Journal of the American Geriatrics Society最新文献

{"title":"What Comes Next for Vitamin D Supplementation and Trials in Older Adults?","authors":"Jatupol Kositsawat, Ariela Orkaby","doi":"10.1111/jgs.19390","DOIUrl":"10.1111/jgs.19390","url":null,"abstract":"<p>Vitamin D, or calciferol, is a fat-soluble hormone essential to many body functions. Naturally, it is present in some foods though it is largely synthesized endogenously through ultraviolet rays from sunlight exposure. Vitamin D deficiency has become increasingly common, and research studies have been undertaken to prove the benefits of vitamin D supplementation. However, benefits of vitamin D supplements have not been supported in rigorously conducted randomized controlled trials (RCTs) and meta-analyses [<span>1-5</span>]. Three recent RCTs have examined the role of vitamin D supplementation in community dwelling, generally healthy older adults: the American based VITAL (<b>VIT</b>amin D and Omeg<b>A</b>-3 Tria<b>L</b>), European DO-HEALTH (Vitamin<b>D</b>3-<b>O</b>mega3-<b>H</b>ome <b>E</b>xercise-He<b>ALTH</b>y Aging and Longevity Trial) [<span>6</span>], and Australian D-Health trial [<span>7</span>]. Each trial has been largely null for the role of supplemental vitamin D for primary outcomes of cardiovascular disease, cancer, fractures, and other health outcomes.</p><p>In this issue of the Journal, Eggimann et al. report post hoc findings from DO-HEALTH, a 2 × 2 × 2 factorial design RCT of vitamin D supplementation, omega-3 fatty acid supplementation, and home-based exercise programs for the prevention of incident sarcopenia and muscle loss in ambulatory community-dwelling healthy adults aged 70 years and older. Similar to the primary findings that supplementation with vitamin D did not impact incident nonvertebral fractures, functional decline, blood pressure, cognition, or infections, this secondary analysis did not find a protective effect of supplemental vitamin D on sarcopenia or muscle loss. Despite this, this study makes significant contributions to continue moving the field forward for research in this area and geriatric practice.</p><p>The results of this study have several implications for ongoing research in this area. First, even though epidemiological evidence has repeatedly demonstrated that low vitamin D levels are associated with multiple medical chronic conditions, including musculoskeletal health [<span>8-11</span>], results from RCTs have been disappointing. Are we targeting the wrong population, or must we provide higher dosages? Notably, currently established normal 25-hydroxyvitamin D (25(OH)D) levels may not apply to various population groups with different characteristics. The data remain unclear for specific populations such as those with obesity and Black Americans [<span>12</span>], populations requiring higher doses of vitamin D for adequate replenishment. Like any other trial, this study used one vitamin D supplementation dosage in all participants. However, heterogeneity in vitamin D responsiveness may dictate different dosages needed to show the benefits of vitamin D replacement in all study participants.</p><p>Another consideration regarding the benefits of vitamin D is the role of inflammation. Given long","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1005-1007"},"PeriodicalIF":4.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627330","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":"Is Frailty the Geriatric Troponin?","authors":"Jacqueline M. McMillan, Julian Falutz","doi":"10.1111/jgs.19423","DOIUrl":"10.1111/jgs.19423","url":null,"abstract":"<p>The incorporation of serum highly sensitive cardiac troponin (hs-cTn) testing into diagnostic strategies identifying persons with a high probability of an acute coronary event is effective for risk stratification of chest pain syndromes [<span>1</span>]. Similarly, in older adults, given the heterogeneity of health status based on chronologic age alone, various tools have been investigated for their utility as risk stratifiers [<span>2</span>].</p><p>Frailty is a familiar term in geriatric medicine. It describes a state of vulnerability causing an impaired ability to maintain homeostasis due to reduced physiologic reserve. Frailty is associated with disability, multimorbidity, cognitive impairment, institutionalization, and mortality [<span>3</span>]. Analogous to troponin testing, frailty assessment has been used to risk stratify older adults.</p><p>The utility of assessing frailty beyond the field of geriatrics has been carefully investigated in other areas, including surgery [<span>4</span>], general internal medicine, and several of its subspecialties. In the United Kingdom, the National Health Service (NHS) requires persons ≥ 65 to be assessed for frailty by their primary care providers [<span>5</span>].</p><p>Given the increasing interest and understanding of frailty, it is opportune to update its role in the care of selected older persons. The recent narrative review by Singh and colleagues summarizes the current range of frailty integration into various internal medicine subspecialties and highlights knowledge gaps to guide future research supporting its integration into clinical care. Across all subspecialties, the authors note a bidirectional association between particular diseases and frailty. Frailty assessment is integrated into the assessment of candidate patients for transthoracic aortic valvuloplasty, candidates for liver transplantation, and persons over 65 with malignancies [<span>6-8</span>]. They demonstrate that in various medical conditions, frailty is associated with impaired clinical status, poorer response to usual management, and increased risk of treatment-related toxicities.</p><p>Their findings support frailty as both a risk stratifier and prognosticator. In chronic obstructive pulmonary disease, frailty is associated with reduced exercise capacity, quality of life, and mortality [<span>9</span>]. In cardiology, frailty predicts cardiac events and adverse outcomes after invasive procedures [<span>10</span>]. In rheumatology, frailty is associated with organ damage, disability, and mortality [<span>11</span>]. In end-stage renal disease, frail patients on dialysis have a twofold increased risk of death [<span>12</span>]. In gastroenterology, frailty is a predictor of rehospitalization and mortality in inflammatory bowel disease [<span>13</span>]. In oncology, frail older adults demonstrate lower treatment tolerance, greater treatment discontinuation, increased health care use, shorter progression-free survival, and ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"999-1001"},"PeriodicalIF":4.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607511","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":"Correction to “Sex Differences in Patterns of Potentially Inappropriate Prescribing and Adverse Drug Reactions in Hospitalized Older People: Findings From the SENATOR Trial”","authors":"","doi":"10.1111/jgs.19410","DOIUrl":"10.1111/jgs.19410","url":null,"abstract":"<p>\u0000 \u0000 <span>O'Mahony, D</span>, <span>Cruz-Jentoft, AJ</span>, <span>Gudmundsson, A</span>, <span>Soiza, RL</span>, <span>Petrovic, M</span>, <span>Cherubini, A</span>, <span>Byrne, S</span>, and <span>Rochon, P.</span> <span>Sex Differences in Patterns of Potentially Inappropriate Prescribing and Adverse Drug Reactions in Hospitalized Older People: Findings From the SENATOR Trial</span>. <i>Journal of the American Geriatrics Society</i> <span>72</span>, no. <span>11</span> (<span>2024</span>): <span>3476</span>–<span>3483</span>. doi: 10.1111/jgs.19071\u0000 \u0000 </p><p>In the author affiliation section, under the title and list of authors, Professor Antonio Cherubini's second affiliation was omitted.</p><p>We apologize for this error.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607507","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":"Disparities in Timely Receipt of Home Healthcare: Neighborhood Disadvantage and Delayed Start-of-Care Visits in New York City","authors":"Sasha M. Vergez,&nbsp;Yolanda Barrón,&nbsp;Margaret V. McDonald","doi":"10.1111/jgs.19406","DOIUrl":"10.1111/jgs.19406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research has shown that delayed receipt of home healthcare (HHC) is linked to negative patients' outcomes such as hospitalizations, emergency department visits, and death. Studies have looked at factors contributing to delays including high-unemployment areas and racial/ethnic backgrounds of patients. However, no previous study had examined how the deliverance of timely care differs among levels of neighborhood disadvantage within an urban city. The objective of this study was to assess if there were associations between neighborhood disadvantage and delayed start-of-care (SOC) HHC visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational study on newly admitted HHC patients after a hospital discharge during the years 2021 and 2022. The total sample included 73,536 HHC episodes of care. We used log-binomial regressions to examine the association between a delayed SOC HHC visit, defined as a first HHC visit occurring after 48 h of hospital discharge, and neighborhood disadvantage, adjusting for patients' age, race, sex, and clinical status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Close to one-third (23,712; 32.3%) of HHC episodes experienced a delayed SOC HHC visit. As the level of neighborhood disadvantage increased, so did the risk of experiencing delayed care. After adjusting for covariates, patients living in the most disadvantaged neighborhoods (level 5) had a 13% (RR 1.13; 95% CI 1.10–1.17) higher risk of experiencing delayed care when compared to those in the least disadvantaged neighborhoods (level 1). As the level of neighborhood disadvantage increased, so did the proportion of minority patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings underscore the disparities in receipt of timely HHC among differing levels of neighborhood disadvantage. As HHC is presented as a safer and more comfortable alternative to institutional post-acute care, ensuring the availability and equitable care is essential for maintaining high-quality care especially for already marginalized populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1462-1471"},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545132","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":"Long-Term Exposure to Non-Steroidal Anti-Inflammatory Medication in Relation to Dementia Risk","authors":"Ilse vom Hofe,&nbsp;Bruno H. Stricker,&nbsp;M. Kamran Ikram,&nbsp;Frank J. Wolters,&nbsp;M. Arfan Ikram","doi":"10.1111/jgs.19411","DOIUrl":"10.1111/jgs.19411","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-steroidal anti-inflammatory (NSAID) medication could reduce dementia risk due to anti-inflammatory and possibly amyloid-lowering properties. However, the results of observational studies and short-term randomized-controlled trials have been inconsistent, and duration and dose–response relationships are still unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 11,745 dementia-free participants from the prospective population-based Rotterdam Study (59.5% female, mean age 66.2 years). NSAID use from 1991 was derived from pharmacy dispensing records, from which we determined cumulative duration and dose. We defined four mutually exclusive categories of cumulative use: non-use, short-term use (&lt; 1 month), intermediate-term use (between 1 and 24 months), and long-term use (&gt; 24 months). We determined the association with dementia risk until 2020 using Cox regression models, including NSAID use as a time-varying exposure. Models were adjusted for lifestyle factors, comorbidity, and comedication use. We repeated the analyses stratified by previously established amyloid-β lowering properties of different NSAIDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During an average follow-up period of 14.5 years, a total of 9520 (81.1%) participants had used NSAIDs at any given time, and 2091 participants developed dementia. Use of NSAIDs was associated with lower dementia risk for long-term users (HR [95% CI]: 0.88 [0.84–0.91]), and a small increased risk with short-term use (HR [95% CI]: 1.04 [1.02–1.07]) or intermediate-term use (HR: 1.04 [1.02–1.06]). The cumulative dose of NSAIDs was not associated with decreased dementia risk (HR for ≤ 25th percentile: 1.06 [1.03–1.09], 26–50th percentile: 1.02 [0.99–1.05], 51–75th percentile: 1.03 [0.99–1.06], &gt; 75th percentile: 0.99 [0.96–1.02]). Associations were somewhat stronger for long-term use of NSAIDs without known effects on amyloid-β than for amyloid-lowering NSAIDs (HR [95% CI]: 0.79 [0.74–0.85] versus 0.89 [0.85;0.93]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Long-term NSAID use, but not cumulative dose, was associated with decreased dementia risk. This suggests that prolonged rather than intensive exposure to anti-inflammatory medication may hold potential for dementia prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1484-1490"},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560315","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":"Depression and Antidepressant Prescription in Hospitalized Centenarians","authors":"Taylor Fistel,&nbsp;Kathryn Lotharius,&nbsp;Gabriella Engstrom,&nbsp;Joseph G. Ouslander","doi":"10.1111/jgs.19415","DOIUrl":"10.1111/jgs.19415","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1618-1620"},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143559835","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":"“Nobody Can Be Equipped for This”: Advice From New Residents of Long-Term Care Facilities","authors":"Kenneth Lam,&nbsp;James D. Harrison,&nbsp;Landon Haller,&nbsp;William J. Deardorff,&nbsp;Rebecca L. Sudore,&nbsp;Kenneth E. Covinsky,&nbsp;Dan D. Matlock,&nbsp;Daniel Dohan","doi":"10.1111/jgs.19405","DOIUrl":"10.1111/jgs.19405","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The transition into a long-term care facility (LTCF) is difficult for older adults, prompting calls for clinicians to help guide and plan. Yet we know little about how those with lived experience of moving into an LTCF would advise others.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted in-person semi-structured interviews with nursing home (NH) and assisted living (AL) residents within 6 months of moving into an urban non-profit continuing care retirement community in California between 2023 and 2024. Interviews were guided by theories of long-term care utilization and asked, “what advice would you give others considering an LTCF?” We thematically analyzed interviews using the constant comparative method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 8 NH and 6 AL residents. Mean participant age was 82 (range 73–90); 8 were female, 1 participant was Asian, 13 participants were White, and mean Montreal Cognitive Assessment was 19 (range 12–25). Residents talked about LTCF entry within a broader phase of life defined by dependence following sudden unexpected health crises. Advice reflected strategies for this phase of life and highlighted challenges outside of their control. Some residents advised <i>preparation</i> by visiting facilities and budgeting time and resources to plan but discovered care arrangements did not work out as promised; care was fragmented, and dependence caused them to re-evaluate what they wanted. Some advised <i>avoidance</i> as they disliked living in an LTCF but had little control over entry, leading to distrust of those making decisions for them. Others advised <i>acceptance</i> and believed luck or fate dictated how everything worked out in the end.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Unanticipated health crises catalyze entry into LTCFs. New residents advised others to prepare for, avoid, or accept LTCF entry, reflecting different strategies for approaching a unique phase of life and highlighting systemic problems that could be improved. Anticipatory guidance for LTCF transitions should acknowledge their sudden nature, these strategies, and the need for system reform.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1506-1516"},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545131","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":"Application of an Electronic Frailty Index to Identify High-Risk Older Adults Using Electronic Health Record Data","authors":"Bharati Kochar,&nbsp;David Cheng,&nbsp;Hanna-Riikka Lehto,&nbsp;Nelia Jain,&nbsp;Elizabeth Araka,&nbsp;Christine S. Ritchie,&nbsp;Rachelle Bernacki,&nbsp;Ariela R. Orkaby","doi":"10.1111/jgs.19389","DOIUrl":"10.1111/jgs.19389","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Measurement of frailty is limited in clinical practice. Existing electronic frailty indices (eFIs) are derived from routine primary care encounters, with near-complete health condition capture. We aimed to develop an eFI from routinely collected clinical data and evaluate its performance in older adults without complete health condition capture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Electronic Health Record (EHR) data from an integrated regional health system, we created a cohort of patients who were ≥ 60 years on January 1, 2017 with two outpatient encounters in 3 years prior or one outpatient encounter in 2 years prior. We developed an eFI based on 31 age-related deficits identified using diagnostic and procedure codes. Frailty status was categorized as robust (eFI &lt; 0.1), prefrail (0.1–0.2), frail (0.2–0.3), and very frail (&gt; 0.3). We estimated cumulative incidence of mortality, acute care visits and readmissions by frailty, and fit Cox proportional hazards models. We repeated analyses in a sub-cohort of patients who receive primary care in the system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 518,449 patients, 43% were male with a mean age of 72 years; 73% were robust, 16% were pre-frail, 7% were frail, and 4% were very frail. Very frail older adults had a significantly higher risk for mortality (HR: 4.1, 95% CI: 4.0–4.3), acute care visits (HR: 5.5, 95% CI: 5.4–5.6), and 90-day readmissions (HR: 2.1, 95% CI: 2.1–2.2) than robust older adults. In a primary care sub-cohort, while prevalence of deficits was higher, associations with outcomes were similar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This eFI identified older adults at increased risk for adverse health outcomes even when data from routine primary care visits were not available. This tool can be integrated into EHRs for frailty assessment at scale.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1491-1497"},"PeriodicalIF":4.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470321","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":"Individualized Net Benefit of Intensive Blood Pressure Lowering Among Community-Dwelling Older Adults in SPRINT","authors":"Mitra S. Jamshidian,&nbsp;Rebecca Scherzer,&nbsp;Michelle M. Estrella,&nbsp;Richard L. Kravitz,&nbsp;Rebecca S. Boxer,&nbsp;Daniel J. Tancredi,&nbsp;Jarett D. Berry,&nbsp;James A. de Lemos,&nbsp;Charles Ginsberg,&nbsp;Joachim H. Ix,&nbsp;Michael G. Shlipak,&nbsp;Simon B. Ascher","doi":"10.1111/jgs.19395","DOIUrl":"10.1111/jgs.19395","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal blood pressure (BP) target for older adults with hypertension remains controversial, particularly among those with advanced age, frailty, or polypharmacy. This study estimated the individualized net benefit of intensive BP lowering among community-dwelling older adults in the Systolic Blood Pressure Intervention Trial (SPRINT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 5143 SPRINT participants age ≥ 65 years, Cox models were internally validated to predict an absolute difference in risk between treating to a systolic BP target of &lt; 120 versus &lt; 140 mm Hg for all-cause death, cardiovascular outcomes, cognitive outcomes, and serious adverse events. Treatment effects were combined using simulated preference weights into individualized net benefits, representing the weighted sum of risk differences across outcomes. Net benefits were compared across categories of age (65–74 vs. ≥ 75 years), SPRINT-derived frailty status (fit, less fit, and frail), and polypharmacy (≥ 5 medications).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>When simulating preferences for participants who view the benefits of BP lowering (reduction in death, cardiovascular events, and cognitive impairment) as much more important than treatment-related harms (e.g., acute kidney injury and syncope), the median net benefit from intensive BP lowering was 4 percentage points (IQR: 3–6), and 100% had a positive net benefit favoring intensive BP lowering. When simulating benefits and harms to have similar, intermediate importance, the median net benefit was 1 percentage point (IQR: 0–2), and 85% had a positive net benefit. Participants with advanced age and frailty had greater net benefits from intensive BP lowering despite experiencing more harm in both simulations, and those with polypharmacy had greater net benefits when benefits were viewed as much more important than harms (<i>p</i> &lt; 0.001 for all comparisons).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among community-dwelling older adults with hypertension in SPRINT, almost all participants had a net benefit that favored a systolic BP target of &lt; 120 mm Hg, but the magnitude of net benefit varied according to estimated risks and simulated preferences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1441-1453"},"PeriodicalIF":4.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451300","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":"Inspiring Undergraduate Student Training in Alzheimer's Research (USTAR): Training the Next Generation of Aging Scientists","authors":"Robin Casten,&nbsp;Megan Kelley,&nbsp;Hakeem Lawal,&nbsp;Bernard L. Lopez,&nbsp;Susan Parks,&nbsp;Erin Perchiniak,&nbsp;Barry Rovner","doi":"10.1111/jgs.19400","DOIUrl":"10.1111/jgs.19400","url":null,"abstract":"<div>\u0000 \u0000 <p>Inspiring Undergraduate Student Training in Alzheimer's Research (USTAR) aims to provide Underrepresented Minority (URM) undergraduate students with mentored didactic, clinical, and research experiences to stimulate interest in research related to Alzheimer's Disease and Related Dementias (ADRD). USTAR specifically focuses on social determinants of health (SDOH) as risk factors for ADRD minoritized populations. USTAR's scientific rationale is that URM undergraduates are less likely to enter the biomedical workforce. Addressing this disparity is important since minorities are disproportionally affected by ADRD, and URM scientists may deeply appreciate the sociocultural forces that create racial health disparities. USTAR unites faculty expertise from Thomas Jefferson University (TJU) and Delaware State University (DSU), a Historically Black College and University (HBCU). The faculty's work spans the full spectrum of ADRD research and care, including neuroscience, biology, gerontology, geriatrics, neurology, and geriatric psychiatry. The 20-month USTAR program will train two cohorts of 10 students. Across all USTAR activities, we emphasize the relationship between SDOH and cognition. USTAR's goals are to: (1) provide interdisciplinary ADRD-related research, educational, clinical, and community experiences; (2) enhance research skills via group research projects; (3) facilitate transition from undergraduate to graduate studies in science; and (4) evaluate USTAR's effectiveness. USTAR has the potential to increase diversity in the national workforce that conducts health disparities research pertaining to ADRD. This goal aligns with the National Institute on Aging's (NIA) mission to meet the nation's biomedical, behavioral, and clinical research needs and to ensure health equity for all Americans.</p>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"894-899"},"PeriodicalIF":4.3,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426888","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}