Journal of the American Geriatrics Society最新文献

{"title":"Cover","authors":"Ganesh M. Babulal","doi":"10.1111/jgs.18430","DOIUrl":"https://doi.org/10.1111/jgs.18430","url":null,"abstract":"<p><b>Cover caption</b>: The Alzheimer's disease Exposome for Brain Equity. For full details, see “Neighborhoods, Networks, and Neurodegeneration: A Call for Population-Level Policy and Advancing the Exposome” on page 340.\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 2","pages":"C1"},"PeriodicalIF":4.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Thank You to JAGS Reviewers","authors":"","doi":"10.1111/jgs.19387","DOIUrl":"https://doi.org/10.1111/jgs.19387","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"337-339"},"PeriodicalIF":4.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404331","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":"The Halo Effect: Perceptions of Information Privacy Among Healthcare Chatbot Users","authors":"Jessica R. Ellis,&nbsp;Natalia S. Dellavalle,&nbsp;Mika K. Hamer,&nbsp;Marlee Akerson,&nbsp;Matt Andazola,&nbsp;Annie A. Moore,&nbsp;Eric G. Campbell,&nbsp;Matthew DeCamp","doi":"10.1111/jgs.19393","DOIUrl":"10.1111/jgs.19393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patient-facing chatbots can be used for administrative tasks, personalized care reminders, and overcoming transportation or geographic barriers in healthcare. Although some data suggest older adults see privacy as an ethical barrier to adopting digital technologies, little is known about privacy concerns regarding information shared with novel patient-facing chatbots. We sought to examine attitudes toward privacy based on age or other sociodemographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a sequential mixed methods study among patient users of a large healthcare system chatbot. We purposively oversampled by race and ethnicity to survey 3089 patient chatbot users online using de novo and validated items. Next, we conducted semi-structured interviews with users (<i>n</i> = 46) purposively sampled based on diversity or select survey responses. We used multivariable logistic regression to analyze survey data and modified grounded theory to analyze interviews. We integrated data using simultaneous visualization and triangulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We received 617/3089 surveys (response rate, 20.0%). Overall, 370/597 (63.9%) expressed worry about the privacy of information shared with the chatbot. Logistic regression found that users ≥ 65 years were 26% points less likely to be worried about information privacy compared to those 18–34 years old (<i>p</i> &lt; 0.001). We found less worry among Black, non-Hispanic users and more worry among those with more than a four-year college degree [Correction added on 4 April 2025, after first online publication: The preceding sentence has been revised in this version.]. By integrating our survey and interview data, we observed that older adult users experienced a halo effect: they worried less because they saw the chatbot as associated with a trusted health system and experienced lower medical mistrust.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Contrary to some prior research, adults aged 65 and older expressed less concern about chatbot privacy than younger adults because of their trust in health care. To maintain this trust and build it among all users, health systems using patient-facing chatbots need to take active steps to maintain and communicate patient privacy protections.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1472-1483"},"PeriodicalIF":4.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401013","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":"Trust in Physicians and End-of-Life Discussions and Preferences for Place of Care Among US Chinese Older Adults","authors":"Hyosin Kim,&nbsp;Yanping Jiang,&nbsp;Paul R. Duberstein,&nbsp;Fengyan Tang,&nbsp;Elizabeth A. Luth","doi":"10.1111/jgs.19396","DOIUrl":"10.1111/jgs.19396","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;Patient trust in physicians is essential for effective end-of-life discussions. Little is known about how Chinese older adults' trust in physicians relates to their end-of-life care discussions and care setting preferences.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To examine the association between medical trust among Chinese older adults and their views on end-of-life discussions and care setting preferences.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Secondary analysis of longitudinal cohort data from the Population Study of Chinese Elderly (PINE) using linear mixed-effects logistic and multinomial logistic regressions, adjusting for covariates. Predicted probabilities of outcome measures were reported.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 2192 Chinese older adult immigrants in greater Chicago participated in the PINE study from 2017 to 2020.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Outcome variables encompass four dimensions of end-of-life care planning: (1) beliefs about the importance of discussions with family; (2) discussions of end-of-life options with family; (3) preference for counseling with a healthcare provider as a resource; and (4) preferred place of care. The main independent variable was trust in physicians. Covariates included age, sex, education, income, years in the United States, living children, self-rated health, and medical conditions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Key Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Respondents with strong trust were less likely to consider end-of-life discussions with family important (AOR = 0.70, 95% CI: 0.55–0.88). Those with strong trust were more likely than those with weak trust to value counseling with a healthcare provider for end-of-life discussions with family (AOR = 5.86, 95% CI: 4.65–7.38). Moderate trust was associated with a preference for end-of-life care in a hospital (AOR = 1.63, 95% CI: 1.30–2.05) over home care, relative to weak trust.&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;Older Chinese immigrants with strong trust tended to place less emphasis on end-of-life discussions with family and favored one-on-one counseling with a healthcare provider for end-of-life discussion. Patient education and family engagement in end-of-life discussions led by trusted healthcare providers may be promising approaches to ensure goal-concordant care for this population.&lt;/p&gt;","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1558-1565"},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384547","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":"Diverticulitis in Older Adults: A Review of Etiology, Diagnosis, and Management","authors":"Jessica K. Hall,&nbsp;Mark A. Supiano,&nbsp;Jessica N. Cohan","doi":"10.1111/jgs.19388","DOIUrl":"10.1111/jgs.19388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diverticulitis accounts for over 300,000 hospitalizations annually in the United States and its incidence increases with age. Among older adults, diverticulitis is the fourth leading cause for emergency surgery. Older adults with multimorbidity and geriatric syndromes are often excluded from clinical studies, leaving a gap in the evidence needed to guide management. Here, we provide a clinically oriented review of the diagnosis and management of older adults with diverticulitis through the lens of age-friendly care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We reviewed the literature describing the epidemiology, diagnosis, management, and prevention of diverticulitis in older adults. Due to age-related physiologic changes, the presence of geriatric syndromes, and multimorbidity, older adults with diverticulitis often present with atypical symptoms, variable laboratory findings, and are at higher risk for complications than younger patients. Guidelines support a more aggressive approach to diagnosis in this population, with lower threshold for obtaining diagnostic imaging. Antibiotics remain a mainstay of treatment for uncomplicated disease, and surgical management should be focused on severity of disease and the balance between the likelihood of improving quality of life and risks and burden of treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Diverticulitis is a common disease that has a unique presentation among older individuals with limited evidence to guide management. Diagnosis and treatment should focus on what matters most to the patient, providing the most meaningful outcome possible within the context of multimorbidity, patient goals, symptom burden, and anticipated treatment outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1598-1607"},"PeriodicalIF":4.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375069","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":"Around the EQUATOR With Clin-STAR: AI-Based Randomized Controlled Trial Challenges and Opportunities in Aging Research","authors":"Betsy Yang,&nbsp;Caroline Park,&nbsp;Steven Lin,&nbsp;Vijaytha Muralidharan,&nbsp;Deborah M. Kado","doi":"10.1111/jgs.19362","DOIUrl":"10.1111/jgs.19362","url":null,"abstract":"<p>The CONSORT 2010 statement is a guideline that provides an evidence-based checklist of minimum reporting standards for randomized trials. With the rapid growth of Artificial Intelligence (AI) based interventions in the past 10 years, the CONSORT-AI extension was created in 2020 to provide guidelines for AI-based randomized controlled trials (RCT). The Clin-STAR “Around the EQUATOR” series features existing reported standards while also highlighting the inherent complexities of research involving research of older participants. In this work, we propose that when designing AI-based RCTs involving older adults, researchers adopt a conceptual framework (CONSORT-AI-5Ms) designed around the 5Ms (Mind, Mobility, Medications, Matters most, and Multi-complexity) of Age-Friendly Healthcare Systems. Employing the 5Ms in this context, we provide a detailed rationale and include specific examples of challenges and potential solutions to maximize the impact and value of AI RCTs in an older adult population. By combining the original intent of CONSORT-AI with the 5Ms framework, CONSORT-AI-5Ms provides a patient-centered and equitable perspective to consider when designing AI-based RCTs to address the diverse needs and challenges associated with geriatric care.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1365-1375"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191680","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":"Use and Discontinuation Rates of Long-Acting Injectable Antipsychotics Between Race/Ethnicity in Older Adults Using Medicaid Databases","authors":"Christopher M. Cassara,&nbsp;Jianing Xu,&nbsp;Daniel B. Hall,&nbsp;Xianyan Chen,&nbsp;Henry N. Young,&nbsp;Joshua Caballero","doi":"10.1111/jgs.19386","DOIUrl":"10.1111/jgs.19386","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The primary objective of this study was to assess the prescribing patterns of long acting injectable (LAI) antipsychotics in an older adult population. Secondary objectives were to determine if there were differences in treatment discontinuation rates between different LAI agents and race/ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Merative MarketScan Multi-State Medicaid Databases (2017–2021) were used to identify patients 65 years or older who were prescribed a LAI antipsychotic. Pharmacy claims for LAI antipsychotics were referenced via National Drug Code (NDC) by brand/generic name and dose. International Classification of Diseases, 10th edition (ICD-10) codes were used to identify older adults diagnosed with schizophrenia, schizotypal or schizoaffective disorders. Those with dementia or related disorders were censored. Conditional associations between race/ethnicity and generation of LAI antipsychotics were investigated using logistic regression controlling for age, sex, and health plan. Cox proportional hazard regression was used to compare the distribution of time until treatment discontinuation among older adults across LAI antipsychotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 526 older adults (59% female) with an average age of 70.4 ± 5.5 years met inclusion for analysis. The most commonly used LAI antipsychotics included paliperidone palmitate-1 month formulation (~35%), haloperidol decanoate (~24%), and risperidone microspheres (~15%). Overall, approximately 32% received LAI first-generation antipsychotics and 68% received LAI second generation antipsychotics. Blacks (<i>n</i> = 204) received LAI first-generation antipsychotics more often than Whites (<i>n</i> = 283); (OR: 1.74, 95% [1.18, 2.56], <i>p</i> &lt; 0.01). When controlling for age, sex, and race/ethnicity, LAI first-generation antipsychotics showed earlier discontinuation rates compared to LAI second-generation antipsychotics (HR: 2.12, 95% CI [1.45, 3.10], <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LAI first-generation antipsychotics showed treatment discontinuation significantly earlier compared to LAI second-generation antipsychotics. Furthermore, Blacks were prescribed LAI first-generation antipsychotics at a higher rate than Whites, which may contribute to poorer health outcomes. Futures studies are needed to establish a causal relationship.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1454-1461"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191684","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":"“By the Time We Knew …”: Poetic Analysis of End-of-Life Caregiving Experiences for Rapidly Progressive and Slower-Duration Dementia Syndromes","authors":"Krista L. Harrison,&nbsp;Brianna E. Morgan,&nbsp;Juliana Friend,&nbsp;Sarah B. Garrett,&nbsp;David Looi,&nbsp;Madina Halim,&nbsp;Jennifer E. James,&nbsp;Nicole D. Boyd,&nbsp;Joni Gilissen,&nbsp;Michael D. Geschwind,&nbsp;Christine S. Ritchie,&nbsp;Alexander K. Smith","doi":"10.1111/jgs.19382","DOIUrl":"10.1111/jgs.19382","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>One in three older adults in the United States dies with or from dementia. Little is known about whether end-of-life caregiving experiences differ by dementia diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a secondary analysis of two qualitative studies. Participants included caregivers of decedents with “rapid-type” sporadic Creutzfeldt–Jakob Disease (sCJD, survival prognosis of &lt; 1 year) or “slow-type” Alzheimer's disease and related dementias (survival prognosis of 5–20 years). We used reflexive thematic analysis and a novel method, poetic analysis, to compare end-of-life caregiving experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>“Rapid-type” caregivers (<i>n</i> = 12) had a median age of 59 (range 45–73) years; 6 were female, and 9 were spouses. “Slow-type” caregivers (<i>n</i> = 15) had a median age of 69 (45–82) years; 9 were female, and 11 were spouses. We identified three main areas of differential experience that were influenced by syndrome rarity and participation in research yet hinged on <i>time</i>. <i>Time enables preparation</i>: Due to the rarity of sCJD, “rapid-type” caregivers struggled to obtain accurate diagnoses, which prevented preparation for end-of-life care. Weeks or months before death, specialists simultaneously disclosed sCJD diagnoses and recommended hospice. In contrast, for “slow-type” dementia, preparation began years before death. <i>Time complicates conflict</i>: Most “rapid-type” caregivers described <i>conflicts</i>, rarely resolved before death, about code status, treatment, or care location decisions. Fewer “slow-type” caregivers experienced such conflicts, and these were typically resolved before death; instead, they experienced conflict between needs and what the care system provides. <i>Postmortem experience contrasts with perimortem</i>: For “rapid-type” dementia, short perimortem periods contrasted with elongated and often intense postmortem logistics and grief. For “slow-type” caregivers, preparation and perimortem grieving typically led to shorter duration and minimally intrusive postmortem logistics and grief.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>End-of-life care for dementia should attend to and support axes of differential experience based on diagnosis and rarity, time since symptom onset (affecting preparation and conflict resolution), and participation in research studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1406-1418"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191667","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":"Implementing in VA CLCs Is Complex, We Know!","authors":"Rhonda L. Toms,&nbsp;Courtney A. Huhn,&nbsp;Scotte R. Hartronft","doi":"10.1111/jgs.19380","DOIUrl":"10.1111/jgs.19380","url":null,"abstract":"&lt;p&gt;In the report of Mor et al. [&lt;span&gt;1&lt;/span&gt;] entitled “Implementing INTERACT in Veterans Health Administration Community Living Centers: A Pragmatic Randomized Trial”, the study found that INTERACT did not reduce rates of all-cause hospitalizations. This study offers valuable insights into improving care for our nation's Veterans in long-term care settings.&lt;/p&gt;&lt;p&gt;The INTERACT program represents a novel and commonsense approach to reducing potentially avoidable hospitalizations among nursing home residents. It includes four basic components: quality improvement, communication, decision support and advance care planning [&lt;span&gt;2&lt;/span&gt;]. In this article, they highlight the “stop and watch” methodology which encourages all employees to increase situational awareness of potential Veteran changes and use Situation, Background, Assessment, and Recommendation (SBAR) to communicate observations and changes in conditions across disciplines. In the day-to-day care of nursing home residents, the trees can obscure the view of the forest. INTERACT reminds us that all team members have a view and should participate in identifying resident changes.&lt;/p&gt;&lt;p&gt;At the Veterans Health Administration (VHA), our sacred duty is to care for those “who have borne the battle” [&lt;span&gt;3&lt;/span&gt;]. At Community Living Centers (CLCs), we care for those who have survived the battle and compounded with the added changes of age, disability, and disease. CLC residents are among our most vulnerable and are often more complex than those in Community Nursing Homes because of higher comorbidity, concurrent mental health conditions, and increased social needs [&lt;span&gt;4, 5&lt;/span&gt;]. The CLC provides transitional care, long term care, and hospice care.&lt;/p&gt;&lt;p&gt;The authors found (a) a high rate of all cause readmission with a lower rate of inappropriate readmission and (b) difficulty implementing INTERACT. These findings highlight the challenges of caring for complex Veterans in an integrated health system. As an integrated health system, where CLCs are often co-located with inpatient hospitals, CLCs play a role in decompressing the system. For example, a Veteran with advanced cancer and low social supports might reside in the CLC between rounds of hospital-based chemotherapy. Readmissions are anticipated and scheduled with the Veteran's goals as the driving force. We understand the difficulty of implementing tools such as the INTERACT methods firsthand.&lt;/p&gt;&lt;p&gt;For background, VHA implemented the CLCs Ongoing National Center for Enhancing Resources and Training (CONCERT) program in 2017 with a train the trainer approach [&lt;span&gt;6&lt;/span&gt;]. CONCERT implements the LOCK bundle, a set of practices based on relational coordination theory, to create high-functioning, relationship-based teams [&lt;span&gt;7&lt;/span&gt;]. Such an implementation required significant investment from CLCs (personnel time, cultural shifts), regional (training, coordination), and national (expertise, phone support, webinars, and coordin","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"682-684"},"PeriodicalIF":4.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19380","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191683","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":"Vestibular Suppressant Utilization and Subsequent Falls Among Patients 65 Years and Older With Dizziness in the United States","authors":"Schelomo Marmor,&nbsp;Pinar Karaca-Mandic,&nbsp;Meredith E. Adams","doi":"10.1111/jgs.19377","DOIUrl":"10.1111/jgs.19377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Falls pose a significant public health threat to older adults. Due to potential fall risk, guidelines recommend against the routine prescription of several medications commonly used for vestibular suppression, including meclizine and benzodiazepines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to determine the factors associated with vestibular suppressant utilization among patients with dizziness ≥ 65 years of age and subsequent falls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A retrospective longitudinal database of US commercial insurance and Medicare beneficiaries was used to study medical claims data (January 1, 2006, through December 31, 2015). Of 190,348 individuals ≥ 65 years old who presented with dizziness, 60,658 (32%) filled a vestibular suppressant prescription (27% anti-emetics, 73% anxiolytics), of which 20,448 were women (34%) within a month after their dizziness diagnosis. Of those individuals using suppressants, 8% experienced a fall resulting in a medical encounter within 60 days of filling the prescription. After adjusting for sociodemographics and comorbidity, individuals with dizziness who received vestibular suppressants were more likely to experience recorded fall incidents (hazard ratio (HR) 3.33, confidence interval (CI) 1.93–5.72, <i>p</i> &lt; 0.0001), than those who did not receive vestibular suppressants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although vestibular suppressants may provide immediate relief from symptoms during an acute vestibular crisis, use is incongruent with guideline-concordant care for most vestibular diagnoses and is also potentially counterproductive and injurious. Multi-faceted interventions that engage clinicians and patients are needed to improve the value of care for patients with vestibular disorders to de-implement the routine use of suppressants for dizziness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1398-1405"},"PeriodicalIF":4.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191686","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}