Journal of the American Geriatrics Society最新文献

{"title":"Deprescribing in Older Adults With Type 2 Diabetes: Associations With Patients' Perspectives: The Diabetes and Aging Study","authors":"Melissa M. Parker,&nbsp;Kasia J. Lipska,&nbsp;Lisa K. Gilliam,&nbsp;Richard W. Grant,&nbsp;Shanzay Haider,&nbsp;Elbert S. Huang,&nbsp;Rajesh K. Jain,&nbsp;Neda Laiteerapong,&nbsp;Jennifer Y. Liu,&nbsp;Howard H. Moffet,&nbsp;Andrew J. Karter","doi":"10.1111/jgs.19352","DOIUrl":"10.1111/jgs.19352","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Little is known about how patients' preferences, expectations, and beliefs (jointly referred to as perspectives) influence deprescribing. We evaluated the association of patients' self-reported perspectives with subsequent deprescribing of diabetes medications in older adults with type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Longitudinal cohort study of 1629 pharmacologically treated adults ages 65–100 years with type 2 diabetes who received care at Kaiser Permanente of Northern California (KPNC) and participated in the Diabetes Preferences and Self-Care survey (2019). The survey asked questions about perspectives regarding the use of diabetes medications. Deprescribing was identified during the 24 months following the survey and defined as any of the following: discontinuation of one or more therapeutic classes, reduction in frequency of daily dosing, reduction in total daily pill count, or reduction in total daily dose for oral hypoglycemic agents. Rates of deprescribing and measures of relative risk were calculated for patients' perspectives and select clinical factors. Models predicting deprescribing were adjusted for age, sex, race/ethnicity, health literacy, baseline number of diabetes medications, duration of diabetes, overtreatment per Endocrine Society guidelines, and KPNC eligibility for targeted deprescribing and weighted to account for the age-stratified complex sampling design and survey response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six hundred seventy-three (38%) patients experienced deprescribing over a mean follow-up of 23 months. Deprescribing was significantly associated with the following patient perspectives: not expecting to need diabetes medication for life (RR = 1.48, 95% CI: 1.07–2.03) and not recognizing that taking fewer medications could lead to higher blood sugar levels (RR = 1.31, 95% CI: 1.09–1.58).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients' perspectives may enable or hinder deprescribing, emphasizing the importance of soliciting these perspectives during shared decision-making. Effective deprescribing will benefit from understanding patients' perspectives and fostering patient–provider communication about medication changes throughout the disease course.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1155-1167"},"PeriodicalIF":4.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960595","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":"Scaling and spreading age-friendly care: Early lessons from the VA National Age-Friendly Action Community","authors":"Andrea Wershof Schwartz MD, MPH, AGSF,&nbsp;Shannon Munro PhD, APRN, BC, NP,&nbsp;Katharina V. Echt PhD,&nbsp;Anna Mirk MD,&nbsp;Laurence M. Solberg MD, AGSF,&nbsp;Kimberly Wozneak MS","doi":"10.1111/jgs.19321","DOIUrl":"10.1111/jgs.19321","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Age-Friendly Health System (AFHS) initiative seeks to improve care for older adults through assessing and acting on the 4Ms (What Matters, Medication, Mentation, Mobility). The Department of Veterans Affairs (VA) joined the initiative in 2020, and from 2022 to 2023, VA led its first Age-Friendly Action Community, a 7-month online educational series to teach clinicians about implementing the 4Ms across VA care settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The VA Action Community was designed to spread awareness about Age-Friendly care for older Veterans, improve interprofessional team knowledge for providing care guided by the 4Ms, and support AFHS implementation across multiple care settings. The VA Action Community included online synchronous webinars, Community of Practice coaching calls, and office hours. A learner experience questionnaire was administered at the completion of the Action Community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Totally 186 care teams enrolled in the VA Action Community, representing 78/171 (45.6%) VA medical centers (VAMCs), across 36 US states and 20 types of care settings. Participants reported high rates of satisfaction and confidence in their ability to apply the knowledge and skills learned. Overall, 58 Action Community teams earned Level 1, Participant recognition, and 43 teams also earned Level 2, Committed to Care Excellence recognition from the Institute for Healthcare Improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The VA Action Community facilitated learning about the 4Ms, supported interprofessional teams in earning AFHS recognition, and offers a promising model for spreading AFHS in other large health systems. Further work is underway to evaluate the impact of this educational experience on clinical process and outcomes measures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"583-591"},"PeriodicalIF":4.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960661","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":"Prevalence of Depression in Older Adults and the Potential Protective Role of Volunteering: Findings From the LongROAD Study","authors":"Yitao Xi,&nbsp;Thelma J. Mielenz,&nbsp;Howard F. Andrews,&nbsp;Linda L. Hill,&nbsp;David Strogatz,&nbsp;Carolyn DiGuiseppi,&nbsp;Marian E. Betz,&nbsp;Vanya Jones,&nbsp;David W. Eby,&nbsp;Lisa J. Molnar,&nbsp;Barbara H. Lang,&nbsp;Guohua Li","doi":"10.1111/jgs.19349","DOIUrl":"10.1111/jgs.19349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As the US population continues to age, depression and other mental health issues have become a significant challenge for healthy aging. Few studies, however, have examined the prevalence of depression in community-dwelling older adults in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Baseline data from the Longitudinal Research on Aging Drivers study were analyzed to examine the prevalence and correlates of depression in a multisite sample of community-dwelling adults aged 65–79 years who were enrolled and assessed between July 2015 and March 2017. The Patient-Reported Outcomes Measurement Information System (PROMIS) depression scale was used to determine the depression status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 2990 study participants, 186 (6.2%) had depression at the time of assessment. Elevated prevalence of depression was found in those who were 65–69 years of age (7.9%); were women (7.2%); were not married (8.1%); had attained an education of high school or less (8.3%); or had annual household incomes less than $50,000 (10.7%). Older adults with a positive history of depression or chronic medical conditions (e.g., diabetes mellitus and anxiety) had a significantly higher prevalence of depression whereas those engaged in volunteering activities had a significantly lower prevalence of depression. With adjustment for demographic characteristics and comorbidities, volunteering was associated with a 43% reduction in the odds of depression (adjusted odds ratio: 0.57, 95% confidence interval 0.40–0.81).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The point prevalence of depression in this multisite sample of community-dwelling older adults in the United States was 6.2%, which varied significantly with demographic characteristics and comorbid conditions. Engagement in volunteering activities might help older adults to reduce their risk of depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1041-1048"},"PeriodicalIF":4.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960652","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":"Successful Aging and the Nonagenarian Community Servant","authors":"Dalane W. Kitzman","doi":"10.1111/jgs.19358","DOIUrl":"10.1111/jgs.19358","url":null,"abstract":"&lt;p&gt;The people of western North Carolina, struggling to recover from hurricane Helene, the most devastating natural disaster in the recorded history of the area, recently received an assist from an unusual source. As soon as the governor announced that nonemergency travel to the area was allowed again, Robert “Bob” Sink leapt into action. Over the past two decades and along with others in our church congregation, Bob has many times loaded up a dedicated disaster recovery trailer they have equipped with generators, chainsaws, and other tools, and traveled throughout the United States to spend several weeks helping with cleanup, clearing, rebuilding, and other recovery efforts following a natural disaster. Bob and the other members of the team have made dozens of such trips, including following in the aftermaths of the devastating hurricanes Katrina in 2006 and Floyd in 1999.&lt;/p&gt;&lt;p&gt;However, the disaster recovery team's youngest member is now nearing age 80, and Bob is 93 years old. So, in the aftermath of Helene, the team decided on a different approach this time—they would quickly refurbish the trailer, fill it with donated equipment and supplies, and take it to Boone, North Carolina, to donate to an awaiting disaster recovery organization.&lt;/p&gt;&lt;p&gt;While other team members were collecting goods, including electrical generators and kerosene heaters, Bob went to work on the trailer. He replaced all the old wooden floorboards, cleaned out all the mildew and mold, greased the axles, repaired the taillights, located the registration, and helped find the title to the trailer they had purchased decades ago, so it could be officially transferred to the new organization.&lt;/p&gt;&lt;p&gt;This is what Bob has done all his life—he cares for and helps others and enthusiastically serves his community. He served in the army signal corps during the Korean conflict. Afterward, he became a public servant for the city of Lexington, North Carolina, as superintendent for natural gas. Although he retired over 35 years ago, the staff at his former department still call him for help and advice. My favorite example is a phone call he received a few months ago. “Bob, can you remember the location of the natural gas connection near Main Steet?” Without hesitation, Bob replied, “Well, we installed it in ’67. It should be 14 feet east of the stop sign at the southwest corner of Sixth and Main, 6 feet below the pavement grade, and connected with a brass collar.” Indeed, that is where it was found, 57 years after Bob supervised its installation.&lt;/p&gt;&lt;p&gt;Bob married his high school sweetheart, Louise, in 1953. They had delayed marriage for 4 years while Louise finished nursing school (marriage was forbidden for nursing students at the time) and Bob finished his military service. They were married 64 years before Louise died 7 years ago at age 86. When Louise developed multiple severe medical problems, including heart failure and multiple debilitating strokes, I started checking on Bob regularl","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1288-1291"},"PeriodicalIF":4.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960574","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":"Reply to Comment on: Clinical Performance of Existing Diagnostic Criteria for Pneumonia in Older Emergency Patients","authors":"Katherine M. Hunold,&nbsp;Jeffrey M. Caterino","doi":"10.1111/jgs.19347","DOIUrl":"https://doi.org/10.1111/jgs.19347","url":null,"abstract":"<p>Thank you to Turgut et al. for their careful review of our manuscript “Clinical performance of existing diagnostic criteria for pneumonia in older emergency patients: a prospective cohort study.” We would like to address each of their comments below.</p><p>In Table 1 [<span>1</span>], in accordance with the STROBE guidelines we chose to present raw data for the demographic/descriptive data without conducting post hoc analyses or presenting <i>p</i>-values [<span>2</span>]. When we conduct these statistical tests, all <i>p</i>-values are &gt; 0.20 except race, which is &lt; 0.001. Regardless of which correction is used for multiple comparisons; the interpretation of these <i>p</i>-values would be the same and only race would be significant.</p><p>Our goal was to describe the performance of diagnostic criteria derived and validated in other settings and to determine if their performance was sufficient for the acute care setting. The study was powered to achieve this goal [<span>1</span>]. We did not seek to and were not powered to rederive or to test various iterations/cutoffs of the previously published criteria. Therefore, there was no ROC curve analysis to perform. We agree that rigorous derivation and validation of a more effective rule is critical and being pursued in our ongoing work [<span>3</span>].</p><p>We agree that long-term patient-centered clinical outcomes must be considered including the side effects of inappropriately prescribed medications (over-diagnosis) [<span>4</span>] and the delay of appropriate medications (under-diagnosis) [<span>5, 6</span>]. The request for patient-centered outcomes such as these is an important but different study that we and others have attempted to answer with results consistently demonstrating potential patient harm from both types of mis-diagnosis [<span>7-9</span>]. Notably previous results demonstrated high diagnostic uncertainty [<span>10</span>], supporting the assertion that before we can affect those outcomes in a prospective study, we must ensure that we can accurately and reliably diagnose pneumonia in the emergency department. While we were not powered to report on outcomes such as mortality, we have previously published on some patient-centered outcomes such as functional decline in this study population.</p><p>Unfortunately, in older adults, accurate diagnosis of pneumonia in the emergency department remains a challenge and thus, we agree with Turgut et al., that this is an important research priority and hope that our ongoing work can contribute to improving the care of older adult emergency department patients.</p><p>K.M.H. and J.M.C. obtained funding for this work and conceived the idea for this manuscript. K.M.H. and J.M.C. drafted the manuscript, performed revisions and contributed their expertise in the area.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1316-1317"},"PeriodicalIF":4.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19347","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770039","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":"Comment on: Clinical Performance of Existing Diagnostic Criteria for Pneumonia in Older Emergency Patients: A Prospective Cohort Study","authors":"Zeynep Iclal Turgut,&nbsp;Emre Ozkan,&nbsp;Orhan Cicek,&nbsp;Mustafa Hakan Dogan,&nbsp;Ilyas Akkar,&nbsp;Merve Yilmaz Kars,&nbsp;Muhammet Cemal Kizilarslanoglu","doi":"10.1111/jgs.19348","DOIUrl":"https://doi.org/10.1111/jgs.19348","url":null,"abstract":"&lt;p&gt;We have read the recently published article “Clinical performance of existing diagnostic criteria for pneumonia in older emergency patients: A prospective cohort study” on pneumonia in older adults seen in the emergency department with great interest [&lt;span&gt;1&lt;/span&gt;]. The study, with its robust design and well-written methods, provides valuable insights, particularly regarding the diagnostic performance of various pneumonia criteria [&lt;span&gt;1&lt;/span&gt;]. However, we would like to highlight some minor points that may further strengthen the findings, building on the solid foundation of the study's design and methods.&lt;/p&gt;&lt;p&gt;First, because some characteristics were significantly different in the three groups in the table, post hoc analyses would be helpful in better understanding where these differences were derived (e.g., post hoc Bonferroni adjusted &lt;i&gt;z&lt;/i&gt;-test for chi-squared test).&lt;/p&gt;&lt;p&gt;Secondly, while &lt;i&gt;p&lt;/i&gt;-values were presented for some comparisons in tab. 2, they were notably absent for the demographic characteristics in tab. 1. Without &lt;i&gt;p&lt;/i&gt;-values for age, gender, race, marital status, and education level, assessing whether these factors significantly differed between the pneumonia and non-pneumonia groups is difficult. Including these &lt;i&gt;p&lt;/i&gt;-values would provide a clearer understanding of the role of demographic factors and others in pneumonia diagnosis and enhance the interpretation of the results [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Additionally, a receiver operating characteristic (ROC) curve analysis would have helped illustrate the discriminative ability of the criteria, offering a more comprehensive view of the data [&lt;span&gt;3&lt;/span&gt;]. Although sensitivity, specificity, and negative and positive predictive values of the different diagnosing criteria for pneumonia were given, it would be better to document these relations with the help of ROC analyses. It would provide some cutoff values, the area under the curve (AUC) levels, &lt;i&gt;p&lt;/i&gt;-values, sensitivity, specificity, and negative and positive predictive values; moreover, it would be possible to compare these calculated AUCs to decide which criteria were more predictive in diagnosing pneumonia.&lt;/p&gt;&lt;p&gt;Furthermore, it would be better considering pneumonia's clinical outcomes, including mortality and requiring intensive care unit (ICU) admission, in the analyses. Considering the severity of pneumonia in individuals aged 65 and older, these outcomes are essential for assessing the effectiveness of diagnostic methods. ICU admission rates and mortality data would provide additional insights into the clinical implications of early diagnosis and management strategies in this population [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Finally, while the study highlighted the problem of overdiagnosis, it did not address the potential side effects of medications prescribed in these cases. Overdiagnosis may lead to unnecessary antibiotic use, particularly when pneumonia is misdiagnosed or treated empirically. However, by addr","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1314-1315"},"PeriodicalIF":4.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770040","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":"Neighborhoods, Networks, and Neurodegeneration: A Call for Population-Level Policy and Advancing the Exposome","authors":"Ganesh M. Babulal","doi":"10.1111/jgs.19333","DOIUrl":"10.1111/jgs.19333","url":null,"abstract":"&lt;p&gt;The past three decades of aging research has rapidly grown with significant federal funding from the National Institutes of Health/National Institutes on Aging, which has been matched by exponential growth in identifying and measuring various risk factors for mild cognitive impairment (MCI) and dementia [&lt;span&gt;1&lt;/span&gt;]. While preclinical AD and MCI have received significant interest in screening and early assessment, limited studies have examined the role of social and environmental factors in risk prediction across diverse samples. Structural and social determinants of health (S/SDOH) are social, economic, and political conditions exerting synergistic direct/indirect effects on health outcomes [&lt;span&gt;2&lt;/span&gt;]. Micro-to-macro-level factors like greenspace, air pollution, poverty, mobility, crime, and interpersonal biases interact within S/SDOH across the life course to create and intensify disparities for specific groups [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;This timely and compelling study [&lt;span&gt;4&lt;/span&gt;] by Dr. Mary Ganguli and colleagues leveraged two well-characterized, diverse, population-based cohorts (Monongahela-Youghiogheny Healthy Aging Team [MYHAT], Seniors Project 15104 [SP15104]) to examine the intersections of social and environment-level factors on the risk of MCI among older adults. The study's cross-sectional analysis of over 2800 older adults reveals striking associations between MCI and several community-level factors, including neighborhood disadvantage, schooling, air pollution, limited greenspace, and elevated local violent crime/homicide rates. The results emphasize how systemic inequities and chronic environmental exposures accumulate and compound to increase vulnerabilities in cognitive functioning among participants recruited from under-resourced, post-industrial towns in Pennsylvania. Key findings show that area deprivation and air pollution disproportionately affected participants racialized as Black, demonstrating the interplay of race as a social construct, geographic location, and environmental exposure. These findings resonate with the broader public health literature, which consistently identifies the compounding effects of systemic racism and poverty on health outcomes and dementia risk [&lt;span&gt;5&lt;/span&gt;]. The study also highlights the consideration of early-life education, specifically schooling in the southern United States, which was linked to elevated odds of MCI, centralizing the role of historical inequities in education quality and their long-term health implications.&lt;/p&gt;&lt;p&gt;The study's emphasis on S/SDOH challenges the paradigm that cognitive health can be preserved solely through individual-level interventions, such as lifestyle modifications or obtaining regular clinical care. While encouraging older adults to adopt brain-healthy behaviors remains crucial, these findings emphasize addressing distal upstream factors, such as urban planning, environmental regulations, and community safety. For example, the associati","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"340-342"},"PeriodicalIF":4.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934192","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":"Antihypertensive Deprescribing and Functional Status in VA Long-Term Care Residents With and Without Dementia","authors":"Xiaojuan Liu,&nbsp;Laura A. Graham,&nbsp;Bocheng Jing,&nbsp;Chintan V. Dave,&nbsp;Yongmei Li,&nbsp;Manjula Kurella Tamura,&nbsp;Michael A. Steinman,&nbsp;Sei J. Lee,&nbsp;Christine K. Liu,&nbsp;Hoda S. Abdel Magid,&nbsp;Veena Manja,&nbsp;Kathy Fung,&nbsp;Michelle C. Odden","doi":"10.1111/jgs.19342","DOIUrl":"10.1111/jgs.19342","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Deprescribing antihypertensives is of growing interest in geriatric medicine, yet the impact on functional status is unknown. We emulated a target trial of deprescribing antihypertensive medications compared with continued use on functional status measured by activities of daily living (ADL) in a long-term care population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 12,238 Veteran Affairs long-term care residents age 65+ who had a stay ≥ 12 weeks between 2006 and 2019. After 4+ weeks of stable antihypertensive medication use, residents were classified as either deprescribed antihypertensives (reduced ≥ 1 medication or ≥ 30% dose) or continued users. Residents were followed up for 2 years, or censored at discharge, admission to hospice, protocol deviation (per-protocol analysis only), or Sept 30, 2019. The outcome was ADL dependencies (scored 0–28; higher score = worse functionality), assessed approximately every 3 months. Our primary approach was to estimate per-protocol effects using linear mixed-effects regressions with inverse probability of treatment and censoring weighting, overall and stratified by dementia status. We estimated intention-to-treat effects as a secondary analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In long-term care residents, ADL scores worsened by a mean of 0.29 points (95%CI = 0.27, 0.31) per 3 months and antihypertensive deprescribing did not impact this worsening (difference between groups −0.04 points every 3 months, 95%CI = −0.15, 0.06). In the non-dementia subgroup, ADL worsened by 0.15 points (95%CI = 0.11, 0.19) every 3 months. However, residents who were deprescribed showed a slightly improved ADL score over time while the continued users showed ADL decline (difference between groups −0.23 points every 3 months, 95%CI = −0.43, −0.03). Deprescribing was not associated with ADL change in the dementia subgroup. The intention-to-treat results were not meaningfully different.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Antihypertensive deprescribing did not have a deleterious effect on functional status in long-term care residents with or without dementia. This may be reassuring to residents and clinicians who are considering antihypertensive medication reduction or discontinuation in long-term care settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1144-1154"},"PeriodicalIF":4.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924291","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":"Proton Pump Inhibitor Use and Incident Cardiovascular Disease in Older Postmenopausal Women","authors":"Ahmed I. Soliman,&nbsp;Jean Wactawski-Wende,&nbsp;Amy E. Millen,&nbsp;Shelly L. Gray,&nbsp;Charles B. Eaton,&nbsp;Kathleen M. Hovey,&nbsp;Chris A. Andrews,&nbsp;Aladdin H. Shadyab,&nbsp;Bernhard Haring,&nbsp;Nazmus Saquib,&nbsp;Karen C. Johnson,&nbsp;Matthew Allison,&nbsp;JoAnn E. Manson,&nbsp;Michael J. LaMonte","doi":"10.1111/jgs.19326","DOIUrl":"10.1111/jgs.19326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Epidemiological studies have been inconsistent regarding an association between proton pump inhibitor (PPI) use and risk of primary cardiovascular disease (CVD) events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 85,189 postmenopausal women (mean age 63 years at baseline) without known CVD at enrollment into the Women's Health Initiative Observational Study (1993–1998). PPI use was determined from medication inventories at baseline and Year-3. CVD events were physician adjudicated and defined as a composite of coronary heart disease, stroke, and CVD mortality. Follow up was from baseline to September 2010. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident CVD according to baseline PPI use (no/yes), use duration (non-user, &lt; 1 year, 1–3 years, &gt; 3 years), and time-varying based on updated Year-3 information. Propensity score adjustment was used to control for residual confounding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, 1747 (2.1%) women reported using PPIs. During a mean follow-up of 11 years, 5778 (6.8%) cases of primary CVD were identified. PPI users had significantly higher risk of CVD compared with non-users in the fully adjusted model (HR: 1.21, 95% CI: 1.02–1.43), and after propensity score adjustment (HR: 1.27, 95% CI: 1.21–1.32). Longer PPI use duration was associated with incrementally higher CVD risk (HRs: &lt; 1 year: 1.11, 1–3 years: 1.27, &gt; 3 years: 1.33; <i>p</i> for trend = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PPI use was associated with higher risk of incident primary CVD in older postmenopausal women. These findings underscore the importance of guideline-directed PPI use to avoid unwanted adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"411-421"},"PeriodicalIF":4.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911405","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":"Life-Space Mobility Is Related to Loneliness Among Living-Alone Older Adults: Longitudinal Analysis With Motion Sensor Data","authors":"Kexin Yu,&nbsp;Chao-Yi Wu,&nbsp;Lisa L. Barnes,&nbsp;Lisa C. Silbert,&nbsp;Zachary Beattie,&nbsp;Raina Croff,&nbsp;Lyndsey Miller,&nbsp;Hiroko H. Dodge,&nbsp;Jeffrey A. Kaye","doi":"10.1111/jgs.19331","DOIUrl":"10.1111/jgs.19331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Life-space mobility can be a behavioral indicator of loneliness. This study examined the association between life-space mobility measured with motion sensors and weekly vs. annually reported loneliness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were older adults who lived alone. Passive infrared motion sensors were placed in the bathroom, bedroom, kitchen, and living room. Time spent in each room and out-of-home across the day was derived and used as the measure of life-space mobility. Participants reported via weekly questionnaires whether they felt lonely. In annual visits, the UCLA loneliness scale was administered to a subsample (<i>n</i> = 71), and the scores were categorized into high, moderate, and low groups. We used generalized estimating equations (GEE) to correlate life-space mobility with weekly and yearly loneliness. Repeated observations from each individual were bootstrapped for 1000 rounds to associate annual and weekly loneliness measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed 4995 weeks of data from 139 participants (age = 78.1 ± 8.6, 74% female, 23% African Americans, 14% with MCI diagnosis). An additional hour in the bedroom in the afternoon was associated with a 21.4% increased odds (OR = 1.214, <i>p</i> = 0.049) of experiencing loneliness in the week. An additional hour out-of-home in the morning and in the afternoon was associated with 18.2% (OR = 0.818, <i>p</i> = 0.040) and 15.3% (OR = 0.847, <i>p</i> = 0.018) fewer odds of experiencing weekly loneliness. In the subsample with annual loneliness assessments, an additional hour out-of-home was associated with 38.1% (OR = 0.619, <i>p</i> = 0.006) fewer odds of being in the high UCLA loneliness group. Compared with the low UCLA group, those with high UCLA scores were five times more likely to report loneliness weekly (OR = 5.260, <i>p</i> = 0.0004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Frequent and objective measurements of mobility combined with self-reported social wellbeing information can offer new insights into the experience of loneliness and provide opportunities for timely interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1125-1134"},"PeriodicalIF":4.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908050","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}