Journal of the American Geriatrics Society最新文献

{"title":"Prevalence of Unmet Service Needs and Associated Person-Reported Outcomes in Long-Term Services and Supports in the United States","authors":"Romil R. Parikh,&nbsp;Jack M. Wolf,&nbsp;Nishka U. Shetty,&nbsp;Ashwin A. Pillai,&nbsp;Benjamin W. Langworthy,&nbsp;Chanee D. Fabius,&nbsp;Stephanie Giordano,&nbsp;Eric Jutkowitz,&nbsp;Tetyana Shippee","doi":"10.1111/jgs.70551","DOIUrl":"10.1111/jgs.70551","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Long-term services and supports (LTSS) serve &gt; 9 million adults in the United States. We examined prevalence and quality of life (QoL)-related outcomes of consumer-reported unmet LTSS needs in publicly-funded LTSS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We pooled cross-sectional data from the 2016–2017, 2017–2018, 2018–2019, 2021–2022, and 2022–2023 National Core Indicators–Aging and Disability Adult Consumer Surveys. We included 61,829 adults (34% with age &lt; 65 years; 66% female; 27 states). Survey weights generated population-representative estimates. We ascertained unmet LTSS needs by response to: “Do the long-term care services you receive meet your current needs and goals?” (dichotomized- yes vs. no). We estimated weighted prevalence of unmet LTSS needs overall and across subpopulations, and examined associations with two self-reported QoL-related outcomes (dichotomized- yes/no): (1) being active in community; (2) satisfied with how one spends one's day. Prevalence ratios (PRs) were estimated using weighted Poisson regression with robust variance estimators, adjusting for demographics, health and functional status, multimorbidity, funding program, residence setting, state, and survey year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among respondents, 18,004 (weighted-estimate, 29%) reported unmet LTSS needs. Prevalence of unmet needs varied across sociodemographic strata, care settings (higher in community-based than in residential-care settings), and funding programs (lower in PACE than in Medicaid programs). Individuals with unmet needs were significantly less likely to report being active in the community (PR, 0.65; 95% CI, 0.62–0.68) and satisfied with how they spend their day (PR, 0.62; 95% CI, 0.60–0.64). Post hoc analyses revealed potential dose–response associations between increasing degree of unmet LTSS needs and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Consumer-reported unmet LTSS needs are frequent, vary greatly across care settings and funding programs, and are associated with poorer QoL-related outcomes; highlighting substantial system-level gaps in the fragmented LTSS landscape and the need for coordinated investments and structural reforms to better meet the needs of individuals relying on these services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2235-2244"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280573","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":"Evaluating the Association of a Self-Guided, Asynchronous, Balance Exercise Application on Fall-Related Injuries","authors":"Kris F. Wain,&nbsp;Claudia A. Steiner,&nbsp;Andrea E. Daddato,&nbsp;Deanna B. McQuillan,&nbsp;John D. Litten,&nbsp;Chris Jentz,&nbsp;Andrew R. Jessen,&nbsp;Wendolyn S. Gozansky","doi":"10.1111/jgs.70544","DOIUrl":"10.1111/jgs.70544","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>More than one in four older adults experience a fall each year. While exercise programs are effective in reducing fall-related injuries (FRI), participation remains low due to access barriers. The primary aim of this study was to evaluate whether older adults who registered for Nymbl, a self-guided, asynchronous, balance application, were associated with fewer FRIs as compared to age-similar individuals non-registrants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used data from Kaiser Permanente Colorado, linked to Nymbl registration and usage records based on patient name and demographic information between February 2018 and September 2024. The cohort included individuals aged 60 and older with continuous health plan enrollment for 12 months before and after Nymbl registration (or a randomly assigned index date). Logistic regression models with inverse probability of treatment weighting estimated the association between Nymbl registration and FRIs during the 12-month follow-up, stratified by history of FRIs. Marginal effects reported the absolute risk difference associated with Nymbl registration. Secondary analyses examined dose–response associations of Nymbl usage and whether the association of Nymbl was additive to participation in other exercise programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 3735 individuals who registered for Nymbl and 114,219 age-eligible non-registrants. Among individuals with a prior FRI, Nymbl registration was associated with a 3.83 percentage point reduction in acute FRIs; however, no significant association was estimated for individuals without a baseline FRI. Secondary analysis indicated that at least five sessions were required to achieve a meaningful reduction in FRIs, and associations were limited to those not already participating in other exercise programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings from this study suggest that asynchronous, self-guided balance applications may reduce FRIs among older adults with a history of falls who are not otherwise engaged in structured exercise programs. Remotely delivered fall prevention programs may help overcome access barriers and can be used to supplement in-person and guided exercise programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2255-2264"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304349","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":"Interventions to Optimize Medication Management in Older Adults: An Umbrella Review of Systematic Reviews","authors":"Saibal Das,&nbsp;Sanskriti Shukla,&nbsp;Rajesh Aadityan,&nbsp;Kristina Skender,&nbsp;Deepasree Sukumaran,&nbsp;Jerin Jose Cherian,&nbsp;Mihir Bhatta,&nbsp;Ashish Pathak,&nbsp;Samiran Panda,&nbsp;Santanu Kumar Tripathi,&nbsp;Cecilia Stålsby Lundborg","doi":"10.1111/jgs.70561","DOIUrl":"10.1111/jgs.70561","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Medication management in older adults with multimorbidity and polypharmacy is inherently challenging. This umbrella review consolidates evidence on interventions aimed at mitigating these challenges to promote safe and effective medication use.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This was an umbrella review. A systematic search was conducted on PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL until 2024 to find relevant systematic reviews of interventions to improve medication management among older adults aged ≥ 60 years (PROSPERO ID: CRD42024607956). Eligible systematic reviews focused on pharmacist-led reviews, deprescribing protocols, educational programs, clinical decision support systems (CDSS), and community-based initiatives. Data were extracted, and methodological quality was evaluated using the AMSTAR-2 tool. Descriptive statistics were applied, and the credibility of the evidence was determined. Outcomes included medication optimization, clinical, healthcare utilization and cost, and acceptability of the intervention among physicians and patients.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Seventy-one systematic reviews with &gt; 1.5 million cumulative participants were included. According to the AMSTAR-2 assessment, the included systematic reviews demonstrated variable methodological quality, with many rated as moderate to high risk of bias. Pharmacist-led reviews and deprescribing interventions both indicated significant improvement in medication appropriateness. Multidisciplinary approaches and CDSS could improve adherence and prescribing practices. Improvements in clinical outcomes, such as quality of life, cognitive function, and mortality, were inconsistent. Economic evaluations showed mixed results. Implementation challenges were identified, including scalability and resource allocation. Evidence was convincing in reducing the number of medications, inappropriate prescribing, and falls.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Pharmacist-led and multidisciplinary medication reviews showed the most consistent benefits, improving medication appropriateness and reducing falls and unplanned healthcare use. Interventions like education, policy and guideline measures, and community-based strategies demonstrated mixed or modest effects, often limited to adherence or prescribing quality. Overall evidence strength was limited by methodological heterogeneity. Future high-quality, context-specific research with standardized outcomes is needed in this regard.&lt;/p&gt;\u0000 ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2297-2307"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310746","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":"Anticholinergic Medication Use in Veterans Affairs Long-Term Care Residents: Clinical Patterns and Opportunities for Deprescribing","authors":"Cellas A. Hayes,&nbsp;Yongmei Li,&nbsp;Bocheng Jing,&nbsp;Laura A. Graham,&nbsp;Chintan Dave,&nbsp;Michelle C. Odden","doi":"10.1111/jgs.70570","DOIUrl":"10.1111/jgs.70570","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Anticholinergic exposure is common in nursing homes; however, the true burden may be underestimated, particularly due to over-the-counter agents such as first-generation antihistamines that are not consistently captured in prior claims-based studies. This gap limits accurate characterization of anticholinergic use and its clinical implications in older adults.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants and Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Veterans aged ≥ 65 years with stays ≥ 90 days (&lt;i&gt;N&lt;/i&gt; = 45,183) residing in US Department of Veterans Affairs (VA) Community Living Centers (CLC). This study is a secondary data analysis of residents identified during fiscal years 2007–2019.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;True anticholinergic exposure through barcode-based medication administration dispensing records allowed daily measurement of anticholinergic exposure, with follow-up extending from admission to discharge, death, or April 1, 2025. Anticholinergic medication use was defined as use ≥ 4 days per week during the CLC stay. Drugs were identified using VA classifications aligned with the 2023 American Geriatrics Society Beers Criteria and grouped into nine anticholinergic classes. Outcomes included prevalence, duration, and number of anticholinergic drug classes used; patterns by dementia status; and temporal trends over time.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among 45,183 CLC residents, 33.4% (&lt;i&gt;n&lt;/i&gt; = 15,074) used anticholinergic medications. Residents with dementia (&lt;i&gt;n&lt;/i&gt; = 20,254) showed substantial exposure to neuropsychiatric anticholinergics, including second-generation antipsychotics (30.6%) and antiparkinsonian agents (10.1%). First-generation antihistamine use remained high in this group (29.5%). Residents without dementia (&lt;i&gt;n&lt;/i&gt; = 24,929) more frequently received antihistamines (34.4%), bladder antimuscarinics (23.7%), and skeletal muscle relaxants (11.1%). From FY2007–2019, anticholinergic use declined modestly, with decreases in antihistamines (12.1%–8.8%), antidepressants (6.8%–3.5%), and antiemetic/antivertigo agents (5.2%–1.2%). Most residents used a single anticholinergic class, increasing from 75.5% to 82.2% over time.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Although some anticholinergic classes may be clinically necessary, our findings highlight potentially underrecognized and modifiable sources of exposure, particularly first-generation antihistamines, underscoring","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2285-2296"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70570","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364477","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":"Stakeholder Perspectives on the Use of Telehealth to Support Deprescribing for Older Patients Transitioning From the Hospital to Home Health Care","authors":"Jinjiao Wang,&nbsp;Jenny Y. Shen,&nbsp;Fang Yu,&nbsp;Sandra F. Simmons,&nbsp;Amanda S. Mixon,&nbsp;Kobi Nathan,&nbsp;Marian S. Moskow,&nbsp;Judith D. Brasch,&nbsp;Sally A. Norton,&nbsp;Kathi L. Heffner,&nbsp;Yun Jiang,&nbsp;Sudha Seshadri,&nbsp;Neela Patel,&nbsp;Lixin Song,&nbsp;Joseph A. Zorek,&nbsp;Christine Lam,&nbsp;Thomas V. Caprio","doi":"10.1111/jgs.70548","DOIUrl":"10.1111/jgs.70548","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Multimorbidity affects most older adults in home health care (HHC), leading to inappropriate polypharmacy and increased risks for adverse outcomes. While deprescribing can mitigate these risks, fragmented communication during hospital-to-home transitions remains a major barrier. This study explored stakeholder perspectives on using telehealth to facilitate deprescribing for older adults with multimorbidity while receiving post-acute HHC.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted semi-structured interviews with 44 stakeholders across 12 U.S. states, including 14 HHC patients and 30 clinicians (physicians, nurse practitioners, pharmacists, and HHC nurses). Guided by the socioecological model of deprescribing, interviews explored factors across individual, interpersonal, organizational, and societal levels associated with telehealth use in deprescribing. Analysis followed a phased, iterative approach with independent double-coding and interprofessional team consensus to ensure credibility.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Findings categorized telehealth as a promising tool to align medications with the “4Ms” (Medications, Mentation, Mobility, and What Matters) through goal-concordant deprescribing. At the individual level, stakeholders noted that telehealth readiness depended on patient cognition and digital literacy. At the interpersonal level, telehealth facilitated real-time multidisciplinary “virtual huddles” that reduced communication delays but could occasionally overwhelm patients and may be logistically challenging to schedule. Organizational barriers included reimbursement constraints and complex synchronous scheduling. Societal factors include equitable access for rural or low-income populations, populations who may benefit the most from telehealth-enabled deprescribing due to challenges in accessing care. Stakeholders emphasized a hybrid approach which pairs virtual prescriber consultation with in-home support of a clinician to provide context and assist with implementation for patient-centered deprescribing.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Telehealth can support goal-concordant deprescribing during post-acute care transitions in HHC. A hybrid model, one that combines remote prescriber consultations with in-home clinician support, is the preferred approach to bridge coordination gaps. To maximize impact, future efforts are needed to improve reimbursement, infrastructure, and scheduling to integrate telehealth into routine deprescribing workflows.&lt;/p&gt;\u0000 ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2265-2276"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364568","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":"American Geriatrics Society Position Statement: Advancing the Healthcare of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and More Older Adults","authors":"Carl H. Burton,&nbsp;Maria H. van Zuilen,&nbsp;Chelsea Namahana Wong,&nbsp;Angela Primbas,&nbsp;Michael Danielewicz,&nbsp;Timothy W. Farrell,&nbsp;Rohin Aggarwal,&nbsp;Carl G. Streed Jr.,&nbsp;Aruna V. Josyula,&nbsp;Reena Karani,&nbsp;Alexia Mary Torke,&nbsp;Bronwyn Keefe,&nbsp;Joseph Shega,&nbsp;Noelle Marie Javier","doi":"10.1111/jgs.70470","DOIUrl":"10.1111/jgs.70470","url":null,"abstract":"<p>In the decade since the American Geriatrics Society (AGS) released a position statement on Care of Lesbian, Gay, Bisexual, and Transgender Older Adults, we have seen significant progress toward achieving equal health and civil rights for lesbian, gay, bisexual, transgender, queer, intersex, and more (LGBTQI+) individuals. Advances have included increased visibility, legalization of same-sex marriage, and legal protections against discrimination. Even so, for LGBTQI+ older adults, substantial gaps, fears of discrimination, and legal uncertainty persist. Older LGBTQI+ adults experience the intersection of ageism with structural discrimination associated with their sexual and gender minority status—homophobia and transphobia. These experiences occur in many sectors of society, including health care, exacerbating disparities, impacting social determinants of health, and leading to accumulated discrimination across time. The potential for setbacks to progress remains as lawsuits are filed and policymakers consider legislation that would roll back rights at the state and federal levels. Recognizing this evolving landscape, AGS established a writing group to update the 2015 position statement with the goals of supporting progress on eliminating discrimination against LGBTQI+ older adults in healthcare and supporting integration of evidence-based approaches to caring for these older adults across care settings. By providing recommendations on inclusive education, policy reform, and focused research, AGS aims to promote the health, independence, quality of life, and dignity of LGBTQI+ older adults. Within education, we recommend standardized training for all healthcare staff, with specialized instruction for clinicians caring for LGBTQI+ older adults. On the policy front, we emphasize maintaining nondiscriminatory measures, supporting chosen families in caregiving, promoting completion of advance directives, and collecting and ensuring privacy of sexual orientation and gender identity (SOGI) information. Research priorities include continuing to advance SOGI data collection, understanding mechanisms driving disparities, developing health promotion interventions, and furthering research into long-term services and supports.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2189-2207"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261015","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":"The Invisible Barrier of Neighborhood Disadvantage in Clinical Trial Recruitment and Retention Among Older Adults","authors":"Raele Donetha Loy,&nbsp;Amy Kind,&nbsp;Nicole Rogus-Pulia","doi":"10.1111/jgs.70518","DOIUrl":"10.1111/jgs.70518","url":null,"abstract":"&lt;p&gt;Older adults are among the most common recipients of interventions tested in clinical research, yet they remain underrepresented in clinical trials [&lt;span&gt;1-3&lt;/span&gt;]. Efforts to close this participation gap have grown in recent years, reflected in initiatives such as the National Institutes of Health (NIH) Inclusion Across the Lifespan clinical trial requirement encouraging age-diverse study designs [&lt;span&gt;4&lt;/span&gt;]. Despite this momentum, significant barriers to adequate and equitable participation in clinical trials among older adults continue to persist. Different explanations for why this gap endures have been offered, including older adult preferences specific to undergoing or avoiding certain therapies [&lt;span&gt;3&lt;/span&gt;], age limits on participation, exclusion criteria for conditions more commonly found among older adults [&lt;span&gt;2, 3&lt;/span&gt;], and a number of other factors.&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;JAGS&lt;/i&gt;, Gill and colleagues draw attention to a recruitment and retention barrier that has received less attention: the social exposomes of the neighborhoods in which participants reside. Living in a resource-poor neighborhood, they argue, may challenge nearly every operational aspect of a clinical trial; yet, the relationship between neighborhood disadvantage (i.e., adverse social exposome) and clinical trial implementation has gone largely unexamined. This is a key gap as it is an easily measured construct that is fundamentally modifiable, providing ready pathways towards interventions and practices which could significantly enhance the inclusivity of clinical trials across the US.&lt;/p&gt;&lt;p&gt;In this study, Gill and colleagues sought to determine whether recruitment and retention of community-living persons at risk of fall-related injuries in a large multi-site clinical trial (Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) Study) differed based on level of neighborhood disadvantage. To quantify neighborhood disadvantage, they used the Area Deprivation Index (ADI), a freely available composite metric that captures social exposome at the Census block group (i.e., “neighborhood”) level by integrating domains including income, education, employment, and housing quality from current Census and American Community Survey data [&lt;span&gt;5&lt;/span&gt;]. ADI can be reported at the national level using percentiles (1–100), or at the state level using deciles (1–10), with higher scores indicating greater adverse social exposome (Figure 1).&lt;/p&gt;&lt;p&gt;The results of this work offer profound insights on the role of neighborhood disadvantage in clinical trial recruitment and retention. Health system patients residing in more disadvantaged neighborhoods were less likely to return the clinical trial's screening postcard during the recruitment period from August 2015 to March 2017; however, they were more likely to screen positive. Those living in high-ADI areas were also less likely to enroll in the trial compared to those in less disadvantaged areas","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2173-2176"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960448","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":"Health Care Contact Days Among Older Adults After Emergency Department Visits: A Cross-Sectional Analysis","authors":"Cameron J. Gettel,&nbsp;Craig Rothenberg,&nbsp;Courtney Kitchen,&nbsp;Yuxiao Song,&nbsp;Susan N. Hastings,&nbsp;Ula Hwang,&nbsp;Michelle A. Fischer,&nbsp;Christina L. Shenvi,&nbsp;Arjun K. Venkatesh","doi":"10.1111/jgs.70550","DOIUrl":"10.1111/jgs.70550","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Study Objective</h3>\u0000 \u0000 <p>Emergency department (ED) visits among older adults represent critical transition points in health care, often resulting in substantial downstream utilization. We aimed to quantify health care contact days in the 30 days following a treat-and-release ED visit among older adults and examine associations with demographic and clinical characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a pooled cross-sectional analysis of 2016–2021 Medicare Current Beneficiary Survey data. The sample included treat-and-release ED visits among beneficiaries ≥ 65 years. Health care contact days were categorized as institutional (ED, hospital, skilled nursing facility, hospice) and ambulatory (outpatient visits, labs, imaging, procedures, or treatments). We applied zero-inflated Poisson regression to estimate the likelihood and intensity of health care contact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analytic sample comprised 10,964 treat-and-release ED visits. Within 30 days, 22.5% of visits resulted in institutional contact and 84.4% in ambulatory contact. On average, each ED visit was followed by 4.3 total contact days (3.0 ambulatory, 1.3 institutional) within 30 days. Having ≥ 2 chronic conditions was associated with greater odds of both institutional (OR: 1.46, 95% CI: 1.28–1.66) and ambulatory contact (OR: 1.44, 95% CI: 1.25–1.66). Dementia was associated with reduced odds of ambulatory contact (OR: 0.51, 95% CI: 0.37–0.72).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older adults experience frequent and sustained health care contact following treat-and-release ED visits, with particularly high intensity among those with multi-morbidity. Reduced ambulatory follow-up among patients with dementia highlights a potential gap in care coordination after ED discharge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2216-2225"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255022","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":"Assessing Associations of Three Types of Higher-Risk Medication Use and Mortality in Older Adults","authors":"Alexander Chaitoff,&nbsp;Katharina Tabea Jungo,&nbsp;Lillian Min,&nbsp;Donovan T. Maust","doi":"10.1111/jgs.70569","DOIUrl":"10.1111/jgs.70569","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Higher-risk medication use—including regimens with polypharmacy, drug–drug interactions (DDIs), and potentially inappropriate medications (PIMs)—has been linked to adverse outcomes in older adults. However, studies establishing associations between higher-risk medication use and mortality have lacked measures of organ function and considered types of higher-risk medication exposures in isolation, allowing potential confounding and overestimation of harm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study of adults aged ≥ 65 years who took part in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016, with mortality follow-up through 2019. Our primary exposures were three types of higher-risk medication use: polypharmacy, DDIs, and PIMs. In primary analyses, these were defined, respectively, as follows: being on ≥ 5 prescription medications (polypharmacy); using two medications with ≥ 1 major DDI; and using ≥ 1 prescription PIM. Exposures were determined by medication review during the baseline survey. The primary outcome was all-cause mortality. Multivariable Cox regression models estimated mortality risk associated with each type of higher-risk medication use, sequentially adjusting for sociodemographic factors and comorbidities, organ function and health behaviors, and patterns of higher-risk medication use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 7828 eligible participants (representing 26.5 million adults), 54.3% experienced at least one type of higher-risk medication use: 40.0% had polypharmacy, 11.4% had a DDI, and 37.6% used a PIM. In fully adjusted models including all higher-risk medication exposures, only polypharmacy remained significantly associated with increased mortality (hazard ratio [HR] 1.38; 95% CI 1.26–1.51). Sensitivity and subgroup analyses by age and health status yielded generally consistent findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When considering multiple types of higher-risk medication exposure, only polypharmacy was consistently and independently associated with increased mortality among older adults. These results highlight the harms of polypharmacy specifically and could help further target deprescribing interventions to the most high-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2308-2316"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Thank You to JAGS Reviewers","authors":"","doi":"10.1111/jgs.70672","DOIUrl":"https://doi.org/10.1111/jgs.70672","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 8","pages":"2167-2169"},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784527","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}