adverse drug withdrawal events (ADWEs). Collectively, ADWEs are the re-emergence of symptoms or a disease state due to the discontinuation of a medication. Although capturing ADWEs is critical to understanding the complications that might arise from deprescribing, these events may not be routinely or systematically captured in clinical trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to determine the frequency of ADWE reporting, compare the strengths and limitations of different approaches, and compare the rates of the number of ADWEs detected across trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The search strategy was developed with a research librarian, and studies were identified using Ovid Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 2, 2024. We included all randomized controlled trials testing a deprescribing intervention in older adults (mean or median age ≥ 65 years) and analyzed a subsample of the studies reporting ADWEs as an outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 139 eligible studies that were identified, only 12 reported an ADWE. These studies utilized 6 approaches to capture ADWEs: Naranjo ADWE Probability Scale; clinical monitoring for specific withdrawal symptoms; identification through ICD-10 codes; identification of ADWEs as a subset of confirmed ADEs; patient/caregiver self-report; and clinical judgment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Results confirmed that few deprescribing studies capture ADWEs and there is a lack of standardized reporting. A harmonized approach to capturing ADWEs with specific criteria could ensure more consistent results in deprescribing trials, improve our understanding of this important outcome, and facilitate future meta-analyses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1918-1928"},"PeriodicalIF":4.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19457","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733830","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}