Journal of the American Geriatrics Society最新文献

{"title":"Comparative Safety of Short-Acting Opioid Dose Escalation and Long-Acting Opioid Initiation in Nursing Home Residents","authors":"Anthony P. Nunes,&nbsp;Heeyoon Jung,&nbsp;Yiyang Yuan,&nbsp;Jonggyu Baek,&nbsp;Jayne Pawasauskas,&nbsp;Anne L. Hume,&nbsp;Shao-Hsien Liu,&nbsp;Kate L. Lapane","doi":"10.1111/jgs.19417","DOIUrl":"10.1111/jgs.19417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>For patients with continued pain while receiving an initial course of a short-acting opioid (SAO), clinicians may intensify the opioid regimen by escalating the SAO dose or initiating a long-acting opioid (LAO). The objective of this study was to assess the comparative safety of opioid intensification regimens in nursing home residents with nonmalignant pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort analysis of US long-stay nursing home residents identified from the national Minimum Data Set (MDS) 3.0 and linked Medicare data, 2011–2016. Opioid regimen changes were assessed using Part D claims to identify dose escalation of SAO, adding LAO to SAO, or a switch from SAO to LAO. The outcomes of interest were hospitalized falls/fractures and delirium identified in the MDS or hospitalization. Resident attributes were described by opioid regimen. Hazard ratios of study outcomes were quantified using as-treated (primary analysis) and intent-to-treat (secondary analysis) doubly robust inverse probability of treatment (IPT) weighted Fine &amp; Gray regression models with a competing risk of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the as-treated analysis, relative to residents in the SAO escalation cohort, the hazard of delirium was elevated in the LAO cohorts (aHR [LAO switch]: 2.05, 95% CI: 1.57–2.67; aHR [LAO add-on]: 1.55, 95% CI: 1.23–1.96). Results for falls and fractures were inconclusive. We did not observe evidence of an association with falls and fractures in the primary as-treated analysis; however, the intent-to-treat analysis observed increased hazards in the LAO switch cohort relative to the SAO escalation cohort (aHR 2.86, 95% CI:1.64–4.99).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is limited evidence to inform the clinical judgment between escalating the SAO dose or incorporating a LAO. Our study suggests increased risks of delirium in nursing home residents with nonmalignant pain when switching or adding an LAO to the opioid regimen relative to increasing the dose of SAOs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1517-1527"},"PeriodicalIF":4.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733829","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":"Change in Fall Status of Older People With Dementia and Caregiving Difficulties: Moderation Effects of Living Arrangements","authors":"Yuanjin Zhou,&nbsp;Kylie Meyer,&nbsp;Ellliane Irani,&nbsp;Xiao Liu,&nbsp;Namkee Choi","doi":"10.1111/jgs.19442","DOIUrl":"10.1111/jgs.19442","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aim to investigate the associations between 2-year fall status among community-dwelling older people with dementia and care partners' emotional, physical, and financial difficulties, with living arrangements (co-residence vs. separate residence) as a moderator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We used the 2015–2017 National Health and Aging Trends Study and the linked survey 2017 National Study of Caregiving (935 care partners for 567 community-dwelling older people with dementia). We employed multilevel generalized linear regression models to examine the associations of fall status between 2015 and 2017 with caregiving difficulties in 2017 for co-residing and non-co-residing care partners. We then evaluated the moderation effect of care partners' living arrangements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For co-residing care partners, high (<i>p</i> = 0.001), increased (<i>p</i> = 0.001), and decreased (<i>p</i> = 0.001) fall frequency over 2 years was significantly associated with emotional difficulties. For non-co-residing care partners, high (<i>p</i> &lt; 0.001), increased (<i>p</i> = 0.001), and decreased (<i>p</i> = 0.002) fall frequency was significantly associated with their physical difficulties. Compared to co-residing care partners, those who lived apart experienced greater physical difficulties when the fall frequency increased over 2 years (<i>p</i> &lt; 0.05), but this effect became non-significant after the Bonferroni correction. High fall frequency was significantly associated with financial difficulties for co-residing (<i>p</i> = 0.009) and non-co-residing (<i>p</i> = 0.003) care partners, and decreased fall frequency was only significantly associated with financial difficulties for non-co-residing care partners (<i>p</i> = 0.018). All findings for financial difficulties became non-significant after the Bonferroni correction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This study found differential associations between fall status over 2 years and care-related difficulties by care partners' living arrangements. Preventing falls for this population can potentially reduce the informal caregiving burden, especially the emotional difficulties for co-residing care partners and the physical difficulties of non-co-residing caregivers. Tailored interventions to manage fall risk among older people with dementia and support care partners with different living arrangements are crucial to improving their well-being.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1808-1818"},"PeriodicalIF":4.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19442","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702578","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":"Effects of Hearing Intervention on Physical Activity Measured by Accelerometry: A Secondary Analysis of the ACHIEVE Study","authors":"Jennifer A. Schrack,&nbsp;Amal A. Wanigatunga,&nbsp;Nancy W. Glynn,&nbsp;Michelle L. Arnold,&nbsp;Sheila Burgard,&nbsp;Theresa H. Chisolm,&nbsp;David Couper,&nbsp;Jennifer A. Deal,&nbsp;Theresa Gmelin,&nbsp;Adele M. Goman,&nbsp;Alison R. Huang,&nbsp;Lisa Gravens-Mueller,&nbsp;Kathleen M. Hayden,&nbsp;Pablo Martinez-Amezcua,&nbsp;Christine M. Mitchell,&nbsp;James S. Pankow,&nbsp;James R. Pike,&nbsp;Nicholas S. Reed,&nbsp;Victoria A. Sanchez,&nbsp;Kevin J. Sullivan,&nbsp;Josef Coresh,&nbsp;Frank R. Lin,&nbsp;the ACHIEVE Collaborative Research Group","doi":"10.1111/jgs.19435","DOIUrl":"10.1111/jgs.19435","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hearing loss is prevalent in older adults and is associated with reduced daily physical activity, but whether hearing intervention attenuates declines in physical activity is unknown. We investigated the 3-year effect of a hearing intervention versus a health education control on accelerometer-measured physical activity in older adults with hearing loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This secondary analysis of the ACHIEVE randomized controlled trial included 977 adults aged 70–84 years with hearing loss. Participants were randomized to either a hearing intervention group or a health education control group. Physical activity was measured using wrist-worn accelerometers at baseline, 1, 2, and 3 years. Linear mixed models assessed the impact of the intervention on changes in total activity counts, active minutes per day, and activity fragmentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 847 participants in the final analysis (mean age 76.2 years; 440 [52%] women; 87 [10%] Black; 5 [0.8%] Hispanic), total activity counts declined by 2.7% annually, and active minutes/day declined by 2.1% annually over 3 years in both intervention and control groups. Activity patterns also became more fragmented over time. No appreciable differences were observed between hearing intervention and health education control in the 3-year change in accelerometry-measured physical activity measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hearing intervention did not appreciably attenuate 3-year declines in physical activity compared to health education control in older adults with hearing loss. Alternative strategies beyond hearing treatment may be needed to enhance physical activity among older adults with hearing loss.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1762-1771"},"PeriodicalIF":4.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Influenza Vaccination on Hospitalization and Mortality Among People With Dementia","authors":"Andreas Moses Appel,&nbsp;Christina Jensen-Dahm,&nbsp;Thomas Munk Laursen,&nbsp;Gunhild Waldemar,&nbsp;Janet Janbek","doi":"10.1111/jgs.19392","DOIUrl":"10.1111/jgs.19392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People with dementia have an increased risk for infection-related complications, which may be mitigated by common vaccinations. The aim was to investigate the association between influenza vaccination and the rates of all-cause and influenza-related hospitalizations and deaths among older adults with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We followed all Danish residents with dementia aged 65 and above from September 1, 2002, to August 31, 2018. Dementia was defined from records in the Danish national registries (positive predictive value 85.8%). People with dementia were identified on September 1 of each year. On this date, vaccination status was also reset, and the status of covariates was assessed. We used proportional hazard Cox regression to compare rates of all-cause hospitalization, hospitalization with a respiratory infection, hospitalization with influenza or pneumonia, and all-cause mortality for vaccinated and unvaccinated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across the entire study period, we included 134,002 people with dementia. Rates of hospitalization were 9%–10% lower, and the mortality rate 9% lower, for vaccinated compared to unvaccinated among people with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Influenza vaccination was associated with lower rates of hospitalization and mortality among people with dementia. Further exploration of the preventive potential of influenza vaccination among people with dementia is important for shaping interventions in this vulnerable group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1498-1505"},"PeriodicalIF":4.3,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694968","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":"Prescribing Patterns and Impact of Sedatives in Hospitalized Older Adults: A Secondary Analysis of the MedSafer Study","authors":"Bennet Desormeau,&nbsp;Allen Huang,&nbsp;James Downar,&nbsp;Peter E. Wu,&nbsp;Emilie Bortolussi-Courval,&nbsp;Sydney B. Ross,&nbsp;Kiran Battu,&nbsp;Louise Papillon-Ferland,&nbsp;Finlay A. McAlister,&nbsp;Sarah Elsayed,&nbsp;Marnie Goodwin Wilson,&nbsp;Rodrigo B. Cavalcanti,&nbsp;Emily G. McDonald,&nbsp;Todd C. Lee","doi":"10.1111/jgs.19437","DOIUrl":"10.1111/jgs.19437","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We aimed to examine the impact of sedative prescription patterns in hospitalized older adults on post-discharge adverse drug events (ADEs), falls, and sleep.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a secondary analysis of the MedSafer randomized controlled trial (RCT; NCT03272607) which included hospitalized adults ≥ 65 years of age who were taking ≥ 5 medications. We identified patients who completed follow-up at 30 days post-discharge and provided patient-reported outcomes for sleep disturbance (PROMIS SD 4a). We grouped patients based on sedative use as follows: nonusers, continued home use (pre- and post-hospitalization), deprescribed home use, and new use at discharge. Using multivariable logistic regression, we compared the odds of patients having experienced ≥ 1 ADE (not necessarily ascribed to sedatives), a fall, or any adverse event within 30 days post-discharge. We also used ordinal logistic regression and a minimal important difference approach to compare the change in sleep disturbance at 30 days post-discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort comprised 3630 patients with a median age of 78. A total of 2810 (77.4%) were categorized as nonusers; 475 (13.1%) continued home use; 293 (8.1%) deprescribed home use; and 52 (1.4%) new users at discharge. Compared to the continued home use group, the deprescribed group was substantially less likely to experience an ADE post-discharge (adjusted odds ratio [aOR], 0.39 [95% CI, 0.16–0.97]). Correspondingly, new users at discharge had substantially higher odds of falls (aOR, 2.51 [95% CI, 1.13–5.61]). Favorable changes in sleep disturbance were more likely among nonusers (aOR, 1.29 [95% CI, 1.05–1.58]) and deprescribed users (aOR, 1.11 [95% CI, 0.82–1.50]) when compared to continued users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this cohort, patients who had their sedatives deprescribed were 61% less likely than continued users to have a post-discharge ADE, and new sedative use at discharge was associated with appreciable risk of falls. Hospitalization likely represents a window of opportunity to improve care by promoting sedative deprescription and avoiding new starts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1753-1761"},"PeriodicalIF":4.3,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694965","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 Association of Dementia and Mild Cognitive Impairment With Outpatient Ambulatory Care Utilization in the Community","authors":"Yi Chen,&nbsp;Bryan D. James,&nbsp;Ana W. Capuano,&nbsp;Mousumi Banerjee,&nbsp;Mellanie V. Springer,&nbsp;Brittney S. Lange-Maia,&nbsp;Lisa L. Barnes,&nbsp;David A. Bennett,&nbsp;Julie P. W. Bynum,&nbsp;Francine Grodstein","doi":"10.1111/jgs.19446","DOIUrl":"10.1111/jgs.19446","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ambulatory care is critical in delivering interventions for dementia and mild cognitive impairment (MCI), from basic services to novel therapeutics. Yet, little is known regarding how community-dwelling persons with dementia/MCI interact with clinicians in outpatient ambulatory settings. We assessed associations of dementia/MCI with outpatient ambulatory evaluation and management (E&amp;M) visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 2116 community-dwelling participants in Rush Alzheimer's Disease Center cohorts, with linked fee-for-service Medicare claims. Annually from 2011 to 2019, cohort neuropsychologic evaluations classified participants as dementia, MCI, or no cognitive impairment (NCI). Across groups, we compared annual probability of visiting providers and number of E&amp;M visits, using repeated measures logistic or generalized Poisson mixed effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across 8672 person-years (PY) of follow-up, the mean age was 82 (SD 7.6) years; 77% of PYs were among females and 24% among Black participants. Controlling for demographics and comorbidity, the annual predicted probability of primary care visits was high in all groups (86%–92%). Although there were few visits with dementia-related specialists, we found a higher probability of these visits among those with dementia (15%) and MCI (17%) than NCI (12%; <i>p</i> = 0.009, dementia vs. NCI; <i>p</i> &lt; 0.001, MCI vs. NCI). There were striking differences in visits to other medical specialties: the mean number of annual visits was 40% lower for those with dementia (<i>p</i> &lt; 0.001) and 10% lower for MCI (<i>p</i> &lt; 0.001) than NCI. Overall, dementia and MCI were associated with 19% (<i>p</i> &lt; 0.001) and 4% (<i>p</i> = 0.005) fewer E&amp;M visits, respectively, compared to NCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older adults with dementia and MCI interact with primary care providers regularly and are more likely to use dementia-related specialists than those with NCI. Yet, we found lower utilization of other medical specialties, without compensatory increases in primary care, leading to fewer overall E&amp;M visits, even in MCI. Together, the findings may suggest lost opportunities to address the scope of health issues in vulnerable groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1819-1826"},"PeriodicalIF":4.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677368","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":"Beyond Reporting and Enforcing: Innovating for Higher Medical Director Engagement","authors":"Arif Nazir","doi":"10.1111/jgs.19424","DOIUrl":"10.1111/jgs.19424","url":null,"abstract":"&lt;p&gt;A recent study published in JAGS by Goldwein et al. [&lt;span&gt;1&lt;/span&gt;], along with an accompanying editorial [&lt;span&gt;2&lt;/span&gt;], once again highlights the gaps associated with the role of medical directors in skilled nursing facilities (SNFs). The study underscores key aspects such as the reporting of administrative tasks, the distinction between administrative and clinical responsibilities, and, at best, minimal influence of compliance and regulatory standards. Despite ongoing discourse on this subject, significant gaps remain, particularly concerning the impact of the medical director role, and the critical question persists: will this renewed attention catalyze actionable stakeholders into some action?&lt;/p&gt;&lt;p&gt;As a geriatrician, medical director, fractional chief medical officer for three NH chains, and co-founder of a technology platform designed to operationalize the medical director role across hundreds of SNFs, I offer unique insights, data, and potential solutions to advance this discussion constructively.&lt;/p&gt;&lt;p&gt;Operationalization of the medical director role requires a systematic approach involving strategic recruitment, well-defined contracts delineating expectations, continuous communication and training for medical directors and facility teams, and performance-based data sharing. A digital platform, centered on self-reporting of administrative (non-clinical) tasks by medical directors in accordance with Center for Medicare and Medicaid Services and Post-Acute and Long-term Care Medical Association (PALTmed) recommendations, offers a comprehensive mechanism to visualize and assess medical director engagement. When juxtaposed with the data reported by Goldwein et al., such insights could provide a more nuanced understanding of medical director contributions.&lt;/p&gt;&lt;p&gt;Data collected from our platform in 2024, encompassing 389 NHs across 22 states (Figure 1), indicates that most NHs report more than 10 h per month of administrative time for their medical directors. Review of the tasks illustrated the frequency of reported administrative tasks, with monitoring of clinical quality and metrics emerging as the most frequently cited activity (22%), followed by leadership meetings (14%). Notably, none of the surveyed NHs reported zero medical director hours for the year—a stark contrast to the 36.1% figure reported in PBJ data by Goldwein et al. This discrepancy underscores the pressing need for more accurate and standardized mechanisms for capturing and reporting medical director contributions.&lt;/p&gt;&lt;p&gt;Before addressing solutions for improved reporting and enforcement, a broader discussion on the medical director role itself is warranted. As Goldwein et al. emphasize, this role demands a clear and distinct definition. Unlike attending physicians or nurse practitioners, medical directors are entrusted with systemic responsibilities, including clinical governance, policy oversight, and quality improvement. Without clearly delineating these duties, their","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1338-1340"},"PeriodicalIF":4.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665759","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 Disparities Based on Race or Ethnicity Require Interventions at Multiple Levels of the Healthcare System","authors":"David K. Conn","doi":"10.1111/jgs.19439","DOIUrl":"10.1111/jgs.19439","url":null,"abstract":"&lt;p&gt;Health disparities have been defined by the Institute of Medicine (IOM) as “differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention” [&lt;span&gt;1&lt;/span&gt;]. The World Health Organization (WHO) describe health inequities as “differences in health status, or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age” [&lt;span&gt;2&lt;/span&gt;]. The WHO emphasizes that health inequities are a global issue which is “unfair and could be reduced by the right mix of government policies” [&lt;span&gt;2&lt;/span&gt;]. Health disparities often lead to negative health outcomes such as increased morbidity and disability, higher mortality rates and reduced quality of life for groups that experience reduced quality of healthcare and treatment. In 2000, the Department of Health and Human Services launched a comprehensive nationwide, health promotion and disease prevention agenda in the United States [&lt;span&gt;3&lt;/span&gt;]. The report called for the elimination of all health disparities, including differences that occur due to ethnicity, sex, education, income, disability, geographic location, or sexual orientation. The Institute of Medicine published a report in 2003 entitled &lt;i&gt;Unequal treatment: confronting racial and ethnic disparities in healthcare&lt;/i&gt; [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Hall-Lipsy and Chisholm-Burns carried out a systematic review of “pharmacotherapeutic disparities” in medication treatment [&lt;span&gt;4&lt;/span&gt;]. A total of 311 research articles were identified that investigated whether race, ethnicity, or sex was associated with disparities in medication treatment. Seventy-seven percent of the included articles revealed significant disparities in drug treatment across race, ethnicity, and sex. The most frequent disparity found in almost three-quarters of the articles studied was differences in the receipt of prescription drugs. Documented disparities also occurred related to differences in the drugs prescribed, drug dosing administration, and wait time to receipt of a drug. Documented outcomes associated with these disparities included increased rates of hospitalization, decreased rates of therapeutic goal attainment, and decreased rates of survival. Clinical content areas included treatment for asthma, cardiovascular disease, diabetes mellitus, HIV infection, mental health, oncology, osteoporosis, pain control/palliative care, and Parkinson's disease. The top three in terms of number of publications were mental health, cardiovascular disease, and pain control/palliative care.&lt;/p&gt;&lt;p&gt;In this edition of the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt; (JAGS), Cassara et al. report on a study related to the use and discontinuation rates of long-acting injectable (LAI) antipsychotic medications among older adults, with a focus on differences based on race/ethnicity [&lt;span&gt;5&lt;/span&gt;]. The ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1341-1343"},"PeriodicalIF":4.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660038","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 Efficacy and Safety of Canagliflozin by Frailty Status in Participants of the CANVAS and CREDENCE Trials","authors":"Tu N. Nguyen,&nbsp;Jie Yu,&nbsp;Vlado Perkovic,&nbsp;Meg Jardine,&nbsp;Kenneth W. Mahaffey,&nbsp;Clara K. Chow,&nbsp;Clare Arnott,&nbsp;Richard I. Lindley","doi":"10.1111/jgs.19444","DOIUrl":"10.1111/jgs.19444","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to improve renal and cardiovascular outcomes in patients with type 2 diabetes. Limited evidence exists about the efficacy and safety of SGLT2 inhibitors in patients with frailty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a post hoc pooled, participant-level data analysis of the CANVAS Program (CANVAS and CANVAS-R) and the CREDENCE trial. We examined the effect of canagliflozin on: (1) Major adverse cardiovascular events (MACE), (2) Cardiovascular mortality, (3) all-cause mortality, and (4) key safety outcomes. Frailty was defined by a Frailty Index (FI) based on a deficit accumulation approach (FI &gt; 0.25: frail). Cox proportional-hazard models were used to estimate the efficacy and safety of canagliflozin overall and according to frailty status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 14,543 participants (10,142 from the CANVAS Program, 4401 from the CREDENCE trial). Their mean age was 63.2 years; 35.3% were female. Frailty was present in 56% of the study participants. The benefits of canagliflozin were observed in both the frail and non-frail subgroups: HRs for MACE 0.80 (95% CI 0.70–0.90) in the frail versus 0.91 (95% CI 0.75–1.09) in the non-frail (<i>p</i> for interaction = 0.27); HRs for cardiovascular mortality 0.79 (95% CI 0.67–0.95) in the frail versus 0.94 (95% CI 0.70–1.27) in the non-frail (<i>p</i> for interaction = 0.38); HRs for all-cause mortality 0.81 (95% CI 0.70–0.94) in the frail versus 0.93 (95% CI 0.74–1.16) in the non-frail (<i>p</i> for interaction = 0.39). Adverse events were similar among frail and non-frail participants, except for osmotic diuresis (HRs 1.67, 95% CI 1.22–2.28 in the frail vs. 3.05, 95% CI 2.13–4.35 in the non-frail, p for interaction = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Canagliflozin improved cardiovascular and mortality endpoints in participants with type 2 diabetes irrespective of frailty status, with a similar safety profile. Our findings, in addition to those from other recent studies, provide evidence to support the introduction of SGLT2 inhibitor therapy in patients perceived to be frail.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> ClinicalTrials.gov CANVAS: NCT01032629; CANVAS-R: NCT01989754; CREDENCE: NCT02065791</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1787-1796"},"PeriodicalIF":4.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19444","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660068","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":"Frailty Matters—Why Isn't It Guiding Clinical Decisions?","authors":"Márlon Juliano Romero Aliberti,&nbsp;Daniel F. Arteaga-Vargas,&nbsp;Thiago Junqueira Avelino-Silva","doi":"10.1111/jgs.19443","DOIUrl":"10.1111/jgs.19443","url":null,"abstract":"&lt;p&gt;Frailty is a powerful predictor of adverse outcomes in older adults, including disability, institutionalization, and mortality [&lt;span&gt;1&lt;/span&gt;]. This geriatric syndrome denotes a decline in physiological reserve and reduced homeostatic capacity, increasing vulnerability to stressors such as acute illness, surgery, and hospitalization [&lt;span&gt;2&lt;/span&gt;]. Prevalence estimates vary widely (3.5%–27.3%) depending on population characteristics and frailty definitions [&lt;span&gt;3&lt;/span&gt;]. In the United States, approximately 15% of community-dwelling older adults are classified as frail [&lt;span&gt;1&lt;/span&gt;]. In lower- and middle-income countries, where aging is mainly affected by socioeconomic disparities, limited healthcare access, and a higher burden of chronic diseases, frailty often manifests at younger ages [&lt;span&gt;2&lt;/span&gt;]. Despite its well-established predictive value, frailty is not a decision node included in most medical guidelines [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Clinical decisions continue to prioritize disease-specific parameters and chronological age over physiological vulnerability measures like frailty [&lt;span&gt;5&lt;/span&gt;]. This approach fails to account for the heterogeneity that defines aging. Standard treatment guidelines, often developed based on younger or healthier populations, do not address the complex interplay of chronic diseases and geriatric syndromes [&lt;span&gt;2&lt;/span&gt;]. Most older adults live with multiple coexisting conditions—chronic diseases (e.g., diabetes, hypertension, arthritis) alongside geriatric syndromes (e.g., frailty, cognitive impairment, falls)—that interact to shape symptoms, treatment risks, and outcomes [&lt;span&gt;5&lt;/span&gt;]. Frailty, for example, has been linked to increased healthcare utilization, poorer recovery, and higher mortality in older adults with chronic diseases. As populations age, frailty is gaining attention as a tool to improve risk stratification and guide individualized treatment decisions [&lt;span&gt;2, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Diabetes illustrates how frailty complicates treatment decisions in older adults [&lt;span&gt;6&lt;/span&gt;]. One in four adults aged 65 and older has diabetes, often with cardiovascular disease, nephropathy, or neuropathy, all of which are associated with frailty. About half of older adults with diabetes meet the criteria for frailty, reflecting their greater physiological vulnerability [&lt;span&gt;7&lt;/span&gt;]. Moreover, frail individuals with diabetes have higher risks of hypoglycemia, poor treatment tolerance, and functional decline. They may also not benefit from treatments that take years to show results [&lt;span&gt;6&lt;/span&gt;]. Rigid glycemic targets may expose frail patients to harm, while complex medication regimens increase the risk of polypharmacy and adverse events. Instead of focusing on strict blood glucose levels, clinicians should tailor diabetes care to minimize harm and preserve independence [&lt;span&gt;6&lt;/span&gt;]. Although frailty assessment may help guide treatment intensity and drug selection based on patient needs","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1665-1670"},"PeriodicalIF":4.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19443","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660035","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}