Journal of the American Geriatrics Society最新文献

{"title":"Racial and Ethnic Differences in Low-Value Care Among Older Adults in a Large Statewide Health System","authors":"Carlos Irwin A. Oronce,&nbsp;Ray Pablo,&nbsp;Susi Rodriguez Shapiro,&nbsp;Phyllis Willis,&nbsp;Ninez Ponce,&nbsp;John N. Mafi,&nbsp;Catherine Sarkisian","doi":"10.1111/jgs.19369","DOIUrl":"10.1111/jgs.19369","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As value-based payment models incorporate both measures of health equity and low-value care (LVC), understanding how LVC varies by race is vital for interventions. Therefore, we measured racial differences in LVC in a contemporary sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional analysis of claims from adults ≥ 55 years receiving care at five academic medical centers in California from 2019 to 2021. Our sample included patients who received a service that could be classified as LVC. The primary outcome was whether a service was classified as LVC. Secondary outcomes included clinical categories of LVC (preventive screening, diagnostic testing, prescription drugs, and preoperative testing). We examined associations between race/ethnicity with outcomes using multivariable regression models adjusted for patient characteristics and medical center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 15,720 members who received potentially LVC, non-Hispanic White older adults comprised 59% of the sample, followed by Asian (17%), unknown race (8%), Latino (8%), non-Hispanic Black (5%), other race (2%). In adjusted models, Asian (−4.9 percentage points [pp]; 95% CI −5.9, −3.8 pp), Black (−5.4 pp; 95% CI −8.0, −2.7 pp), and Latino (−2.5 pp; 95% CI −4.6, −0.4 pp) older adults were less likely to receive LVC compared to White older adults, specifically preventive and preoperative services. Asian, Black, and Latino older adults, however, were more likely to receive low-value prescriptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These diverging racial patterns in LVC across different measures likely reflect differential mechanisms, underscoring the need to use clinically specific measures rather than composite measures, which obscure underlying heterogeneity and could lead to potentially harmful and inequity-producing interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"900-909"},"PeriodicalIF":4.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082897","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":"Aligning Medications With What Matters Most: Conversations Between Pharmacists, People With Dementia, and Care Partners","authors":"Ariel R. Green,&nbsp;Rosalphie Quiles Rosado,&nbsp;Andrea E. Daddato,&nbsp;Aleks Wec,&nbsp;Kathy Gleason,&nbsp;Tobie Taylor McPhail,&nbsp;Jessica Merrey,&nbsp;Linda Weffald,&nbsp;Meghan Swarthout,&nbsp;Scott Feeser,&nbsp;Cynthia M. Boyd,&nbsp;Jennifer L. Wolff,&nbsp;Marcela D. Blinka,&nbsp;Elizabeth A. Bayliss,&nbsp;Rebecca S. Boxer","doi":"10.1111/jgs.19379","DOIUrl":"10.1111/jgs.19379","url":null,"abstract":"<p>See related editorial by Gurwitz et al. in this issue.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1189-1197"},"PeriodicalIF":4.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082872","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":"Network Analyses to Explore Comorbidities Among Older Adults Living With Dementia","authors":"Samuel Quan,&nbsp;Barret A. Monchka,&nbsp;Philip D. St. John,&nbsp;Malcolm B. Doupe,&nbsp;Maxime Turgeon,&nbsp;Lisa M. Lix","doi":"10.1111/jgs.19336","DOIUrl":"10.1111/jgs.19336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older persons living with dementia (PLWD) often have multiple other chronic health conditions (i.e., comorbidities). Network analyses can describe complex profiles of chronic health conditions through graphical displays grounded in empirical data. Our study compared patterns of chronic health conditions among PLWD residing in and outside of long-term care (LTC) settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Population-based administrative data, including outpatient physician claims, inpatient records, pharmaceutical records, and LTC records, for the study were from the Canadian province of Manitoba. We included PLWD, ages ≥ 67 years, with two or more other chronic health conditions, who resided in Manitoba from 2017 to 2020. A total of 138 chronic health conditions were ascertained using a modification of the open-source Clinical Classification Software. Networks defined by nodes (health conditions) and edges (associations between nodes) were stratified by residence location (in versus outside LTC). Network properties were described, including: density (ratio of number of edges to number of potential edges), and modularity (associations between and within clusters of health conditions), and the median and interquartile range (IQR) for node degree (number of associations per node).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The population comprised 19,672 PLWD, of which 17,534 (89.1%) had two or more chronic health conditions. The median number of co-occurring conditions was similar among PLWD in LTC (median: 6, IQR: 3–10) versus outside LTC (median: 7, IQR: 4–10). Network properties were similar for PLWD and multiple comorbidities residing in versus outside LTC, including node degree (median 11 vs. 12), density (0.15 vs. 0.14), and modularity (0.18 vs. 0.26).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multiple chronic diseases characterize PLWD residing in and outside of LTC. Using network analyses, chronic diseases among PLWD do not form easily distinguishable groups or patterns. This suggests the need for comprehensive clinical assessments, individualized approaches for disease management, and highlights the importance of person-specific care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1168-1178"},"PeriodicalIF":4.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026188","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":"Food for Thought: Papas Fritas","authors":"Marina Silva Ferreira,&nbsp;Juan Carlos Nunez,&nbsp;Mandi Sehgal","doi":"10.1111/jgs.19343","DOIUrl":"10.1111/jgs.19343","url":null,"abstract":"&lt;p&gt;Mrs. M is an 80-year-old fully dependent, Spanish-speaking woman with severe Alzheimer's dementia seen as an inpatient by Geriatric Medicine for a goals of care discussion.&lt;/p&gt;&lt;p&gt;She was admitted due to septic shock (MRSA bacteremia) and possible endocarditis, requiring a prolonged admission in the intensive care unit (ICU). She was started on pressors and broad-spectrum antibiotics and underwent invasive procedures. Due to her prolonged ICU stay, her clinical status significantly deteriorated, including severe dysphagia. Eventually, she was transferred from the ICU to the general medical floor; however, her severe frailty and dysphagia remained unchanged, and PEG tube placement and other invasive procedures were brought up by the interprofessional admitting team.&lt;/p&gt;&lt;p&gt;Her daughter, who was her health care surrogate (HCS), requested ‘everything to be done,’ including maintaining full code status, a transesophageal echo to confirm endocarditis, and PEG placement, and refused consultation from palliative care. Geriatric medicine was then consulted for a goals of care discussion.&lt;/p&gt;&lt;p&gt;During our consultation, we observed Mrs. M to be a frail person living with severe dementia, whose speech was limited to yes and no answers. We called her daughter and asked if she could join us and her mother in person to identify her concerns and expectations regarding her mother's health.&lt;/p&gt;&lt;p&gt;After a long discussion with Mrs. M's daughter, we identified that one of her biggest fears was that her mother was not able to nourish herself due to dysphagia and, as a result, was getting weaker. This was her reason for wanting a PEG tube to be placed. We took the time to explain the importance of small pleasures at the end of life and that the PEG tube would provide more harm than good at this stage of her mother's illness. We asked what her favorite food was, and her daughter answered ‘papas fritas’ (French fries); see Figure 1: image of Papas Fritas or French Fries. We recommended a liberalized diet, and in the following days her daughter started to give her small amounts of french fries as tolerated. After that, her daughter requested a change of code status to DNR, declined PEG tube placement, and accepted a hospice consultation for her mother.&lt;/p&gt;&lt;p&gt;Mrs. M's story reminds us how important goals of care discussions are to identify &lt;b&gt;what matters most&lt;/b&gt; to our patients and to make sure we work to always honor their wishes, but especially at the end of life. It also reminds us how crucial it is, even more in a setting of the &lt;b&gt;diagnosis of dementia&lt;/b&gt;, to have those conversations early rather than when the disease is already too advanced for them to be able to determine their priorities at the end of life.&lt;/p&gt;&lt;p&gt;Many times, goals of care discussions are avoided due to time restraints, moral barriers, or due to perceived resistance from patients or families. In practice, we do see resistance from patients to talk about this matter, and depending on their indiv","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"993-994"},"PeriodicalIF":4.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018989","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":"Characteristics of nursing homes with high rates of invasive methicillin-resistant Staphylococcus aureus infections","authors":"Isaac See MD,&nbsp;Kelly A. Jackson MPH,&nbsp;Kelly M. Hatfield MSPH,&nbsp;Prabasaj Paul PhD,&nbsp;Rongxia Li PhD,&nbsp;Joelle Nadle MPH,&nbsp;Susan Petit MPH,&nbsp;Susan M. Ray MD,&nbsp;Lee H. Harrison MD,&nbsp;Laura Jeffrey BS,&nbsp;Ruth Lynfield MD,&nbsp;Carmen Bernu MPH,&nbsp;Ghinwa Dumyati MD,&nbsp;Anita Gellert RN,&nbsp;William Schaffner MD,&nbsp;Tiffanie Markus PhD,&nbsp;Runa H. Gokhale MD,&nbsp;Nimalie D. Stone MD,&nbsp;Kara Jacobs Slifka MD","doi":"10.1111/jgs.19189","DOIUrl":"10.1111/jgs.19189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nursing home residents experience a large burden of invasive methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections. Data are limited regarding nursing home characteristics associated with differences in facility-level invasive MRSA rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 2011–2015 data from CDC's Emerging Infections Program (EIP) active population- and laboratory-based surveillance for invasive MRSA cases within seven states. A nursing home-onset case was defined as MRSA cultured from a normally sterile site in a person living in a nursing home 3 days before culture collection. Facility rates were calculated as nursing home-onset cases per 100,000 resident-days. Nursing home resident-day denominators and facility characteristics were obtained from four Centers for Medicare &amp; Medicaid Services (CMS) datasets. A general estimating equations model with a logit link assessed characteristics of the facilities with highest rates comprising 50% of nursing home MRSA cases (“high rates”).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 626 nursing homes in the surveillance area had 2824 invasive MRSA cases; 82% of facilities had at ≥1 case. The 20% of facilities with highest rates (≥3.84 cases/100,000 resident-days) had 50% of nursing home-onset cases. In multivariable regression, facilities with high rates were more likely to have CMS-derived characteristics of presence of a resident with a multidrug-resistant organism; or greater proportions of residents who were male, were short stay (in the facility &lt;100 days), had a nasogastric or percutaneous gastrostomy tube, or require extensive assistance with bed repositioning; and more likely to be in an EIP area with higher hospital-onset MRSA rates. Higher registered nurses staffing levels (hours/resident/day) and higher proportions of White residents were associated with lower rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Facilities with higher invasive MRSA rates served residents with more clinical and functional care needs. Increasing registered nurse staffing in high-risk facilities might assist with reduction of invasive MRSA rates. These findings could help prioritize nursing homes for future MRSA prevention work.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"849-858"},"PeriodicalIF":4.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018984","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":"From Gap to Implementation: Integrated Geriatrics and Palliative Care Leadership and Life Skills Course Pilot","authors":"Debora Afezolli,&nbsp;Caitlyn Kuwata,&nbsp;Deborah Watman,&nbsp;Helen Fernandez","doi":"10.1111/jgs.19375","DOIUrl":"10.1111/jgs.19375","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"990-992"},"PeriodicalIF":4.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018992","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":"Mortality and Function After Hip Fracture or Pneumonia in People With and Without Dementia","authors":"Lauren J. Hunt,&nbsp;R. Sean Morrison,&nbsp;Siqi Gan,&nbsp;Edie Espejo,&nbsp;W. John Boscardin,&nbsp;Rebecca Rodin,&nbsp;Katherine A. Ornstein,&nbsp;Alexander K. Smith","doi":"10.1111/jgs.19354","DOIUrl":"10.1111/jgs.19354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The extent to which disruptive surgical or medical events impact mortality and function is critical for anticipatory planning and informing goal-aligned care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Health and Retirement Study data (2008–2018), we employed propensity score matching to compare the impact of hospitalization for hip fracture (a surgical event) or pneumonia (a medical event) among people with dementia to two groups: (1) people with dementia who did not experience these events; and (2) people without dementia who experienced an event. Dementia status was determined using validated cognitive assessments (Hurd method); hip fracture and pneumonia were identified from Medicare claims. Outcomes were 1-year mortality and function, defined as a summary score of requiring assistance with 6 ADL's and 5 IADL's, with higher scores indicating better function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among people with dementia, predicted 1-year mortality was higher among those with hip fracture (35.4%) versus those without hip fracture (14.8%), with similar patterns for pneumonia (49.6% vs. 13.0%). Among people with dementia, function declined abruptly at time of hip fracture (−2.09 [95% CI −2.94, −1.25]) and continued to decline after (−0.48 [95% CI −0.87, −0.09]). There were similar patterns for pneumonia (drop at time of pneumonia of −1.49 [95% CI −2.0, −0.97] and after −0.05 [95% CI, −0.29, 0.19]). Compared to people without dementia with hip fracture, people with dementia had higher 1-year mortality (35.4%) versus people without dementia (24%), with similar patterns for pneumonia (49.6% vs. 39.7%). Function stabilized for people without dementia after hip fracture (−0.03, 95% CI −0.22, 0.16), which was significantly different than people without dementia (<i>p</i> &lt; 0.0001). Function improved for people without dementia after pneumonia (0.13, 95% CI 0.03, 0.24), but was not statistically different than for people with dementia (<i>p</i> = 0.17).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Disruptive events such as hip fracture or pneumonia substantially alter the clinical trajectories of people with dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1179-1188"},"PeriodicalIF":4.3,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985810","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":"Colin Farrelly PhD","doi":"10.1111/jgs.18428","DOIUrl":"https://doi.org/10.1111/jgs.18428","url":null,"abstract":"<p><b>Cover caption</b>: A new care pathway to overcome care connections gaps between hospitals and community services in the Emergency Department. For full details, see “A public health/hospital partnership to improve Emergency Department transitions of care for vulnerable older adults” on page 243.\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 1","pages":"C1"},"PeriodicalIF":4.3,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143115251","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":"Cognitive Trajectory Before and After Cataract Surgery: A Population-Based Approach","authors":"Hyundeok Joo,&nbsp;L. Grisell Diaz-Ramirez,&nbsp;Catherine L. Chen,&nbsp;Catherine Q. Sun,&nbsp;Alexander K. Smith,&nbsp;W. John Boscardin,&nbsp;Elizabeth L. Whitlock","doi":"10.1111/jgs.19372","DOIUrl":"10.1111/jgs.19372","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cataract surgery is the most common surgical procedure performed for older US adults. Cataracts are associated with poor cognition and higher rates of dementia, but whether cataract surgery improves cognition for US older adults is not known. We examined the relationship between cataract surgery and long-term change in cognition in the Health and Retirement Study, a population-based study of older US adults linked with Medicare billing data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed community-dwelling participants who underwent cataract surgery between 2000 and 2018, propensity-matched on age, sex, education (four levels), diabetes status (four levels), pre-procedural latent cognition, vision impairment, and interview timing and mode to older adults who did not have cataract surgery during the study period. Cataract surgery date was ascertained using Medicare billing data. We calculated latent value of cognition using biennial self/proxy cognitive assessments, and used linear mixed effects models adjusting for demographic and health factors to model cognition from 5 years before, to 5 years after, cataract surgery (or a simulated event, for controls). The primary measure was difference-in-differences estimate of latent cognition comparing the year prior, to the year after, cataract surgery or a simulated event.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed 4384 older adults who underwent cataract surgery and 4384 matched controls (mean [SD] age 76.1 [6.8] years, 62.0% women, 83.9% non-Hispanic white). Across the first postoperative year, cataract surgical participants declined 0.002 (−0.002 to 0.006) units faster than nonsurgical controls (<i>p</i> = 0.37), equivalent to 8 (−10 to 26) days more cognitive aging. Post hoc subgroup analyses also found no difference in cognition for groups stratified by pre-procedural latent cognition (i.e., normal vs. cognitively impaired) or vision (i.e., vision-impaired vs. intact).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Under typical United States practice, cataract surgery for older patients was not significantly associated with cognitive improvement or decline in the year after, compared with the year before, surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1073-1081"},"PeriodicalIF":4.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967368","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":"Instruments for Value Elucidation in Older Adults in Clinical Practice—A Scoping Review","authors":"Geerke van den Bosch,&nbsp;Kathelijn Versteeg,&nbsp;Suzanne Metselaar,&nbsp;Lotte Koot,&nbsp;George Burchell,&nbsp;Olaf Geerse,&nbsp;Josephine M. J. Stoffels","doi":"10.1111/jgs.19356","DOIUrl":"10.1111/jgs.19356","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To ensure appropriate care for the individual older adult, an ideal treatment should align with patients' values. However, healthcare professionals struggle with how to elucidate patient values effectively. To offer guidance to healthcare professionals, we performed a scoping review, thereby mapping and categorizing instruments specifically developed to elucidate values of older adults in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted from inception up to October 2023 in PubMed, Psychinfo, CINAHL, and Cochrane Library. Articles on instruments clarifying older adults' values in a clinical setting were included. Articles on instruments elucidating patients' wishes, preferences, or goals were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After screening 7759 eligible studies, we included 37 studies outlining unique instruments. Instruments were subdivided into the following categories, based on the setting in which the instruments were used: “instruments with a general scope,” “health record-based interventions,” “advance directives,” “advance care planning programs,” and “decision support tools.” Values were made plain in different ways, and instruments promoted different approaches. We further categorized these approaches alongside different axes: “open versus closed,” “process-oriented versus decision-oriented,” “confronting versus nonconfronting,” and “explicit versus implicit.” Some instruments focused on establishing a process of deliberation, whereas others focused on achieving treatment decisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found and categorized a large range of instruments, which promoted different ways to elucidate older adults' values. This scoping review serves as an introduction for healthcare professionals to available instruments, which help to clarify patients' values. By categorizing the instruments along different axes of approaching value clarification, we offer healthcare professionals guidance for selecting an appropriate instrument.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1267-1287"},"PeriodicalIF":4.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962490","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}