Journal of the American Geriatrics Society最新文献

{"title":"An Initiative to Address Health Disparities: Calls, Advocacy, and Resources for OldEr Adults (CARE)","authors":"Morgan M. Nakatani,&nbsp;Victoria Lue,&nbsp;Nicole J. Schindler,&nbsp;Sandro Pinheiro de Oliveira,&nbsp;Liza Genao","doi":"10.1111/jgs.19558","DOIUrl":"10.1111/jgs.19558","url":null,"abstract":"<p>Goals and components of the Calls, Advocacy, and Resources for OldEr Adults program.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2319-2322"},"PeriodicalIF":4.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228090","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":"Reply to: Comment on “Accelerating the Pace of Elder Justice Policy to Meet the Needs of a Growing Aging Population”","authors":"Kristin E. Lees Haggerty,&nbsp;Gary Epstein-Lubow","doi":"10.1111/jgs.19523","DOIUrl":"10.1111/jgs.19523","url":null,"abstract":"&lt;p&gt;Thank you for the opportunity to respond to Dr. Marian Liu's thoughtful letter regarding our recent article, “Accelerating the Pace of Elder Justice Policy to Meet the Needs of a Growing Aging Population” [&lt;span&gt;1&lt;/span&gt;]. We are grateful for Dr. Liu's insights and her deep, ongoing contributions to the field of elder justice.&lt;/p&gt;&lt;p&gt;We especially appreciate Dr. Liu's emphasis on the critical importance of sustained and expanded investment in Adult Protective Services (APS). As we highlighted in our article, APS serves as the front line in responding to elder abuse, neglect, and exploitation. In addition to leading investigations to understand the context of abuse, neglect, exploitation, and self-neglect, APS staff address risks and act to prevent crises, provide essential referrals to resources to address financial barriers, provide legal services, and address mental and physical health needs.&lt;/p&gt;&lt;p&gt;At this moment, APS faces significant headwinds. The broader political climate—including increasing calls to cut federal domestic spending—poses real risks to the future of APS. Some states' APS workers may have few co-workers and higher caseloads, or their APS system may become diminished to almost no activities. Proposed funding reductions, along with recent and ongoing administrative changes such as the reorganization of the Administration for Community Living (ACL), could destabilize essential elder justice infrastructure to such a degree that access to APS will become impossible at a time when the need is growing.&lt;/p&gt;&lt;p&gt;In this context, it is critical that we stand firmly behind APS. Federal leadership and investment remain vital—not only to maintain the current workforce and ensure consistency and equity across states, but also to foster innovation, workforce development, and data-driven improvements. We must advocate not just to preserve existing supports, but to expand them meaningfully.&lt;/p&gt;&lt;p&gt;At the same time, we recognize the importance of building a broader, more resilient elder justice ecosystem. This requires a “both/and” approach—one that continues to grow and protect federal investments while also activating local, philanthropic, and private−sector partnerships. These additional channels can amplify impact, foster cross-sector collaboration, and sustain momentum, especially in times of federal uncertainty.&lt;/p&gt;&lt;p&gt;Finally, we would like to extend our sincere appreciation to Dr. Liu for her leadership and for acknowledging the historic and ongoing work of the U.S. Senate Special Committee on Aging. The Committee has played a critical role in advancing elder justice policy, raising awareness, and holding systems accountable. Its continued productivity and bipartisan commitment are deeply valued.&lt;/p&gt;&lt;p&gt;Thank you again for the opportunity to respond, and for helping to advance this dialogue. We look forward to continued collaboration to accelerate progress and strengthen protections for older adults nationwide.&lt;/p&gt;&lt;p&gt;Kristin Lees Haggerty ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2625-2626"},"PeriodicalIF":4.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228007","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":"Facilitators of and Barriers to Deprescribing Diabetes Medications in Older Adults: A Qualitative Study","authors":"Aimee N. Pickering,&nbsp;Sam Richardson,&nbsp;Shari Rogal,&nbsp;Carolyn T. Thorpe,&nbsp;Jennifer Brach,&nbsp;Thomas R. Radomski","doi":"10.1111/jgs.19550","DOIUrl":"10.1111/jgs.19550","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Over half of older adults with diabetes remain on overly intensive or inappropriate medication regimens to treat diabetes and related complications, leading to adverse drug events, polypharmacy, and increased risk of hospitalization and death. This study aimed to identify facilitators and barriers to deprescribing diabetes medications in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted 15 semi-structured interviews with adults aged 65 and older with diabetes who were on at least one high-risk hypoglycemic medication (e.g., sulfonylurea) or potentially inappropriate medication to treat diabetes-related peripheral neuropathy (e.g., tricyclic antidepressant) and 10 family caregivers of older adults meeting inclusion criteria. Interviews explored participants' general perspectives on diabetes medications, as well as barriers to and facilitators of following a prescriber's recommendation to deprescribe a diabetes medication. Interviews were audio recorded and transcribed verbatim. Two members of the research team developed a codebook, coded the transcripts, and reconciled any discrepancies. We then conducted a thematic analysis to identify key themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified various factors influencing the views of patients and caregivers, which we categorized into four groups: patient-, prescriber-, medication-, and process-related facilitators and barriers. Patient-related facilitators included understanding of prescriber rationale and preference to minimize medications, while barriers included fear of negative consequences. Prescriber-related facilitators included trust, perceived investment in care, perceived expertise, and collaboration with other prescribers. Medication-related barriers included perceived benefit and a lack of side effects impacting quality of life. Lastly, process-related facilitators included a gradual reduction of medications, a detailed follow-up plan, and the option to restart the medication if necessary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We identified key facilitators and barriers that influence patients' and caregivers' willingness to have diabetes medications deprescribed. Our findings will inform the development of targeted strategies to support deprescribing diabetes medications in older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2447-2456"},"PeriodicalIF":4.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228005","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":"Oral Health, Xerogenic Medications, and Frailty in Acutely Ill Older Adults","authors":"Ingrid Beate Ringstad,&nbsp;Rita Romskaug,&nbsp;Leonor Roa Santervas,&nbsp;Katrine Gahre Fjeld,&nbsp;Lene Hystad Hove,&nbsp;Eva Skovlund,&nbsp;Torgeir Bruun Wyller,&nbsp;Janicke Liaaen Jensen","doi":"10.1111/jgs.19564","DOIUrl":"10.1111/jgs.19564","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oral health is an essential part of overall health and well-being in older adults and may be influenced by medications and frailty. This study aimed to describe the prevalence of xerostomia and hyposalivation and examine their associations with xerogenic medications and frailty in acutely ill older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included patients aged ≥ 70 years admitted to the Municipal In-Patient Acute Care unit in Oslo, Norway. General xerostomia was defined as a score ≥ 3 on the General Xerostomia Question (GXQ). Specific xerostomia was measured with the Summated Xerostomia Inventory (SXI). Objective dry mouth measures included unstimulated whole saliva (UWS) secretion rate and the Clinical Oral Dryness Score (CODS), with hyposalivation defined as UWS ≤ 0.1 mL/min. Examination of dentition included numbers of missing teeth and posterior occluding pairs of teeth. Medication data included total drug burden and number of xerogenic medications. Frailty was assessed using the Clinical Frailty Scale (CFS). Associations were analyzed using logistic regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 382 patients (mean age 84 years, 72% women), general xerostomia was present in 30% and hyposalivation in 56%. Mean number (SD) of xerogenic medications was 3.7 (±2.2). The number of xerogenic medications used was significantly associated with general xerostomia in both unadjusted (OR: 1.17, 95% CI: 1.05–1.29) and adjusted models (OR: 1.13, 95% CI: 1.01–1.26). Median UWS declined numerically with increasing number of xerogenic medications. Higher CFS scores were associated with increased subjective xerostomia scores (GXQ and SXI), elevated CODS, more missing teeth, and reduced occlusion, but not with general xerostomia or hyposalivation when predefined cut-off values were applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Xerostomia and hyposalivation were common among acutely ill older adults. General xerostomia was associated with xerogenic medication use and frailty. Our findings highlight the need to incorporate oral health assessments into routine geriatric care and emphasize the importance of interdisciplinary collaborations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2466-2474"},"PeriodicalIF":4.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210591","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":"Behind Bars and Beyond Reach: Systemic Barriers to Preventive and Palliative Healthcare for Justice-Involved Older Adults","authors":"Kriti Prasad,&nbsp;Ricardo Cruz,&nbsp;Ryan Chippendale","doi":"10.1111/jgs.19560","DOIUrl":"10.1111/jgs.19560","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2638-2640"},"PeriodicalIF":4.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210590","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":"Unveiling Hidden Abuse of Older Adults: A Case Study on the Critical Role of Clinical Vigilance and Skin Examinations","authors":"Yuka Shichijo,&nbsp;Thomas Fusillo,&nbsp;Fay Kahan,&nbsp;Sonica Bhatia,&nbsp;Yuji Yamada","doi":"10.1111/jgs.19561","DOIUrl":"10.1111/jgs.19561","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2316-2318"},"PeriodicalIF":4.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188735","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":"Short- and Long-Term Effect of Multidomain Lifestyle Intervention on Frailty: Post Hoc Analysis of an RCT","authors":"Johanna Pöyhönen,&nbsp;Hanna-Maria Roitto,&nbsp;Jenni Lehtisalo,&nbsp;Esko Levälahti,&nbsp;Timo Strandberg,&nbsp;Miia Kivipelto,&nbsp;Jenni Kulmala,&nbsp;Riitta Antikainen,&nbsp;Hilkka Soininen,&nbsp;Jaakko Tuomilehto,&nbsp;Tiina Laatikainen,&nbsp;Tiia Ngandu","doi":"10.1111/jgs.19552","DOIUrl":"10.1111/jgs.19552","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prevalence of frailty is increasing as the population ages. Lifestyle interventions have shown potential in frailty prevention. Intervention studies have been generally limited by short interventions and follow-ups or by focusing on single-domain approaches. We aimed to investigate whether a 2-year multidomain lifestyle intervention prevents phenotypic pre-frailty or frailty and whether baseline factors predict phenotypic pre-frailty or frailty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 1259 participants (aged 60–77 years) in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) were randomized to a multidomain intervention group or to a regular health advice group for 2 years. Frailty was defined by modified Fried phenotype. Pre-frail and frail participants were grouped for analyses. The prevalence of pre-frailty/frailty at baseline and at 2, 7, and 11 years, the change in prevalence from baseline, and the difference in these changes between intervention and control groups were estimated using a mixed-effects logistic regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The intervention reduced the risk of pre-frailty/frailty up to 7 years. The prevalence decreased in the intervention group from baseline (47%) to 2 years (42%), while it increased in the control group (45% to 49%), resulting in a −9.6-percentage point difference in the change (<i>p</i> = 0.007). After the active intervention period, the prevalence began to increase in both groups, but the difference in the change remained in favor of the intervention group at 7 years (−6.2 percentage points, <i>p</i> = 0.049). The beneficial effect was no longer evident at 11 years. Older age, lower protein intake, and a higher number of chronic diseases were strongly associated with pre-frailty/frailty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A 2-year multimodal lifestyle intervention effectively prevented phenotypic pre-frailty/frailty, with sustained benefits observed up to 7 years. Continuous support for a healthy lifestyle may be necessary to prevent late-life pre-frailty or frailty.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2457-2465"},"PeriodicalIF":4.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188734","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":"Self-Perceptions of Aging Predict Recovery After a Fall: Prospective Analysis From the English Longitudinal Study of Aging","authors":"Mathew W. Hill,&nbsp;Elmar Kal,&nbsp;Stephen Ronald Lord,&nbsp;Hayley Wright,&nbsp;David Broom,&nbsp;Toby J. Ellmers","doi":"10.1111/jgs.19486","DOIUrl":"10.1111/jgs.19486","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate how mindsets around aging at baseline affect physical recovery following a subsequent fall.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Longitudinal observational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>English Longitudinal Study of Aging (ELSA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>We analyzed data for 694 individuals who had not fallen in the 2 years prior to baseline (Wave 4) but experienced a fall during follow-up (between Waves 4 and 5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Self-perceptions of aging at baseline (Wave 4) and gait speed, activities of daily living (ADL) dependence, and physical (in)activity after a fall at a 2-year follow-up (Wave 5). Multivariable logistic regression analyses were used to determine to what extent aging-related mindset variables as measured at baseline predicted outcome measures at follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a fully-adjusted model controlling for confounding baseline factors (including baseline gait speed, ADL dependence and physical inactivity), individuals with positive self-perceptions of aging at baseline had significantly lower odds of slow gait speed (OR = 0.729; 95% CI = 0.627–0.849), ADL dependence (OR = 0.667; 95% CI = 0.561–0.792) and physical inactivity (OR = 0.795; 95% CI = 0.700–0.904) following a fall at a 2-year follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings identify self-perceptions of aging as a strong predictor of physical recovery and disability following a fall, independent of other important factors such as age, gender, and pre-fall physical function. These novel observations advance our understanding of the psychological factors impacting physical recovery from a fall. Future work should explore if targeting such perceptions can directly improve physical recovery and outcomes following a fall.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2097-2105"},"PeriodicalIF":4.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121791","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":"Low Social Engagement and Risk of Death in Older Adults","authors":"Ashraf Abugroun,&nbsp;Sachin J. Shah,&nbsp;Kenneth Covinsky,&nbsp;Colin Hubbard,&nbsp;John C. Newman,&nbsp;Margaret C. Fang","doi":"10.1111/jgs.19511","DOIUrl":"10.1111/jgs.19511","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Social engagement contributes to healthy aging, yet the mechanisms linking social engagement to mortality risk remain poorly understood. This study investigated the biological, behavioral, and psychological pathways mediating this relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study using Health and Retirement Study (HRS) data on participants aged 60 and older who completed the Psychosocial and Lifestyle Questionnaires and provided blood samples in 2016. Social engagement was assessed using nine items from the HRS Social Participation questionnaire, with responses categorized as low, moderate, or high. Biological age was calculated using the Klemera–Doubal method and compared to chronological age to identify decelerated aging. We explored mediating pathways between social engagement and 4-year mortality risk using counterfactual mediation analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 2268 participants were included. Higher social engagement was associated with lower all-cause mortality rates over 4 years of follow-up. The high social engagement group participants had a lower median biological age, healthier behaviors, and lower prevalence of depressive symptoms than those in the low and moderate engagement groups. High social engagement was associated with lower mortality risk than low engagement (a-HR: 0.58 [95% CI: 0.39, 0.86; <i>p</i> = 0.009]). This effect was partially mediated by regular physical activity (16%) and decelerated biological age (15%). Other factors such as high depressive symptoms, excess alcohol use, and tobacco use showed no significant mediating effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher social engagement in older adults is associated with reduced mortality risk possibly due to decreased biological aging and increased physical activity levels.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2166-2175"},"PeriodicalIF":4.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19511","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113174","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":"Effects of Initiating Different Antidepressant Subclasses on Motor Vehicle Crash Risk Among Older Adults With Depression","authors":"Marzan A. Khan,&nbsp;Nina R. Joyce,&nbsp;Melissa R. Pfeiffer,&nbsp;Melissa R. Riester,&nbsp;Brian R. Ott,&nbsp;Arman Oganisian,&nbsp;Allison E. Curry,&nbsp;Seth A. Margolis,&nbsp;Andrew R. Zullo","doi":"10.1111/jgs.19527","DOIUrl":"10.1111/jgs.19527","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antidepressants are prescribed for depression among older adults but might increase the risk of motor vehicle crash (MVC) through adverse effects (AEs) like sedation, dizziness, and blurred vision. Antidepressant subclasses may have different MVC risks since AE risks vary across subclasses. Our objective was to estimate the comparative one-year risks of MVC upon initiating atypical (AA) or tricyclic (TCA) versus selective serotonin reuptake inhibitor (SSRI) antidepressants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We emulated 470 sequential target trials each week from January 6, 2008, through January 1, 2017, using Medicare fee-for-service claims linked to New Jersey police-reported MVCs and driver's licensing data. Our sequential target trial emulation included older adults aged ≥ 66 years with a recent diagnosis of depression who initiated AAs, SSRIs, or TCAs. The unit of analysis was the “person-trial” a unique instance of a person in a sequential trial. Using inverse probability of treatment and censoring weighted Kaplan–Meier estimators to account for potential confounding and selection bias, we estimated the intention-to-treat cumulative incidence and risk ratios (RRs) of MVC over 1 year of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 13,034 person-trials from 11,604 persons (median [first quartile, third quartile] age: 76.0 [71.0, 82.0] years, 69.8% female, 89.4% non-Hispanic White race). There were 31 (37.6 [95% confidence limits {CLs} 20.3, 59.5] per 1000), 65 (37.6 [95% CLs 25.7, 47.7] per 1000), and 380 (38.0 [95% CLs 24.1, 39.7] per 1000) MVCs among 644 TCA-treated, 2130 AA-treated, and 10,260 SSRI-treated person-trials, respectively. The adjusted RRs were 0.99 (95% CLs 0.72, 1.56) comparing AAs versus SSRIs and 0.99 (95% CLs 0.56, 1.86) comparing TCAs versus SSRIs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We observed no differences in the one-year risk of MVC between antidepressant subclasses. When selecting among antidepressant subclasses to manage depression in older adults, MVC risk should not guide prescribing decisions, and other considerations should take precedence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2397-2409"},"PeriodicalIF":4.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103390","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}