Journal of the American Geriatrics Society最新文献

{"title":"Utilization of Hospice and Palliative Care Among Patients With Mental Illness: A Retrospective Cohort Study","authors":"Sean O'Mahony,&nbsp;Utpol Das,&nbsp;Yuanyi Zhang,&nbsp;Anirudh S. Babu,&nbsp;Mukaila A. Raji,&nbsp;James Gerhart,&nbsp;Yong-Fang Kuo","doi":"10.1111/jgs.70583","DOIUrl":"10.1111/jgs.70583","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individuals with mental illness (MI) experience premature mortality and health disparities, yet little is known about their access to hospice and palliative care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine hospice enrollment, timing, length of stay, and palliative care utilization among Medicare decedents with mental illnesses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study using 100% Texas Medicare claims data (2016–2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Texas Medicare beneficiaries aged ≥ 20 years who died between 2016 and 2022, with chronic life-limiting medical conditions identified 13–24 months prior to death (<i>N</i> = 288,566).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Outcomes included hospice enrollment, hospice length of stay, timing of first hospice enrollment, and palliative care receipt. Mental illnesses were identified using ICD-10 codes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 288,566 decedents, 120,695 (41.8%) had at least one mental health diagnosis 13–24 months prior to death; the remaining 167,871 (58.2%) had no mental health diagnosis and constituted the comparison group. Compared with controls, beneficiaries with schizophrenia and related psychotic disorders (SRPDs) had longer hospice stays (median 43 vs. 16 days), higher adjusted hospice length of stay (adjusted coefficient 0.26 [95% CI, 0.21–0.31]), and a temporally heterogenous enrollment pattern: a lower likelihood of enrollment within 180 days of death (aHR, 0.88 [95% CI, 0.85–0.91]) but a higher likelihood of enrollment more than 300 days before death (aHR, 2.74 [95% CI, 2.37–3.17]). Neurocognitive conditions were the primary hospice diagnosis for 55.1% of patients with SRPDs versus 22.8% of controls. Despite longer hospice stay, patients with SRPDs had lower odds of receiving a palliative care consultation (aOR, 0.90 [95% CI, 0.85–0.96]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mental illnesses were associated with complex hospice utilization patterns characterized by longer length-of-stay, higher likelihood of enrollment far from death, lower likelihood of enrollment within 180 days before death, and lower palliative care consultation use in some groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2628-2639"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427755","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":"Hearing Aid Use Attenuates the Association Between Hearing Loss and Frailty: A 2003–2018 NHANES Cross Sectional Analysis","authors":"Cora Leigh White,&nbsp;Suryaa Gupta,&nbsp;Sarah B. Andrea,&nbsp;Deborah Karasek,&nbsp;Lisa N. Miura,&nbsp;Kelly M. Reavis","doi":"10.1111/jgs.70581","DOIUrl":"10.1111/jgs.70581","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the association between objectively measured hearing ability and frailty using the accumulation of deficits model in adults aged ≥ 65 years and assess if the strength of this association differs by sex and hearing aid use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NHANES data pooled from six cycles (2003–2018) formed the analytic sample (<i>n</i> = 2644). Hearing ability was examined continuously using an audiometrically determined hearing threshold. Frailty was defined using a 52-item frailty index (Rockwood's model) and was treated continuously and categorically. Analysis consisted of adjusted linear regression and multinomial logistic regression models. We tested for effect measure modification by sex and hearing aid use, with the latter analysis limited to those with at least mild hearing loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The weighted prevalence of frailty was 22.5%. A modest association between hearing ability and frailty was observed in covariate adjusted models. Each 10 dB (dB) increase in hearing threshold (poorer hearing) was associated with 24% higher odds of being frail compared to being robust (odds ratio 1.24, 95% confidence interval (CI) 1.14, 1.34). A 10 dB increase in hearing threshold was associated with a 6.9% increase in frailty index score (95% CI: 1.8, 12.2). Sex did not modify the observed association (<i>p</i> = 0.436), but hearing aid use did (<i>p</i> = 0.031). For non-hearing aid users, each 10 dB increase in hearing threshold corresponded to a 17.9% (95% CI: 1.9, 36.5%) higher frailty index score. For hearing aid users, the corollary result was null at −4.2% (95% CI: −10.1, 2.2%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrated a positive association between hearing threshold and frailty, such that poorer hearing (higher thresholds) was associated with greater frailty. Hearing aid use attenuated this association, highlighting the need for better access to hearing care and informing the development of frailty screening tools.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2619-2627"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414362","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":"Why We Continue to Advance the Science of Advance Care Planning","authors":"Ryan D. McMahan,&nbsp;Jasmine Santoyo-Olsson","doi":"10.1111/jgs.70536","DOIUrl":"10.1111/jgs.70536","url":null,"abstract":"&lt;p&gt;&lt;i&gt;Reports of the death of advance care planning (ACP) are greatly exaggerated&lt;/i&gt;:&lt;/p&gt;&lt;p&gt;For decades, ACP has been both championed and criticized: praised as a cornerstone of patient-centered care, yet questioned for its limited impact on end-of-life outcomes. Among ACP's most visible tools, advance directives have been extensively studied, but their real-world effectiveness remains contested [&lt;span&gt;1&lt;/span&gt;]. As ACP has evolved from a document-centered activity to a longitudinal, communication-based process of care planning across the life course, much of the literature remains anchored in the measurement of advance directive completion [&lt;span&gt;2&lt;/span&gt;]. This disconnect between how ACP is defined and how it is studied continues to shape the conclusions we draw about its effectiveness.&lt;/p&gt;&lt;p&gt;Completion of advance directives has become one of the most frequently studied outcomes in ACP research, in part because it is so easy to measure. It is discrete, documentable, and increasingly extractable from electronic health records (EHRs). Yet this convenience is also a limitation. We have known for some time that advance directives alone do not reliably improve end-of-life care or ensure that care aligns with patient preferences [&lt;span&gt;1&lt;/span&gt;]. Continued emphasis on advance directive completion risks prioritizing what is easy to measure over what is meaningful to patients and families. This raises a fundamental question: after nearly four decades of research, do we need more advance directive studies, or are we still asking the wrong questions?&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt;, Scerpella and colleagues present a secondary analysis of a cohort study examining whether EHR-documented advance directives are associated with end-of-life outcomes among older adults receiving primary care. Their findings suggest that patients with an advance directive documented in the EHR at least 6 months prior to death were less likely to receive potentially burdensome care and less likely to die in the hospital.&lt;/p&gt;&lt;p&gt;Using a retrospective cohort of 2850 decedents from the SHARING Choices pragmatic trial, the authors found that early EHR-documented advance directives were associated with lower rates of intensive procedures near the end of life and reduced in-hospital death, even after adjustment for clinical and demographic factors. Importantly, these associations were not uniform across subgroups, with attenuated or absent effects among patients with dementia and among Black patients. Those subgroup findings matter because they suggest that the utility of documented preferences is neither universal nor equitably distributed.&lt;/p&gt;&lt;p&gt;These findings stand in contrast to the parent SHARING Choices trial, in which the intervention increased advance directive documentation but was also associated with higher rates of potentially burdensome end-of-life care [&lt;span&gt;3, 4&lt;/span&gt;]. The contrast between the parent trial and this cohort ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2495-2497"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274360","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":"Michael Fang,&nbsp;Natalie Rula Daya,&nbsp;Yein Jeon,&nbsp;Justin B. Echouffo-Tcheugui,&nbsp;B. Gwen Windham,&nbsp;Scott Zeger,&nbsp;Elizabeth Selvin","doi":"10.1111/jgs.70701","DOIUrl":"https://doi.org/10.1111/jgs.70701","url":null,"abstract":"<p><b>Cover caption</b>: Timing of percent time spent in Level 1 hypoglycemia over a 24-hour period by high-risk medication use: Blue panel A high risk medication (insulin or sulfonylurea); Red panel B no high-risk medication. The solid line indicates the median time spent in hypoglycemia and the shading indicates the 25th to 75th percentiles. See the related article by Fang et al., pages 2530–2537.\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":"74 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70701","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007494","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":"Outcomes for Frail Dialysis Patients Not Referred for Transplantation: A Cohort Study","authors":"Joshua Goodwin,&nbsp;Jordan Thorne,&nbsp;Amanda Vinson,&nbsp;David Clark,&nbsp;Bryce Kiberd,&nbsp;Micheal Sun,&nbsp;Karthik Tennankore","doi":"10.1111/jgs.70496","DOIUrl":"10.1111/jgs.70496","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty is highly prevalent in kidney failure, but it is unclear whether frailty impacts health outcomes for those initiating dialysis who are not referred for transplantation. Our objective was to determine if frailty is associated with death or development of a permanent contraindication to transplantation among eligible non-referred patients following dialysis initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed all incident adult dialysis patients from January 2009 to December 2018 (last follow-up December 2020) who lacked an identifiable absolute contraindication to transplant, but were not referred to our institution. Frailty was captured using the Clinical Frailty Scale (CFS) and categorized by severity. Time to death or development of a permanent contraindication to transplantation was analyzed using an adjusted Cox Proportional Hazards Regression model. Associations with the composite outcome were reported using hazard ratios (HR) and 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 401 patients were included, 14% had a CFS of 6–8; 90% of patients with CFS 6–8 either died or developed a permanent contraindication to transplant and none received a transplant during follow-up. Among patients with CFS 6–8, 27% died or developed a permanent contraindication at 1 year; increasing to 81% by 5 years. After adjusting for patient characteristics, frailty was associated with the composite outcome (CFS 4–5: HR 1.71, 95% CI 1.17–2.21; CFS 6–8: HR 2.34, 95% CI 1.42–3.37).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among patients not referred for transplantation, a higher frailty severity was associated with death or development of a contraindication, particularly after the first year following dialysis initiation. Future studies should explore whether alternative approaches to the timing of transplant referral in frail patients are associated with improved outcomes and focus on novel strategies to reduce frailty severity or better support frail patients who may otherwise be eligible for transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2520-2529"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70496","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059281","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":"Clin-STAR Corner: Practice Changing Advances at the Interface of Artificial Intelligence/Machine Learning and Geriatrics","authors":"Tue T. Te,&nbsp;Alex A. T. Bui,&nbsp;William Speier,&nbsp;Constance H. Fung","doi":"10.1111/jgs.70527","DOIUrl":"10.1111/jgs.70527","url":null,"abstract":"<p>Artificial intelligence (AI) methods, including machine learning (ML), are transforming healthcare by enabling personalized interventions that integrate multimodal data to support rehabilitation, preventive care, and remote monitoring. Despite their broad potential, older adults remain underrepresented in model development, raising concerns about bias and limited generalizability. As AI/ML adoption expands, it is essential to critically appraise emerging tools to ensure ethical, equitable, person-centered implementation in aging populations and long-term randomized evaluations. A structured MEDLINE search identified randomized controlled trials (RCTs) published between January 2023 and December 2025 that evaluated AI/ML-based interventions in adults ≥ 65 years. Of 31 records identified, 19 underwent abstract screening, seven underwent full-text assessment, and four articles were identified as meeting all criteria for inclusion, which focused on scalability, clinical impact, and methodological rigor. Across postoperative rehabilitation and preventive care, AI/ML interventions demonstrated meaningful clinical benefits. Transformative applications of AI/ML described robotic systems quantifying weight-bearing, algorithm-guided paired rehabilitation interventions, paired exercises in geriatric hip fracture rehabilitation, smartphone platforms delivering continuously personalized exercise programs, and conversational chatbots providing tailored vaccine counseling. The included RCTs show that AI-driven interventions can enhance physical recovery, support psychosocial well-being, and improve uptake of preventive measures compared with conventional approaches. Key considerations for future implementation include digital health literacy, long-term follow-up, and potential bias arising from healthier or more motivated study populations. As evidence grows, geriatric innovation must prioritize safety, ethics, and equitable access to ensure that technological precision enhances, rather than replaces, person-centered care.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2501-2510"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70527","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007786","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":"A Cohort Study of Advance Directives in Electronic Health Records and End-of-Life Outcomes","authors":"Danny L. Scerpella,&nbsp;David L. Roth,&nbsp;Erin R. Giovannetti,&nbsp;Jennifer L. Wolff","doi":"10.1111/jgs.70458","DOIUrl":"10.1111/jgs.70458","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Advance directives (ADs) are intended to document patient preferences for future care, including end-of-life (EOL). Knowledge of the impact of electronic health record (EHR)-documented ADs on actual care experiences is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants and Setting</h3>\u0000 \u0000 <p>This is a retrospective cohort analysis of 2850 patients aged <i>≥</i> 65 years who died during a cluster-randomized trial of the impact of advance care planning (ACP). Subgroups included gender, marital status, patient portal access, dementia, and race. A total of 553 (19.4%) of the deceased patients had an EHR-documented AD 6 months prior to death. The setting was 51 primary care practices in two health systems in the Maryland and Washington, DC areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To examine the association between EHR-documented ADs and EOL experiences, a retrospective cohort study of older adults who died between September 2020 and October 2023 was conducted. Multilevel logistic regression models analyzed whether an EHR-documented AD at least 6 months before death was associated with potentially burdensome EOL care in the last 6 months of life and in-hospital death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 553 decedents who had an EHR-documented AD at least six months before death (mean [SD] age 82.5 (8.8)); 311 were women [56.2%]; 203 [36.7%] had a diagnosis of dementia, 128 (23.1%) were Black, and 400 (72.3%) were White [Correction added on 18 June 2026, after first online publication: The preceding sentence has been amended in this version.]. Patients with an AD in the EHR were less likely to experience potentially burdensome EOL care (110 (19.9%) vs. 616 (26.8%); aOR = 0.75) and in-hospital death (128 (23.2%) vs. 738 (32.1%); aOR = 0.69). Effects persisted both before and after adjusting for demographics, comorbidities, healthcare utilization, patient portal access, organization, and whether the clinic was randomized to the ACP intervention or control. Significant associations were observed in married patients and those with portal access, but not among patients with dementia or Black race.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this cohort study, EHR-documented ADs were associated with reduced potentially burdensome EOL care and a lower likelihood of in-hospital death.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2538-2545"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978158","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":"Changes in Life Expectancy After Stroke Among Americans Aged 50 and Above by Sex, 1996–2018","authors":"Octavio Bramajo,&nbsp;Moumita Chakraborty,&nbsp;Lynda Lisabeth,&nbsp;Neil Mehta","doi":"10.1111/jgs.70585","DOIUrl":"10.1111/jgs.70585","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stroke remains a leading cause of mortality and disability in the United States. As the population ages, understanding trends in survival among stroke survivors is critical for healthcare planning and evaluating secondary prevention efforts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using longitudinal data from the nationally representative Health and Retirement Study (1996–2018; 39,084 individuals, 225,316 person-wave observations), in which stroke status is self-reported, we computed life expectancy at Age 50 (LE50) for those with and without a previous stroke history using discrete-time multistate models (a Markov chain approach for panel data). Estimates were stratified by sex and compared across two 10-year periods (1996–2006 vs. 2008–2018), with 95% confidence intervals obtained from 1000 bootstrap iterations. Cox proportional hazards models with progressively expanded covariate sets (sociodemographics, heart disease, BMI, insurance type, race/ethnicity) were fitted as exploratory analyses to assess the robustness of stroke–mortality associations to potential confounding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LE50 among individuals with a self-reported previous stroke history at baseline increased by 3.1 years (95% CI: 1.7–4.4) between 1996–2006 and 2008–2018 for both sexes combined, with men gaining 3.4 years (2.0–4.8) and women 2.5 years (0.8–4.3). Gains exceeded those in the general population (1.1 years, 0.6–1.6). Point estimates suggested somewhat larger gains among men, though confidence intervals overlapped and a statistically significant sex difference could not be confirmed. For first-time incident strokes during the observation period, post-stroke survival showed no statistically significant change across periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long-term consequences of stroke appear to be becoming less lethal, likely reflecting improvements in secondary prevention and post-stroke long-term care. Nonetheless, a gap of approximately 10 years in LE50 between stroke survivors and the general population persisted in 2008–2018. Continued investment in both acute stroke care and long-term secondary prevention remains essential to further close this gap.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2583-2594"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427679","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":"Implications of Missing Data Mechanisms in Randomized Controlled Trials: Current Practices and Suggestions Utilizing the ACTIVE Study","authors":"Jody S. Nicholson,&nbsp;Pascal R. Deboeck,&nbsp;Waylon Howard,&nbsp;Brenna Gomer","doi":"10.1111/jgs.70591","DOIUrl":"10.1111/jgs.70591","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Missingness in randomized controlled trials (RCTs) might mask or inflate effects with consequences for translating results confidently. The current study presents three steps to establishing confidence in results in light of missing data using an RCT examining the preventive potential of computerized cognitive training for the onset of dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants (<i>n</i> = 2832) consented to complete a computerized cognitive training study and ranged in age from 65 to 94 years (<i>M</i> = 73.33; SD = 5.74). Variables related to baseline demographic, physical, cognitive, and psychological functioning were examined as predictors of missingness to identify auxiliary variables. Secondary data analysis was conducted using data from the Advanced Cognitive Training for Independent and Vital Elderly study (ACTIVE). Confidence in the sustained impact of the intervention group was examined using two types of MNAR models (i.e., selection and pattern mixture modeling frameworks).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using auxiliary variables, there were slight changes in the pattern of results of the cognitive training intervention, suggesting that missing data was contributing to slight increases and decreases in model estimates, but not creating major changes in the interpretation of the trial. The analysis under MNAR models did not suggest any systemic bias in the study outcomes due to missing data but highlighted potential differences in those with complete data compared to those with incomplete data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The current study demonstrates how to expand examination of missingness and triangulate multiple methods for investigating bias under MAR and MNAR. It is recommended that the checklist for reporting for randomized controlled trials (i.e., CONSORT-ROUTINE) be amended to reflect specificity for requirements necessary for missingness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2640-2651"},"PeriodicalIF":4.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70591","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698710","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":"Medicare Advantage Prior-Authorizations Are Linked to Racial Differences in End-of-Life Home Health Use","authors":"Tessa Jones,&nbsp;Mohamed K. Benyamine,&nbsp;Evan Bollens-Lund,&nbsp;David J. Meyers,&nbsp;R. Sean Morrison,&nbsp;Claire K. Ankuda","doi":"10.1111/jgs.70556","DOIUrl":"10.1111/jgs.70556","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medicare-funded home health care is providing critical care to homebound older adults, especially those in the last year of life. In Medicare Advantage, Hispanic and Asian or Pacific Islander decedents are less likely to receive Medicare home health compared to their counterparts in traditional Medicare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We aim to investigate if prior authorization contributes to racial and ethnic differences in Medicare home health use at the end of life. In this cross-sectional study, we used a 100% Medicare cohort of adult's age ≥ 66 who died in 2019 and were enrolled in Medicare Advantage. We fit a logistic regression model with and without a Medicare Advantage plan-level fixed effects and tested interactions between decedent race and ethnicity and whether the Medicare Advantage plan required prior authorization for Medicare home health care. All models adjusted for individual and regional characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In our sample of 369,195 decedents (49.3% female, mean age 84.9), 240,339, or 65.1%, were in Medicare Advantage plans that required prior authorization for home health care. Racial and ethnic differences were primarily driven by between-plan differences, with prior authorization increasing differences in utilization between racial and ethnic groups. For example, prior authorization was associated with a 5.60% (95% CI 0.08–0.03) decrease for Hispanics and a 4.05% (95% CI 0.07–0.01) decrease for Asian/Pacific Islanders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that prior authorizations contribute to racial and ethnic differences in the Medicare Advantage program.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2277-2284"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407735","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}