Journal of the American Geriatrics Society最新文献

{"title":"More than dollars: Healthcare utilization among spouses of persons with dementia","authors":"Molly J. Horstman MD, MS","doi":"10.1111/jgs.19174","DOIUrl":"10.1111/jgs.19174","url":null,"abstract":"<p>Being the spouse of a person with dementia can be a significant source of strain and can negatively impact one's health.<span><sup>1</sup></span> Although not all spouses serve as the primary caregiver, many spouses provide physical or emotional support to the person with dementia. Studies have shown that spouses of persons with dementia are more likely to have depression, anxiety, and sleep disturbances compared with spouses of persons who do not have dementia.<span><sup>2-4</sup></span> Identifying opportunities to improve health among spouses of persons with dementia is essential. In the United States, families provide most of the long-term care to persons with dementia.<span><sup>1</sup></span> Family members need to maintain sufficient health to fulfill caregiving roles and responsibilities to sustain this system. Spouses of a person with dementia may have less time and fewer financial resources to participate in recommended health behaviors and receive healthcare services, which, over time, may impact their ability to care for the person with dementia.<span><sup>5</sup></span></p><p>In this issue, <i>Ingraham</i> et al. present the results of a matched study examining Medicare Fee-for-Service expenditures for spouses of persons living with dementia compared with spouses of persons without dementia in the 5 years after the person with dementia was diagnosed with dementia.<span><sup>6</sup></span> Using the Health and Retirement Study with linked Medicare Claims, the authors measured three categories of health utilization costs: (1) inpatient or hospital expenditures; (2) outpatient or ambulatory expenditures, which included emergency room visits if a hospitalization did not follow the visit; and (3) skilled nursing facility, hospice, and home health expenditures. In the adjusted analysis, there was no difference in total Medicare expenditures between spouses of persons with dementia and spouses of persons without dementia in the 5 years after dementia was diagnosed. However, in Year 5, there was an increase in total Medicare expenditures among spouses of persons living with dementia driven by an increase in inpatient expenditures, with a total difference of $2748 (95% CI $321–$5447).</p><p>The results of this study differ from prior matched studies examining healthcare expenditures among spouses of persons living with dementia.<span><sup>3, 4, 7, 8</sup></span> As the authors note, prior studies had relied on claims data to identify persons with dementia, while the methods used by <i>Ingraham</i> et al. for identifying incident diagnoses of dementia from the Health and Retirement Study identified adults at an earlier stage of the disease. However, several other differences existed between this study and prior published studies. These include the methods by which spouses were identified, the type of insurance the spouse had, and the types of expenditures included in the total expenditures.<span><sup>3, 4, 7, 8</sup></span> In addition, <i>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"2969-2971"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116615","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":"Many studies, but little certainty about the effects of statin discontinuation on outcomes","authors":"Michelle C. Odden PhD, Chintan V. Dave PharmD, PhD","doi":"10.1111/jgs.19157","DOIUrl":"10.1111/jgs.19157","url":null,"abstract":"<p>In this issue of the <i>Journal of the American Geriatrics Society</i>, Piexoto et al. conducted a systematic review of studies of statin discontinuation on clinical outcomes.<span><sup>1</sup></span> They identified only one randomized trial of statin discontinuation, conducted in people near the end of life, which found no difference in 60-day mortality or 1-year cardiovascular mortality among people who discontinued statins compared with those who continued statins. In contrast, among 35 nonrandomized studies among people not near the end of life, statin discontinuation was associated with a higher risk of all-cause mortality, cardiovascular mortality, and cardiovascular events. However, the authors noted concerns around bias of confounding by indication, along with concerns about imprecision, inconsistency, and heterogeneity. Together, the findings from observational studies were evaluated as having a high degree of uncertainty and bias, leaving providers and their patients with little useful information outside of the end-of-life setting.</p><p>There is discordance among the major Northern American and European guidelines on the evaluation of the benefit of statins in older adults, especially for primary prevention.<span><sup>2</sup></span> This is compounded by the challenge of accurate prediction of cardiovascular events in older adults, as a risk-based prevention strategy is the cornerstone of many of the guideline recommendations. Adding to the complexity, there is also insufficient evidence to capture potential harms of statin use due to the limited representation of older adults in large randomized statin trials. Further, limited evidence on statins and patient-centered outcomes such as frailty or statin-associated physical or cognitive changes exists, although one modestly sized trial demonstrated worsening decline in energy and exertional fatigue among persons randomized to statins.<span><sup>3</sup></span> Taken collectively, these factors have contributed to a growing interest in medication discontinuation or dose reduction, otherwise referred to as deprescribing, of statins in older adults.</p><p>Piexoto aimed to address this evidence gap by synthesizing the evidence for statin discontinuation, but their systematic review only highlights the challenges in estimating medication effects in observational studies.<span><sup>1</sup></span> Despite recent advancements in observational research methodologies, the majority of studies included in the review were assessed to have a serious risk of bias. The primary limitation of observational studies, in contrast to randomized trials, is that of confounding, or which occurs when the populations who discontinue statins are systematically different than those who continue statins. This limitation is especially challenging for studies of medication deprescribing and mortality, as limited life expectancy is a common reason for medication review and deprescribing.<span><sup>4</sup></span> The","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3291-3293"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116614","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":"Gait performance in older adults across the cognitive spectrum: Results from the GAIT cohort","authors":"Pauline Ali MD, MSc,&nbsp;Pauline Renaud MD,&nbsp;Manuel Montero-Odasso MD, FRCPC, PhD, AGSF, FGSA,&nbsp;Jennifer Gautier MS,&nbsp;Mickaël Dinomais MD, PhD,&nbsp;Cédric Annweiler MD, PhD","doi":"10.1111/jgs.19162","DOIUrl":"10.1111/jgs.19162","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gait performance can provide valuable insights into cognitive functioning in older adult and may be used to screen for cognitive impairment. However, the optimal test condition and spatiotemporal parameter for accuracy have not yet been determined. This study aims to determine the gait measure with the highest accuracy identifying cognitive decline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 711 participants were recruited, including 332 cognitively healthy individuals, 264 with mild cognitive impairment (MCI), and 115 with dementia, with a mean age of 72 years (interquartile range 69–76), and 43% (<i>n</i> = 307) of women. The participants underwent gait assessment in three different conditions, including a single task and dual tasks of counting backward by ones and naming animals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Gait performance was deteriorated as cognitive impairment progressed. The gait test performed during naming animals condition was the most accurate in differentiating between cognitive groups. Specifically, the naming animals gait speed was more accurate in discriminating control participants from those with cognitive impairment (area under the curve [AUC] = 76.9% for MCI and 99.7% for people with dementia with control group as reference). The coefficient of stride length variability while naming animals was the most effective parameter in discriminating between MCI and dementia groups (AUC = 96.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The naming animals dual-task gait test can be a valuable assessment for screening cognitive impairment in older adults, regardless of their cognitive abilities. The test is useful in clinical settings for subjects with a range of cognitive profiles.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3437-3447"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116612","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":"Anxiety and aging: A marker of brain changes and potential treatment target to promote brain health","authors":"Jordan F. Karp MD,&nbsp;Eric J. Lenze MD","doi":"10.1111/jgs.19168","DOIUrl":"10.1111/jgs.19168","url":null,"abstract":"&lt;p&gt;Almost 7 million Americans have Alzheimer's dementia. Approximately 20% of middle-aged women and 10% of middle-aged men will eventually develop Alzheimer's dementia in their lifetime, usually occurring after age 65.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Given the aging of the population, absent incident prevention or efforts that slow the course of the illness there will be close to 14 million Americans living with the disease by 2060.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although new treatments exist, there is no currently available scalable cure that is cost-effective (accounting for Quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and costs), nor will one likely be launched within the next decade. Thus, there needs to be a greater focus on modifiable risk factors (12 of which account for 40% of worldwide dementias)&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; to prevent new cases in the United States and across the globe.&lt;/p&gt;&lt;p&gt;Anxiety disorders are common: they have a lifetime prevalence of approximately 34% in the United States&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; and are the second most common neuropsychiatric disease after depression.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Anxiety is linked with higher rates of both depression&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; and addiction&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;; reflects a state of both psychic and physical stress&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;; and is linked with pro-inflammatory&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; states, cognitive impairment,&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; cardiovascular disease,&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; and all-cause mortality.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; It is also treatable. Elucidating the interaction between having anxiety in late-life and rates of incident dementia may add to the list of modifiable risk factors for cognitive decline and neurodegenerative diseases.&lt;/p&gt;&lt;p&gt;This issue of the journal includes a study by Khaing and colleagues entitled “The effect of anxiety on all-cause dementia: a longitudinal analysis from the Hunter Community Study.”&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; Their communication describes the association of chronic versus resolved versus new onset anxiety on subsequent diagnosis of dementia. The investigators hypothesized that both the (1) chronicity of anxiety and (2) age of exposure to anxiety would be linked with all-cause dementia risk. The sample (&lt;i&gt;n&lt;/i&gt; = 2132, mean age = 76) was an existing cohort of community-dwelling Australians who were recruited between 2004 and 2007. Wave 2 and Wave 3 assessments were completed at 5-year intervals after Wave 1. The natural history of anxiety was categorized as (1) Chronic Anxiety (present at Wave 1 and Wave 2); (2) Resolved Anxiety (present only at Wave 1); and (3) New Anxiety (present only at Wave 2). The primary outcome was incident all-cause dementia up to 13 years after Wave 1. Sixty-four participants (3%) were diagnosed with dementia with the average onset at year 10. Chronic Anxiety (HR = 2.80) and New Anxiety (HR = 3.20) at Wave 2 were both associated with increased risk of all-cau","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3294-3295"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116609","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":"Racial and ethnic differences in unmet needs among older adults receiving publicly-funded home and community-based services","authors":"Chanee D. Fabius PhD, MA,&nbsp;Romil Parikh MBBS, MPH,&nbsp;Jack M. Wolf BA,&nbsp;Stephanie Giordano DLP, MEEP,&nbsp;Shekinah Fashaw-Walters PhD,&nbsp;Eric Jutkowitz PhD,&nbsp;Tetyana Shippee PhD, FGSA","doi":"10.1111/jgs.19153","DOIUrl":"10.1111/jgs.19153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Unmet need for home and community-based services (HCBS) may disparately impact older adults from racial and ethnic minoritized groups. We examined racial and ethnic differences in unmet need for HCBS among consumers ≥65 years using publicly funded HCBS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the National Core Indicators-Aging and Disability survey data (2015–2019) from 21,739 community-dwelling HCBS consumers aged ≥65 years in 23 participating states. Outcome measures included self-reported unmet need in six service types (i.e., personal care, homemaker/chore, delivered meals, adult day services, transportation, and caregiver support). Racial and ethnic groups included non-Hispanic Black, Asian, non-Hispanic White, Hispanic, and multiracial groups. Logistic regression models examined associations between race and ethnicity and unmet need, adjusting for sociodemographic, health, and HCBS program (i.e., Medicaid, Older Americans Act [OAA], Program for All-Inclusive Care for the Elderly [PACE]) characteristics, and use of specific service types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 21,739 respondents, 23.3% were Black, 3.4% were Asian, 10.8% were Hispanic, 58.8% were non-Hispanic White, and 3.7% were multiracial or identified with other races/ethnicities. Asian and Black consumers had higher odds of reporting unmet need in personal care than White consumers (adjusted odds ratio [aOR], 1.45, <i>p</i> value &lt; 0.01; and aOR, 1.25, <i>p</i> &lt; 0.001, respectively). Asian and Black consumers had significantly higher odds of unmet need in adult day services versus White consumers (aOR, 1.94, <i>p</i> &lt; 0.001 and aOR, 1.39, <i>p</i> &lt; 0.001, respectively). Black consumers had higher odds of unmet need versus non-Hispanic White consumers in meal delivery and caregiver support services (aOR, 1.29; <i>p</i> &lt; 0.01; and aOR 1.26, <i>p</i> &lt; 0.05, respectively). Race and ethnicity were not significantly associated with experiencing unmet need for homemaker/chore or transportation services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Future research should identify driving forces in disparities in unmet need to develop culturally appropriate solutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3520-3529"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116619","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":"Comment on: Willingness to take less medication for type 2 diabetes among older patients","authors":"Petra Denig PhD,&nbsp;Peter J. C. Stuijt MSc","doi":"10.1111/jgs.19175","DOIUrl":"10.1111/jgs.19175","url":null,"abstract":"&lt;p&gt;When people with type 2 diabetes age and their health status deteriorates, reevaluation of their treatment is needed. Medication de-intensification is recommended for older patients with a poor health status when they have low levels of hemoglobin A1c while taking medication. The recently published study of Haider et al. investigated the willingness of older people with diabetes to de-intensify their medication.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Of particular interest, they examined which patient characteristics were associated with such willingness and whether this aligned with the guideline recommendations. A key finding was that the people who may benefit the most from treatment de-intensification according to the guidelines were less likely to be willing to take less diabetes medication.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;As Pilla et al. mentioned in an editorial, the study was limited by its reliance on responses to the question “I would be willing to take less medication for my diabetes” that lacks clinical context.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; An alternative question has been posed by Crutzen et al. in a study among older people on diabetes and/or cardiovascular drugs.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This concerns the question from revised Patients Attitudes Towards Deprescribing (rPATD) questionnaire, “If my doctor said it was possible, I would be willing to stop one or more of my regular medicines.”&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Crutzen et al. observed that 88% of older patients were willing to stop medication if their doctor said it was possible. This is clearly higher than the 51% willing to take less medication in the study of Haider et al. Although this could indicate that the willingness was higher given the context “that the doctor said it was possible,” an alternative explanation is that the willingness depends on the type of medication. Where the question posed by Haider et al. referred to “less medication for my diabetes,” the medication is not specified in the willingness question of the rPATD.&lt;/p&gt;&lt;p&gt;Differences regarding attitudes toward specific medication were further explored by Crutzen et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; In particular, attitudes towards de-intensifying insulin, sulfonylurea, or statins were studied, showing remarkable differences. For example, few of the older people would like their doctor to reduce the dose of their insulin and more than half were reluctant to stop insulin (Table 1). For patients taking sulfonylurea or statins, these percentages were more in favor of de-intensification (Table 1). Furthermore, few people would like to try stopping the insulin or sulfonylurea they were taking to see how they would feel without, whereas more patients would like to try stopping their statin (Table 1). This might be related to experiencing drug-related problems, such as side effects. Very few patients believed they experienced side effects from their insulin or sulfonylurea, but this was clearly different for statins (Table 1). The findin","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3607-3608"},"PeriodicalIF":4.3,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094349","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":"Clinical performance of existing diagnostic criteria for pneumonia in older emergency patients: A prospective cohort study","authors":"Katherine M. Hunold MD, MPH,&nbsp;Lorraine C. Mion PhD, RN, FAAN,&nbsp;Tanya R. Gure MD,&nbsp;Andrew L. Schwaderer MD,&nbsp;Matthew Exline MD, MPH,&nbsp;Courtney Hebert MD, MS,&nbsp;Brent C. Lampert DO,&nbsp;Lauren T. Southerland MD,&nbsp;Julie A. Stephens MS,&nbsp;Edward W. Boyer MD, PhD,&nbsp;Michael Hill RN,&nbsp;Ching-Min B. Chu BS,&nbsp;Carson Reider PhD,&nbsp;Jeffrey M. Caterino MD, MPH","doi":"10.1111/jgs.19113","DOIUrl":"10.1111/jgs.19113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pneumonia accounts for over half a million older adult emergency department (ED) visits annually, but ED pneumonia diagnosis is inaccurate. Geriatric-specific pneumonia diagnostic criteria exist for other settings; no prospective data exist to determine if application in the older adult ED population is feasible. The objective was to prospectively evaluate the utility of four current diagnostic criteria (Loeb; Modified McGeer; Infectious Disease Society of America/American Thoracic Society; American College of Emergency Physicians) in older adult ED patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective, observational cohort study of older adult ED patients ≥65 years of age in two U.S. EDs with suspected pneumonia defined as having chest radiography ordered and treating physician suspicion. The standard we used for defining the presence, absence, or inability to determine a diagnosis of pneumonia diagnosis was expert physician chart adjudication. We report the summary statistics for demographic characteristics and symptoms/exam findings and sensitivity, specificity, and likelihood ratios with 95% confidence intervals of the existing diagnostic criteria. Pre-specified cutoff values of a positive LR &gt;10 and a negative LR &lt;0.3 were considered clinically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 135 patients enrolled, 27 had pneumonia by adjudicator review. Typical patient-reported pneumonia symptoms, such as fever (18.5%) and new/worse cough (51.9%), were not consistently present in pneumonia. The IDSA/ATS and ACEP criteria had positive LR &gt;10 and negative LR &lt;0.3; however, all confidence intervals included pre-specified cutoffs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older adults presented to the ED with low frequency of typical pneumonia symptoms. Although existing diagnostic definitions had promising test characteristics, they may not perform well enough for clinical application without refinement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3068-3077"},"PeriodicalIF":4.3,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047670","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":"Individual socioeconomic status, neighborhood disadvantage, and cognitive aging: A longitudinal analysis of the CLSA","authors":"John R. Best PhD","doi":"10.1111/jgs.19155","DOIUrl":"10.1111/jgs.19155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There are likely many contributors to variation in the rate of cognitive decline in middle and late adulthood, including individual and neighborhood socio-economic factors. This study examines whether individual socio-economic factors, namely income and wealth, correlate with cognitive decline, in part, through neighborhood-level social and material disadvantage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the three waves of data collection from the Canadian Longitudinal Study on Aging (CLSA), this study included 51,338 participants between the age of 45 and 85 years at baseline (51% female). Individual socio-economic status (SES) was assessed by annual household income and by the current value of savings and investments. Neighborhood disadvantage was measured by area-based material and social deprivation indices. Cognition was measured at each wave using verbal fluency, mental alternations, and delayed word recall. Latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of individual SES on cognitive change through area-level disadvantage. Multi-group models were constructed on the basis of age-group (45–64 years; 65–74 years; or 75+ years) to allow for varying estimates across age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 45–64-year-olds, income and wealth had indirect effects on initial cognitive level and on rate of cognitive decline through material disadvantage (standardized indirect effects = 0.01, <i>p</i> &lt; 0.001), but only wealth had an indirect effect through social disadvantage (<i>p</i> = 0.019). Among 65-74-year-olds, income and wealth had indirect effects on initial cognitive level (<i>p</i> &lt; 0.01) but not on rate of cognitive decline (<i>p</i> &gt; 0.05), and among 75+ year-olds, no indirect effects were observed (<i>p</i> &gt; 0.05). Wealth and income had direct effects, independent of neighborhood disadvantage, on cognition in all age groups (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among middle-aged adults, greater individual SES may mitigate cognitive decline, in part, by allowing individuals to live in more materially and socially advantaged neighborhoods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3335-3345"},"PeriodicalIF":4.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038126","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":"Veterans' use of inpatient and outpatient palliative care: The national landscape","authors":"Brystana G. Kaufman PhD, MSPH,&nbsp;Sandra Woolson MS,&nbsp;Catherine Stanwyck BA,&nbsp;Madison Burns BS,&nbsp;Paul Dennis PhD,&nbsp;Jessica Ma MD,&nbsp;Shelli Feder PhD, APRN,&nbsp;Joshua M. Thorpe PhD,&nbsp;S. Nicole Hastings MD,&nbsp;David B. Bekelman MD,&nbsp;Courtney H. Van Houtven PhD","doi":"10.1111/jgs.19141","DOIUrl":"10.1111/jgs.19141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010–2017) to describe veteran demographics, socioeconomic status, life-limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241–99245).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (<i>n</i> = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (<i>n</i> = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one-third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3385-3397"},"PeriodicalIF":4.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Peptic ulcers with ChEIs, NSAIDs","authors":"Máté Szilcz PhD,&nbsp;Jonas W. Wastesson PhD,&nbsp;Amaia Calderón-Larrañaga PhD,&nbsp;Daniel Prieto-Alhambra MD, PhD,&nbsp;Pierre-Olivier Blotière PhD,&nbsp;Géric Maura PharmD, PhD,&nbsp;Kristina Johnell PhD","doi":"10.1111/jgs.19133","DOIUrl":"10.1111/jgs.19133","url":null,"abstract":"&lt;p&gt;We sincerely thank Professor Montastruc for their letter.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; We appreciate that our call for further research on the interaction between non-steroidal anti-inflammatory drugs (NSAIDs) and cholinesterase inhibitors (ChEIs) and their effects on peptic ulcer was noticed.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; We value the use of established pharmacovigilance methods for detecting a signal for the drug–drug interaction we identified. Signal detection is an important first step in the process of establishing evidence, which we omitted in our research, where we directly moved to hypothesis testing with pharmacoepidemiologic methods.&lt;/p&gt;&lt;p&gt;Professor Montastruc investigated the drug–drug interaction using disproportionality analyses, which focuses on the differences in the proportion of adverse event reports in a global pharmacovigilance database. They found that the reporting odds ratios of peptic ulcer for the combination of ChEIs and NSAIDs were three times as high as for NSAIDs alone, an effect estimate that is in line with our findings. Furthermore, they highlighted that their study extends our research, as we compared treatment episodes with no treatment, whereas they compared the combination treatment with NSAIDs alone.&lt;/p&gt;&lt;p&gt;To quantify the comparison between combination of ChEIs and NSAIDs and NSAIDs alone, similarly to Montastruc, we performed a post hoc analysis on the results obtained from our self-controlled case series study. We found that the incidence rate ratio of peptic ulcer with concomitant use of ChEIs and NSAIDs is 1.74 (95% confidence interval: 1.27–2.38) compared to NSAIDs alone. This is a slightly smaller effect size than reported by Montastruc. This discrepancy could be due to the fact that Montastruc calculated &lt;i&gt;reporting&lt;/i&gt; odds ratios, which might overestimate the true risk of adverse effects in pharmacovigilance databases, especially in the case of drug–drug interactions.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We appreciate that our work has inspired further research on the topic, but there are necessary next steps. Following the detected signal from Montastruc and our pharmacoepidemiologic research, future studies should use big data, for example via federated networks of health data.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Analyzing a large cohort would potentially allow for the examination of subgroups, such as different combinations of chemical substances in ChEIs (e.g., donepezil, rivastigmine, galantamine) and NSAIDs (e.g., diclofenac, naproxen, ibuprofen), and their effects on bleeding or non-bleeding peptic ulcers—analyses we could not perform. Increasing the size of the study population via federated networks would further enhance precision and enable wider generalizability of the results. Ultimately, when enough evidence is gathered, concomitant ChEIs and NSAIDs use should be carefully evaluated and potentially included in guidelines to prevent inappropriate medication use, ensuring better safety and outcomes for patients.&lt;","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3612-3613"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019934","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}