Journal of the American Geriatrics Society最新文献

{"title":"Respiratory Syncytial Virus (RSV)-Related Hospitalization and Increased Rate of Cardiovascular Events in Older Adults","authors":"Chris P. Verschoor,&nbsp;Joshua O. Cerasuolo,&nbsp;Joseph M. Caswell,&nbsp;Mark Tatangelo,&nbsp;Atilio Costa-Vitali,&nbsp;David W. Savage,&nbsp;Jeffrey C. Kwong","doi":"10.1111/jgs.19591","DOIUrl":"10.1111/jgs.19591","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent studies suggest that respiratory syncytial virus (RSV) can cause severe illness in terms of in-hospital outcomes and mortality. The degree to which RSV hospitalization is associated with cardiovascular outcomes, particularly those known to occur following acute respiratory infections, is poorly described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of adults aged ≥ 65 years hospitalized with a diagnosis of RSV, influenza, urinary tract infection (UTI), or fracture between 2011 and 2020 in Ontario, Canada. Outcomes included subsequent heart failure, myocardial infarction, stroke, or atrial fibrillation events up to 1-year post-discharge, as well as in-hospital and acute outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cardiovascular events were subsequently identified in 18.5% (<i>n</i> = 474/2558) of patients who had an RSV-related hospitalization, compared to 17.7% (2961/16,688), 12.1% (8908/73,587), and 8.4% (941/11,262) of patients initially hospitalized with influenza, UTI, or fracture, respectively. In matched analyses, RSV hospitalization was associated with a greater rate of subsequent heart failure events relative to all other patient groups (HR range, 1.48–3.74), both in patients with or without pre-existing cardiovascular conditions. The rate of atrial fibrillation events was also higher in RSV patients, although this was dependent on pre-existing cardiovascular conditions and the comparator group considered. RSV patients were also more likely to be transferred to intensive care (OR range, 1.48–3.55) and had a higher rate of mortality (HR range, 1.49–3.98).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that RSV is an important determinant of serious post-discharge cardiovascular outcomes in older adults. Further, they underline the importance of vaccination in this population, regardless of pre-existing risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2685-2694"},"PeriodicalIF":4.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19591","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692863","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":"Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria®","authors":"American Geriatrics Society Beers Criteria® Alternatives Panel,&nbsp;Michael A. Steinman","doi":"10.1111/jgs.19500","DOIUrl":"10.1111/jgs.19500","url":null,"abstract":"<div>\u0000 \u0000 <p>The American Geriatrics Society (AGS) Beers Criteria® serve to identify medications whose potential for harm outweighs their intended benefit in older adults. This highlights the need for guidance not only on what therapies to avoid but also on readily available alternative treatment strategies. AGS thus convened a multidisciplinary, interprofessional panel to develop a list of these alternative treatment strategies for older adults based on guidelines and evidence, updating an earlier effort published in 2015. This report presents these in a manner intended to be easily usable by front-line clinicians facing common clinical scenarios. The list includes pharmacologic alternatives to medications on the AGS Beers Criteria® as well as non-pharmacologic management strategies that are often safer and equally or more effective than the potentially inappropriate medications they are replacing. Clinician, patient, and caregiver resources are also provided to support the implementation of alternative treatment strategies in clinical practice.</p>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2657-2677"},"PeriodicalIF":4.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692887","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":"An Elusive Ideal—Why a Pragmatic “Home Time” Quality Measure Remains Hard to Define","authors":"Kyra O'Brien,&nbsp;Robert E. Burke,&nbsp;Debra Saliba","doi":"10.1111/jgs.19594","DOIUrl":"10.1111/jgs.19594","url":null,"abstract":"&lt;p&gt;“Days at home,” “facility-free days,” “excess days of acute care,” and “healthcare contact days” are increasingly common measures used to evaluate the outcomes of healthcare interventions [&lt;span&gt;1-4&lt;/span&gt;]. These home time measures have broad appeal, and researchers have used them as outcomes in a range of studies [&lt;span&gt;5-8&lt;/span&gt;]. These measures are also gaining traction in policy circles. For example, the Centers for Medicare &amp; Medicaid Services (CMS) include home time performance measures in alternative payment models such as the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH).&lt;/p&gt;&lt;p&gt;Part of the reason for the increased use of these outcomes is their intuitive appeal. We as clinicians think most patients value being at home, and many believe it is cheaper for the health care system—a rare win-win. In addition, home time measures are viewed as “pragmatic” because they can be derived from existing administrative claims data [&lt;span&gt;9&lt;/span&gt;]. However, these measures have not been subjected to careful evaluation to understand the degree to which they are truly person-centered [&lt;span&gt;1, 10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;JAGS&lt;/i&gt;, Van Houtven and colleagues describe [&lt;span&gt;11&lt;/span&gt;] part of a larger effort to address this gap and develop a universal person-centered quality of life measure, based on time spent at home as compared to time spent in healthcare settings. This study is noteworthy in its focus on anchoring days at home to older adults' quality of life. The authors convened a panel of Veterans Affairs (VA) leadership, clinician scientists, and researchers and presented the panel with data from a mixed methods study that combined quantitative analyses and qualitative work with older Veterans surrounding their perceptions of home time versus the value of health care contact [&lt;span&gt;12, 13&lt;/span&gt;]. Delphi panel methodology was employed here because the team's prior work revealed discordance between prior qualitative and quantitative findings about how stays in different healthcare settings (e.g., hospital, emergency department, and skilled nursing facilities) affected patients' quality of life. To reconcile these past contradictions, the Delphi panel was charged with: (1) determining whether to include, in addition to hospital and post-acute facilities, the emergency department as a setting in time away from home; (2) creating relative “weights” to capture varying effects of stays in different healthcare settings on quality of life; and (3) establishing the timeframe over which to most meaningfully assess days away from home.&lt;/p&gt;&lt;p&gt;Perhaps the most striking finding of this careful approach was that—like the prior mixed methods study—this panel of experts was unable to come to consensus. While 75% of panelists rated as acceptable the inclusion of emergency department (ED) stays in time away from home, panelists had significant disagreement on establishing relative weights or an appropriat","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2333-2335"},"PeriodicalIF":4.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19594","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651620","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":"Editor's Note on Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials","authors":"Edward R. Marcantonio","doi":"10.1111/jgs.19590","DOIUrl":"10.1111/jgs.19590","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19590","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144914873","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":"Editor's Note on the Idea of Health","authors":"Soo Borson","doi":"10.1111/jgs.19589","DOIUrl":"https://doi.org/10.1111/jgs.19589","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129081","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 Trajectories of Neuromuscular Aging (TRAJECTOR-AGE Clinical Trial): Study Rationale and Methodological Protocol","authors":"Fulvio Lauretani,&nbsp;Marcello Maggio,&nbsp;Andrea M. Pilotto,&nbsp;Massimiliano Ansaldo,&nbsp;Clarissa M. Brusco,&nbsp;Marco Carbonaro,&nbsp;Caterina Amendola,&nbsp;Marco Nabacino,&nbsp;Crescenzo Testa,&nbsp;Andrea Ciuni,&nbsp;Nicola Sverzellati,&nbsp;Irene Zucchini,&nbsp;Marco Salvi,&nbsp;Alfonso Mastropietro,&nbsp;Rebecca Re,&nbsp;Alberto Botter,&nbsp;Martino V. Franchi,&nbsp;Simone Porcelli","doi":"10.1111/jgs.70005","DOIUrl":"10.1111/jgs.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine the structural, metabolic, and functional trajectories of neuromuscular decline in aging and identify key mechanisms and early biomarkers to guide interventions preserving function and independence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The TRAJECTOR-AGE project is a prospective, longitudinal cohort study conducted over 2 years across multiple centers in Italy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>Community-dwelling, physically and cognitively healthy middle-aged (50–60 years) and older (&gt; 70 years) adults are recruited. Individuals with significant comorbidities (e.g., diabetes, neurological disorders, severe heart failure) are excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Participants undergo comprehensive clinical and physiological evaluations every 6 months, including assessments of geriatric status, body composition, cardiovascular function, and neuromuscular performance. Imaging includes periodic quadriceps ultrasound and annual multiparametric MRI to assess muscle volume and fat infiltration. Biological samples (blood, urine and Vastus lateralis muscle biopsy) are collected yearly to evaluate inflammatory, metabolic, and neuromuscular biomarkers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Expected Results</h3>\u0000 \u0000 <p>By integrating clinical, functional, and molecular data over time, the TRAJECTOR-AGE study aims to clarify the pathophysiological mechanisms underlying neuromuscular decline, capture inter-individual variability, and explore the influence of habitual physical activity on aging trajectories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This multidimensional approach may enable earlier identification of individuals at risk for functional decline and inform the development of targeted preventive or therapeutic interventions to promote independence and healthy aging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2819-2827"},"PeriodicalIF":4.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621627","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":"Longitudinal Association of Inflammatory Diets on Cognition in Older Adults: Insights from the Oral–Gut–Brain Axis","authors":"Yi-Chun Chou,&nbsp;Ming-Lun Han,&nbsp;Tina H. T. Chiu,&nbsp;Meei-Shyuan Lee,&nbsp;Jeng-Min Chiou,&nbsp;Jen-Hau Chen,&nbsp;Yen-Ching Chen","doi":"10.1111/jgs.19599","DOIUrl":"10.1111/jgs.19599","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The oral–gut–brain axis is known to influence dementia development, but the interactions between an inflammatory diet, inflammatory conditions such as periodontitis and \u0000 &lt;i&gt;Helicobacter pylori&lt;/i&gt;\u0000 (Hp) infection, and their effects on cognitive function remain unclear. This study aims to investigate how periodontitis and Hp infection affect the association between an inflammatory diet and cognitive performance.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This prospective cohort study was conducted from 2011 to 2019, involving community-dwelling older adults (≥ 65 years old) without dementia, recruited between 2011 and 2013 (&lt;i&gt;N&lt;/i&gt; = 511). At baseline, dietary inflammatory potential was assessed by the Empirical Dietary Inflammatory Index (EDII) using a 44-item semi-quantitative food frequency questionnaire. Periodontal status was evaluated by a dentist, and Hp immunoglobulin G levels were measured. Global and domain-specific cognitive functions were assessed at baseline and during three biennial follow-ups. A generalized linear mixed model was used to examine the association between the EDII and cognitive function, adjusting for important covariates. Stratified analyses were further conducted by periodontal status and Hp seropositivity, respectively.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;One unit increase in the EDII, indicating a more pro-inflammatory diet, was associated with poor memory performance (Logical Memory-immediate free recall: &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 \u0000 &lt;semantics&gt;\u0000 \u0000 &lt;mrow&gt;\u0000 \u0000 &lt;mover&gt;\u0000 \u0000 &lt;mi&gt;β&lt;/mi&gt;\u0000 \u0000 &lt;mo&gt;̂&lt;/mo&gt;\u0000 &lt;/mover&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;/semantics&gt;\u0000 &lt;/math&gt; = −0.61, 95% confidence interval (CI) = −1.02 to −0.21; delayed free recall: &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 \u0000 &lt;semantics&gt;\u0000 \u0000 &lt;mrow&gt;\u0000 \u0000 &lt;mspace&gt;&lt;/mspace&gt;\u0000 \u0000 &lt;mover&gt;\u0000 \u0000 &lt;mi&gt;β&lt;/mi&gt;\u0000 \u0000 &lt;mo&gt;̂&lt;/mo&gt;\u0000 &lt;/mover&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;/semantics&gt;\u0000 &lt;/math&gt; = −0.64, 95% CI = −1.06 to −0.22). Thi","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2747-2756"},"PeriodicalIF":4.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19599","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602677","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":"Inflammatory Diets and Cognitive Decline: Connecting the Dots Across the Oral-Gut-Brain Axis","authors":"Peter M. Abadir","doi":"10.1111/jgs.19623","DOIUrl":"10.1111/jgs.19623","url":null,"abstract":"&lt;p&gt;In their longitudinal study “Longitudinal association of inflammatory diets on cognition in older adults: insights from the oral-gut-brain axis”, Chou et al. [&lt;span&gt;1&lt;/span&gt;] provide evidence linking pro-inflammatory dietary patterns to poorer memory performance in older adults, particularly highlighting stronger associations among individuals with periodontitis or \u0000 &lt;i&gt;Helicobacter pylori&lt;/i&gt;\u0000 (Hp) seropositivity. Their research, utilizing the Empirical Dietary Inflammatory Index (EDII), involved 511 community-dwelling older adults without dementia, examining the integration of dietary intake data with clinical assessments of oral and gastrointestinal inflammation. This multimodal approach underscores the significance of the oral-gut-brain axis in cognitive aging, as prior research supports emerging hypotheses connecting systemic inflammation to neurodegeneration, characterized notably by chronic low-grade inflammation as a contributing factor in cognitive decline [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The role of inflammatory mediators, such as IL-6 and TNF-α, is critical, serving as vital links between oral and gut dysbiosis and neurodegenerative processes. Recent studies explored how inflammatory pathways initiated by oral pathogens could further exacerbate systemic inflammation, subsequently influencing cognitive functions [&lt;span&gt;1&lt;/span&gt;]. Moreover, recent studies have also established a communicative framework within the oral-gut-brain axis that implicates systemic dysbiosis in cognitive impairment [&lt;span&gt;3, 4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The neuroprotective benefits of anti-inflammatory dietary patterns, particularly the Mediterranean and DASH diets, are also well-documented. These dietary patterns are rich in antioxidants and anti-inflammatory agents, including olive oil and omega-3 fatty acids, which are consistently linked to reduced levels of inflammatory markers and lower incidences of neurodegenerative diseases [&lt;span&gt;5-8&lt;/span&gt;]. Research demonstrates that these dietary approaches not only promote a healthy body weight but also enhance gut microbiota composition, which is crucial for optimal brain health through the gut-brain axis framework [&lt;span&gt;6, 9&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Together, these findings advocate for advancing research that integrates lifestyle-based prevention strategies for cognitive decline, focusing not just on dietary improvements but also considering oral and gastrointestinal health. A holistic model that incorporates both diet and microbiome health may lead to more effective prevention strategies against cognitive decline in aging populations [&lt;span&gt;10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Peter M. Abadir was solely responsible for the conception, drafting, and final approval of this editorial.&lt;/p&gt;&lt;p&gt;There was no external sponsor involved in the preparation, review, or approval of this editorial.&lt;/p&gt;&lt;p&gt;The author declares no conflicts of interest.&lt;/p&gt;&lt;p&gt;This publication is linked to a related article by Chou et al. To view this article, visit ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2649-2650"},"PeriodicalIF":4.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602676","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":"Polypharmacy's Association With Mortality: Confounding From Underlying Morbidity","authors":"Emma Bjørk,&nbsp;Christopher T. Rentsch,&nbsp;Rishi J. Desai,&nbsp;Jacob H. Andersen,&nbsp;Carina Lundby,&nbsp;Anton Pottegård","doi":"10.1111/jgs.19572","DOIUrl":"10.1111/jgs.19572","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Studies consistently associate use of multiple medications with increased mortality. However, such studies often lack adequate adjustment for confounding, particularly from underlying diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To illustrate challenges in studying the association between polypharmacy and mortality by examining this relationship in two separate populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A register-based nationwide study utilizing a cohort of all Danish citizens admitted to nursing homes 2015–2021 (<i>n</i> = 95,057) and a community dwelling population cohort aged ≥ 65 years (<i>n</i> = 1,005,963). We examined the 1-year mortality using a Kaplan Meier plot from date of nursing home admission or index date and modeled the association between the number of medications used and death using restricted cubic splines with varying levels of adjustment. Further, we modeled the association between the 20 most used drugs and 1-year mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the nursing home cohort, we found an approximately linear increase in mortality with the number of medications used. Adjusting for sex, age, and comorbidities markedly attenuated the association from an odds ratio of 4.70 (95% CI: 4.24–5.21) to 2.23 (95% CI: 1.99–2.49). Paradoxical associations were observed for individual drug classes, such as antidementia drugs showing a strong inverse association with mortality. When examining the stability of the number of drugs used over time, we found considerable fluctuations for individual residents. In the community dwelling population cohort, adjustment for covariates showed an even stronger impact on the association, reducing the odds ratio from 10.39 (95% CI: 9.79–11.03) to 1.34 (95% CI: 1.25–1.43). Further, the individual-level use of medication was found to be stable over time in the general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The association between levels of polypharmacy and mortality is strongly affected by confounding by indication. Basic adjustment for comorbidities attenuates but does not fully eliminate the association, with residual association possibly driven by residual confounding. This emphasizes the need for cautious interpretation of findings associating high use of medication with mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2485-2493"},"PeriodicalIF":4.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19572","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565587","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":"Nutritional Impairment and Quality of Life Trajectories Among Older Adults With Advanced Cancer","authors":"Surbhi Singhal,&nbsp;Ying Wang,&nbsp;Richard F. Dunne,&nbsp;Lee Kehoe,&nbsp;Michael B. Sohn,&nbsp;Marielle Jensen-Battaglia,&nbsp;Beverly Canin,&nbsp;Rachael Tylock,&nbsp;Mostafa Mohamed,&nbsp;Jamil Khatri,&nbsp;James Bearden III,&nbsp;Tony Philip,&nbsp;Supriya Mohile,&nbsp;Kah Poh Loh","doi":"10.1111/jgs.19617","DOIUrl":"10.1111/jgs.19617","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Nutritional impairment is common among older adults with advanced cancer. The association between baseline nutritional impairment and the trajectory of quality of life (QOL) and psychological health among patients receiving palliative cancer treatment is not known.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We performed a secondary analysis of a nationwide clinical trial (NCT02107443; PI: Mohile, UG1CA189961). Adults aged &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 \u0000 &lt;semantics&gt;\u0000 \u0000 &lt;mrow&gt;\u0000 \u0000 &lt;mo&gt;≥&lt;/mo&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;/semantics&gt;\u0000 &lt;/math&gt; 70 years with &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 \u0000 &lt;semantics&gt;\u0000 \u0000 &lt;mrow&gt;\u0000 \u0000 &lt;mo&gt;≥&lt;/mo&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;/semantics&gt;\u0000 &lt;/math&gt; 1 impaired geriatric domain were enrolled (2014–2017). Nutritional impairment was defined as Mini Nutritional Assessment-Short Form score of &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 \u0000 &lt;semantics&gt;\u0000 \u0000 &lt;mrow&gt;\u0000 \u0000 &lt;mo&gt;≤&lt;/mo&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;/semantics&gt;\u0000 &lt;/math&gt; 11. The Functional Assessment of Cancer Therapy-General (FACT-G, range 0–108) assessed QOL and the Geriatric Depression Scale-15 (GDS-15, range 0–15) assessed psychological health. We modeled group-based trajectories for FACT-G and GDS-15 via a discrete mixture model that identifies distinct subgroups with similar trajectories or patterns. After identifying distinct groups, we used multinomial logistic regression to assess the association of nutritional impairment with FACT-G and GDS-15 trajectory group membership.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among 479 patients, mean age was 77 (range 70–93) and 56% had nutritional impairment. We identified four QOL trajectories and four psychological health trajectories. Nutritional impairment was associated with group membership in Lowest (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0–8.9), Middle-Low (OR 3.8, 95% CI 2.1–6.9), and Middle-High QOL (OR 2.4, 95% CI 1.4–4.2), compared to Highest QOL. For depression, nutritional impairment was associated with membership in Worsening Mild Depression group (OR 3.7, 95% CI 1.8–7.5), compared to No Depression group.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Baseline nutritional impairment was independently assoc","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2789-2797"},"PeriodicalIF":4.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568285","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}