Journal of the American Geriatrics Society最新文献

{"title":"RETRACTION: The Prevalence of Dementia in Older People in an Urban Population of Korea: The Seoul Study","authors":"","doi":"10.1111/jgs.19574","DOIUrl":"10.1111/jgs.19574","url":null,"abstract":"<p>\u0000 \u0000 <b>RETRACTION</b>: <span>D. Y. Lee</span> MD, PhD, <span>J. H. Lee</span> MD, PhD, <span>Y-S. Ju</span> MD, PhD, <span>K. U. Lee</span> PhD, <span>K. W. Kim</span> MD, PhD, <span>J. H. Jhoo</span> MD, <span>J. C. Yoon</span> MD, <span>J. Ha</span> RN, <span>J. I. Woo</span> MD, PhD. <span>The Prevalence of Dementia in Older People in an Urban Population of Korea: The Seoul Study</span>, <i>Journal of the American Geriatrics Society</i> <span>50</span>, no. <span>7</span> (<span>2002</span>): <span>1233</span>–<span>1239</span>, https://doi.org/10.1046/j.1532-5415.2002.50310.x\u0000 \u0000 </p><p>The above article, published online on 7 August 2002, on Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Joseph G. Ouslander; the American Geriatrics Society; and Wiley Periodicals LLC. The retraction has been agreed because the authors had not obtained permission to use the primary instrument of research reported in the article. The authors were contacted for comment, but did not respond.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19574","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546678","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":"Associations of CT Muscle Area and Density With Functional Outcomes and Mortality Across Anatomical Regions in Older Men","authors":"Megan Hetherington-Rauth,&nbsp;Tyler A. Mansfield,&nbsp;Leon Lenchik,&nbsp;Ashley A. Weaver,&nbsp;Peggy M. Cawthon","doi":"10.1111/jgs.19583","DOIUrl":"10.1111/jgs.19583","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The automated segmentation of computed tomography (CT) images has made their opportunistic use more feasible, yet, the association of muscle area and density from multiple anatomical regions with functional outcomes and mortality risk in older adults has not been fully explored. We aimed to determine if muscle area and density at the L1 and L3 vertebra and right and left proximal thigh were similarly related to functional outcomes and 10-year mortality risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Men from the Osteoporotic Fractures in Men (MrOS) study who had CT images, measures of grip strength, 6 m walking speed, and leg power (Nottingham Power Rig) at the baseline visit were included in the analyses (<i>n</i> = 3290, 73.7 ± 5.8 years). CT images were automatically segmented to derive muscle area and muscle density. Deaths were centrally adjudicated over a 10-year follow-up. Linear regression and proportional hazards were used to model relationships of CT muscle metrics with functional outcomes and mortality, respectively, while adjusting for covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Muscle area and density were positively related to functional outcomes regardless of anatomical region, with the most variance explained in leg power (adjusted <i>R</i>\u0000 ² = 0.40–0.46), followed by grip strength (adjusted <i>R</i>\u0000 ² = 0.25–0.29) and walking speed (adjusted <i>R</i>\u0000 ² = 0.18–0.20). A one-unit SD increase in muscle area and density was associated with a 5%–13% and 8%–21% decrease in the risk of all-cause mortality, respectively, with the strongest associations observed at the right and left thigh.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Automated measures of CT muscle area and density are related to functional outcomes and risk of mortality in older men, regardless of CT anatomical region.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2717-2726"},"PeriodicalIF":4.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532095","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":"Advancing Age and Risk From the Elevated Atherogenic Index: Triglyceride (TG) to High-Density Cholesterol (HDL-C) Ratio","authors":"Manish Kumar,&nbsp;Shangshu Zhao,&nbsp;Peter Robinson,&nbsp;George A. Kuchel,&nbsp;Richard H. Fortinsky,&nbsp;Ariela R. Orkaby,&nbsp;Karen P. Alexander,&nbsp;Paul D. Thompson,&nbsp;John A. Batsis,&nbsp;Chia-Ling Kuo","doi":"10.1111/jgs.19607","DOIUrl":"10.1111/jgs.19607","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low-density lipoprotein cholesterol (LDL-C) is associated with atherosclerotic cardiovascular disease (ASCVD), but this association diminishes with age. The triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio, also known as the atherogenic index, is a surrogate marker for small-density low-density lipoprotein cholesterol (sdLDL-C), a more specific LDL-C biomarker associated with ASCVD. It is unclear if age influences the association between the atherogenic index and incident ASCVD. We aimed to assess the influence of advancing age and an elevated atherogenic index on the risk of ASCVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included UK Biobank participants without self-reported, pre-existing ASCVD and with available lipid biomarkers. We then estimated the effect of age on the associations between TG: HDL-C quintiles and incident ASCVD using a nonlinear Cox regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from 342,979 participants were analyzed. The mean age was 56 ± 8 years (55% females), and the mean duration of follow-up was 12.7 ± 2.8 years. Individuals who developed clinical ASCVD were older (mean age at baseline 60 vs. 56 years, <i>p</i> &lt; 0.001) and had a higher mean TG to HDL-C ratio (3.72 vs. 3.03, <i>p</i> &lt; 0.001). Higher quintiles of the TG/HDL-C ratio (Q2–Q5) were associated with an increased risk of ASCVD compared to the first quintile (Q1) across all age groups up to 65 years. However, there was a declining risk with advancing age, as indicated by the HR for Q5 versus Q1 at ages 45, 55, and 65, which were 1.60, 1.37, and 1.07, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The association between the TG/HDL-C ratio (atherogenic index) and incident ASCVD steadily attenuates with age. In adults over 65, an elevated ratio may be associated with a lower risk of incident ASCVD. These findings may reflect changes in metabolic atherosclerotic risk or a survival effect associated with aging and require further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2738-2746"},"PeriodicalIF":4.5,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532083","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":"A Multimodal Fall Prevention Intervention in the Setting of the Emergency Department","authors":"Joshua D. Niznik,&nbsp;Cassandra Small,&nbsp;Casey J. Kelley,&nbsp;Jessica McMullen,&nbsp;Greta Anton,&nbsp;Ellen Roberts,&nbsp;Sophia Lourduraj,&nbsp;Martin F. Casey,&nbsp;Jan Busby-Whitehead,&nbsp;Katie Davenport","doi":"10.1111/jgs.19613","DOIUrl":"10.1111/jgs.19613","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The emergency department (ED) is an opportune setting for fall prevention interventions. We implemented and evaluated a multimodal falls prevention intervention addressing medications, mobility, and functional risk factors among older adults presenting to the ED for fall-related injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We implemented a quality improvement intervention at two hospitals among ED visits for adults aged 65 and older with a chief complaint of fall between May 2023 and June 2024. The intervention included: (1) medication review by a pharmacist; (2) assessment by physical therapy (PT); and (3) assessment by occupational therapy (OT). We conducted a retrospective evaluation of electronic health records and reported the proportion of patients that received screening along with risk factors, recommendations, adherence to recommendations, and return visits at 3 and 6 months. We used logistic regression to examine factors associated with return visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 686 older adults who received ≥ 1 screening. Most patients received PT and OT evaluations (94.8% and 93.4%), while fewer (15.2%) received medication reviews. The most common problems identified by PT and OT were fall risk, decreased mobility, and impaired balance. Discharge to a skilled nursing facility was the most common recommendation (55.5% PT, 55.1% OT) followed by home care (33.1% PT, 31.2% OT). High-risk medications most often identified were anticoagulants, antidepressants, and gabapentin. The most common recommendation was to “discuss with a primary care physician.” Among those who received ≥ 1 intervention, 8.9% experienced a return visit within 3 months and 12.8% within 6 months. Inpatient admission was associated with increased likelihood of return visits compared to discharge from the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The most prevalent risk factors for falls among older adults presenting to the ED are likely modifiable through PT and OT intervention. Further research is needed to address uptake barriers and longitudinal impact on outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2780-2788"},"PeriodicalIF":4.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover","authors":"Achamyeleh Birhanu Teshale,&nbsp;Htet Lin Htun,&nbsp;Mor Vered,&nbsp;Alice J. Owen,&nbsp;Joanne Ryan,&nbsp;Kevan R. Polkinghorne,&nbsp;Monique F. Kilkenny,&nbsp;Andrew Tonkin,&nbsp;Rosanne Freak-Poli","doi":"10.1111/jgs.18438","DOIUrl":"10.1111/jgs.18438","url":null,"abstract":"<p><b>Cover caption</b>: Conceptual framework: Social determinants and traditional risk factors impacting cardiovascular disease. See the related article by Teshale et al., pages 1797-1807.\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 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503149","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":"Resident Physician Experiences of Discharging Hospitalized Older Adults to Skilled Nursing Facilities","authors":"Bingyan Shi,&nbsp;Margaret C. Fang,&nbsp;Rebecca L. Sudore,&nbsp;Audrey Lyndon,&nbsp;Tasce Bongiovanni,&nbsp;James D. Harrison","doi":"10.1111/jgs.19592","DOIUrl":"10.1111/jgs.19592","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2973-2975"},"PeriodicalIF":4.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510116","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":"Function Focused Care in Acute Care: A Philosophy","authors":"Fatima Naqvi,&nbsp;Tahira Lodhi","doi":"10.1111/jgs.19601","DOIUrl":"10.1111/jgs.19601","url":null,"abstract":"&lt;p&gt;Cognitive deficits in older adults pose significant challenges in all healthcare settings, particularly in acute care hospitals. These challenges often lead to a higher incidence of delirium, extended hospital stays, increased pain, and a decline in functional abilities [&lt;span&gt;1-4&lt;/span&gt;]. In this issue of JAGS, Resnick et al. [&lt;span&gt;5&lt;/span&gt;] provide evidence that function focused care (FFC) in the acute care hospital (AC) implemented through the Evidence Integration Triangle (EIT) [&lt;span&gt;6&lt;/span&gt;] helps prevent functional decline and enhances physical activity in patients living with dementia.&lt;/p&gt;&lt;p&gt;This nurse-led initiative is based on a care philosophy rather than a structured mobility program. The philosophy incorporates elements of the Social Ecological Model, Social Cognitive Theory, and the EIT. A key aspect of this approach is the understanding that self-efficacy and expectations of outcomes influence behavior. The EIT brings together stakeholders including the nurse champions, unit managers, rehabilitation therapists, social workers, quality improvement staff, and a research nurse facilitator. They engaged hospitalized patients with dementia in several ways: by observing others performing the activities, receiving verbal encouragement to participate themselves, and experiencing the positive feelings associated with those activities.&lt;/p&gt;&lt;p&gt;The study is a clustered randomized clinical trial with an intervention consisting of patients who received function focused care by the stakeholder teams. The control group was patients who received education only about function focused care. Both the intervention group (FFC-AC-EIT) and the function-focused education-only group (FFC-EO) demonstrated an increase in function and physical activity over the course of their hospital stay. Notably, these improvements in function and physical activity were sustained in the intervention group in the month after discharge from the hospital compared to the control group. In addition, the patients who received FFC-AC-EIT had less increase in pain, delirium, and neuropsychiatric behaviors during hospitalization compared to the control group. However, these findings were not significantly carried through 1 month after discharge from the hospital, which may be due to the challenges assessing pain, delirium, and dementia-associated behaviors in these patients.&lt;/p&gt;&lt;p&gt;Hospitalization is a sentinel event for a patient living with dementia. It can present with unique challenges, often associated with increased cognitive decline and potential adverse outcomes alongside management of acute illness [&lt;span&gt;1, 2&lt;/span&gt;]. Despite the challenges associated with a post Covid healthcare scenario, with differing hospital policies, rates of staff turnover, different types of dementia patients, and coincident multimorbidity, this study provides an anchor for models of Age Friendly Health Systems to provide individualized, comprehensive care to hospitalized patients with dementia","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2336-2337"},"PeriodicalIF":4.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19601","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513023","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":"Enhancing Geriatric Knowledge and Board Certification Outcomes Through AGS Pre-Conference Board Review Course","authors":"Renee Flores,&nbsp;Rachel Jantea,&nbsp;Lynn M. Wilson,&nbsp;Amanda Lathia,&nbsp;Sarwat Jabeen,&nbsp;Sivan Ben Moshe,&nbsp;Becky Powers","doi":"10.1111/jgs.19593","DOIUrl":"10.1111/jgs.19593","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The American Geriatrics Society (AGS) Board Review Course aims to enhance geriatric knowledge and increase the number of board-certified geriatricians. This study evaluated the feasibility of offering the course both virtually and in-person at a national conference and assessed whether participation improved confidence and supported board certification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between May 2021 and May 2022, 233 participants (196 virtual, 37 in-person) completed precourse and postcourse surveys. Participants included first-time test-takers and those seeking recertification through the American Board of Internal Medicine (ABIM), American Board of Family Medicine (ABFM), or Osteopathic Boards (AOBIM, AOBFP). Subgroup analyses compared virtual versus in-person formats and internal medicine (IM) versus family medicine (FM) backgrounds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 233 participants, 114 pursued initial certification, 70 recertification, and 49 had unspecified certification status. Postcourse follow-up showed 172 (74%) achieved board certification (167 ABIM or ABFM; 5 AOBIM or AOBFP), 28 remained uncertified, and 33 had unknown status. Confidence significantly improved, with pretest scores averaging 64.3 (2021) and 60.6 (2022), aligning with precourse self-assessments. Some discrepancies emerged between confidence and performance in geriatric syndromes and functional assessment. Course satisfaction was high, particularly with content delivery and board preparation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Offering the AGS Board Review Course during the annual meeting was feasible and effective in boosting participants' confidence and supporting board certification, with pass rates comparable to national averages. These findings highlight the course's value and suggest future research should focus on optimizing delivery methods and addressing persistent knowledge gaps in geriatric education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2539-2544"},"PeriodicalIF":4.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487577","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":"Boarding in Emergency Department Hallways Circa 2025: Why Older Adult Patients Deserve Better","authors":"Jesse M. Pines,&nbsp;Raj M. Ratwani,&nbsp;Edward R. Melnick","doi":"10.1111/jgs.19602","DOIUrl":"10.1111/jgs.19602","url":null,"abstract":"&lt;p&gt;Over the past three decades, the hospital practice of emergency department (ED) boarding and the crowding that results from it have been regularly and consistently named as a public health crisis. Yet, despite repeated stakeholder discussions and engagement, no broad policy solutions nor durable, structural changes in ED care have addressed the ED boarding crisis and its negative effect on patient care and outcomes in a meaningful way. Recent evidence has shown that the problem has worsened substantially since the onset of the COVID-19 pandemic [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;A missing element in these repeated calls for action is the lived experience of geriatric ED boarders. A study in this issue of the &lt;i&gt;Journal of the American Geriatric Society&lt;/i&gt; performed at the Massachusetts General Hospital titled “Hallways Feel Like Homelessness,” fills that gap [&lt;span&gt;2&lt;/span&gt;]. It offers an insightful look into the experience and perceptions of geriatric ED boarders—ill older adults admitted to the hospital who experienced long delays in the ED to be transferred to their inpatient beds.&lt;/p&gt;&lt;p&gt;The study presents a qualitative analysis of 26 patients aged 65 and older who boarded in the ED for at least 4 h. The mean age of participants was 77 years. Through their own words, the authors present a window into a world where stretchers become beds, noise replaces rest, and naked vulnerability is on display. The authors found that patients were not just distressed by their long waits. Geriatric ED boarders felt powerless, exposed, and forgotten. For some, boarding in a hallway was likened to being homeless or imprisoned. One participant described the experience as being “in exile.” The irony of this sentiment should not be lost when considering the origin of the word &lt;i&gt;hospital&lt;/i&gt;, from French and medieval Latin, meaning a place of reception for guests, with the words, hotel and hostel, coming from the same origin. Given this origin, the lack of hospitality in the hospital described in this study is disturbing.&lt;/p&gt;&lt;p&gt;The hospital practice of ED boarding is not just about a lack of creature comforts. Nearly 20 years of literature have found the practice to be directly harmful to the ill and injured—linked to increased delirium, longer hospitalizations, and higher mortality [&lt;span&gt;3-5&lt;/span&gt;]. The deleterious effects are magnified in vulnerable older adults [&lt;span&gt;6&lt;/span&gt;]. The voices in this study tell us something the quantitative study data cannot: how older patients internalize these conditions, what they observe, and what they fear. Geriatric ED boarders are starkly aware of being placed in locations that lack basic safety features—no call bells, no privacy, and sometimes not even food.&lt;/p&gt;&lt;p&gt;A notable study finding was that participants did not blame their doctors or nurses. They reserved their criticism for the physical environment and the hospital systems that tolerate it. This distinction is vital. The healthcare workforce is compassionate and dedicate","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2331-2332"},"PeriodicalIF":4.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19602","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478339","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":"Right Message and Right Time: Maximizing Effect of Patient-Directed Education to Promote Deprescribing","authors":"Amy M. Linsky,&nbsp;Kristin M. Zimmerman","doi":"10.1111/jgs.19604","DOIUrl":"10.1111/jgs.19604","url":null,"abstract":"&lt;p&gt;The prevalence of and harms associated with polypharmacy and potentially inappropriate medications (PIMs) in older adults have been well explicated. Benzodiazepine receptor antagonists have significant risks for older adults and are categorized as “potentially inappropriate” on the 2023 Beers Criteria, leading them to be a frequent target of medication safety efforts [&lt;span&gt;1&lt;/span&gt;]. Deprescribing, an intervention aimed at optimizing medication use, is defined as the supervised cessation or dose reduction of medication. Common implementation strategies to increase deprescribing include system-level changes, clinician-directed, or patient-directed [&lt;span&gt;2-4&lt;/span&gt;]. Patient-directed deprescribing strategies are specifically designed to engage and educate patients as active participants in and initiators of decision-making, rather than relying on the clinician or healthcare system to spark change. Such strategies can include written materials, verbal counseling, or digital interfaces. In contrast, clinician-directed strategies focus on changing prescribing behavior, often via guidelines, electronic health record alerts, or academic detailing. The seminal EMPOWER study of benzodiazepine deprescribing among community dwelling older adults presented an effective, low-tech, highly adaptable model of a patient-directed deprescribing strategy and garnered significant attention to more widely adapt and disseminate. It is unsurprising that the low-tech simplicity of patient-directed materials is alluring, especially in the context of complex health systems and difficulty changing prescriber behavior. Further, deprescribing tightly aligns with the expansion of Age Friendly Health Systems (AFHS) and the centrality of “what matters most” to patients [&lt;span&gt;5&lt;/span&gt;]. This approach also echoes the American Geriatrics Society's Guiding Principles for the Care of Older Adults with Multimorbidity, which underscores the importance of incorporating patient goals and preferences into shared decision-making [&lt;span&gt;6&lt;/span&gt;]. In the years since EMPOWER, there have been numerous studies of patient-directed strategies to increase deprescribing of benzodiazepines and other medication classes.&lt;/p&gt;&lt;p&gt;McEvoy and colleagues sought to assess the impact of patient-directed, non-pharmacological strategies to deprescribe benzodiazepine receptor antagonists (i.e., benzodiazepines and z-drugs) used to treat insomnia in adults aged 65 years and older and in people living with cognitive impairment [&lt;span&gt;7&lt;/span&gt;]. They identified 17 reports from 16 studies; given the heterogeneity of the interventions and the settings, the results were summarized by narrative review. Papers were broadly categorized as either solely patient-directed education or multi-component (e.g., addition of prescriber-directed activities), with further division by whether the patient education was written, verbal, or both. Of the solely patient-directed educational studies, six featured written materials ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2654-2656"},"PeriodicalIF":4.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478340","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}