Journal of the American Geriatrics Society最新文献

{"title":"Racial and Ethnic Differences in Low-Value Care Among Older Adults in a Large Statewide Health System","authors":"Carlos Irwin A. Oronce,&nbsp;Ray Pablo,&nbsp;Susi Rodriguez Shapiro,&nbsp;Phyllis Willis,&nbsp;Ninez Ponce,&nbsp;John N. Mafi,&nbsp;Catherine Sarkisian","doi":"10.1111/jgs.19369","DOIUrl":"10.1111/jgs.19369","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As value-based payment models incorporate both measures of health equity and low-value care (LVC), understanding how LVC varies by race is vital for interventions. Therefore, we measured racial differences in LVC in a contemporary sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional analysis of claims from adults ≥ 55 years receiving care at five academic medical centers in California from 2019 to 2021. Our sample included patients who received a service that could be classified as LVC. The primary outcome was whether a service was classified as LVC. Secondary outcomes included clinical categories of LVC (preventive screening, diagnostic testing, prescription drugs, and preoperative testing). We examined associations between race/ethnicity with outcomes using multivariable regression models adjusted for patient characteristics and medical center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 15,720 members who received potentially LVC, non-Hispanic White older adults comprised 59% of the sample, followed by Asian (17%), unknown race (8%), Latino (8%), non-Hispanic Black (5%), other race (2%). In adjusted models, Asian (−4.9 percentage points [pp]; 95% CI −5.9, −3.8 pp), Black (−5.4 pp; 95% CI −8.0, −2.7 pp), and Latino (−2.5 pp; 95% CI −4.6, −0.4 pp) older adults were less likely to receive LVC compared to White older adults, specifically preventive and preoperative services. Asian, Black, and Latino older adults, however, were more likely to receive low-value prescriptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These diverging racial patterns in LVC across different measures likely reflect differential mechanisms, underscoring the need to use clinically specific measures rather than composite measures, which obscure underlying heterogeneity and could lead to potentially harmful and inequity-producing interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"900-909"},"PeriodicalIF":4.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082897","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":"Aligning Medications With What Matters Most: Conversations Between Pharmacists, People With Dementia, and Care Partners","authors":"Ariel R. Green,&nbsp;Rosalphie Quiles Rosado,&nbsp;Andrea E. Daddato,&nbsp;Aleks Wec,&nbsp;Kathy Gleason,&nbsp;Tobie Taylor McPhail,&nbsp;Jessica Merrey,&nbsp;Linda Weffald,&nbsp;Meghan Swarthout,&nbsp;Scott Feeser,&nbsp;Cynthia M. Boyd,&nbsp;Jennifer L. Wolff,&nbsp;Marcela D. Blinka,&nbsp;Elizabeth A. Bayliss,&nbsp;Rebecca S. Boxer","doi":"10.1111/jgs.19379","DOIUrl":"10.1111/jgs.19379","url":null,"abstract":"<p>See related editorial by Gurwitz et al. in this issue.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1189-1197"},"PeriodicalIF":4.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082872","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":"Enhancing Geriatric Assessment in Cancer Rehabilitation: Suggestions for Future Research","authors":"Qing Su,&nbsp;Xiaofeng Zeng","doi":"10.1111/jgs.19384","DOIUrl":"10.1111/jgs.19384","url":null,"abstract":"&lt;p&gt;We would like to express our appreciation of the study by Brick et al. [&lt;span&gt;1&lt;/span&gt;], which provides valuable insights into geriatric assessment (GA)-driven rehabilitation referrals among older adults with advanced cancer and explores their functional outcomes and survival. The researchers have addresses an important area in cancer rehabilitation, especially so for older adults with functional impairments. Nevertheless, as clinicians involved in gerontology, we would like to offer a few suggestions.&lt;/p&gt;&lt;p&gt;First, although the study used the OARS Comorbidity Scale to assess comorbidiy-associated impairment in the patients, it did not consider specific disease types. Multimorbidity is common in the geriatric population [&lt;span&gt;2&lt;/span&gt;], and the healthcare priorities of patients may vary due to the need to manage chronic conditions. For example, patients requiring regular dialysis may be less likely to accept rehabilitation referrals.&lt;/p&gt;&lt;p&gt;Second, the researchers did not specifically consider patients with lymphoma. The study included patients with advanced solid malignant tumors or lymphoma, with the patients classified into three groups according to the cancer type, namely, gastrointestinal, lung, and other. Given the significant differences in treatment and prognosis between hematological and solid tumors [&lt;span&gt;3&lt;/span&gt;], we recommend classifying patients with lymphoma as a single subgroup.&lt;/p&gt;&lt;p&gt;Third, the oncologists in the study may have had limited knowledge of GA. The study provided a summary of GA and recommendations to oncologists in the intervention arm [&lt;span&gt;1&lt;/span&gt;]. However, these oncologists only received brief training in GA at the start of the study and thus may not have fully appreciated its importance. Moreover, they had the freedom to decide how to apply GA in the patients, and it is possible that different oncologists may have differed in their referral criteria, which could have led them to provide treatment recommendations essentially from an oncologist's perspective. We suggest that geriatricians should be involved in a collaborative process with oncologists and be available for consultation and answering their questions. Multidisciplinary collaboration is one of the critical principles in geriatric medicine [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Fourth, it might not be easy to generalize the study's findings. The results may not be suited to other countries or regions as the study was only conducted in the USA. Additionally, the study did not fully assess consistencies among different community oncology settings. Variations in healthcare resources, access to rehabilitation services, and clinical practices in different settings may influence the opportunities available to patients for rehabilitation, which could affect the generalization of the findings of this study.&lt;/p&gt;&lt;p&gt;Finally, the study did not account for the impact of the willingness of patients and their families to accept rehabilitation referrals. The researchers consider","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1631-1632"},"PeriodicalIF":4.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076792","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":"Response to: “Enhancing Geriatric Assessment in Cancer Rehabilitation: Suggestions for Future Research”","authors":"Supriya Mohile,&nbsp;Rachelle Brick,&nbsp;Marielle Jensen-Battaglia,&nbsp;Brennan P. Streck,&nbsp;Lindsey Page,&nbsp;Eva Culakova","doi":"10.1111/jgs.19385","DOIUrl":"10.1111/jgs.19385","url":null,"abstract":"&lt;p&gt;We thank the authors of the letter (Su and Zeng) [&lt;span&gt;1&lt;/span&gt;] for their questions and thoughtful insights. We agree that this study is one of the first to describe referral patterns to rehabilitation in community oncology settings in the United States (U.S.) using the geriatric assessment (GA) [&lt;span&gt;2&lt;/span&gt;]. We welcome the opportunity to respond to the suggestions.&lt;/p&gt;&lt;p&gt;The first suggestion was to evaluate individual comorbidities and their relationship to referrals to rehabilitation services. In the original trial, “Communicating about Aging and Cancer Health” (COACH) study (clinicaltrials.gov identifier: NCT02107443), comorbidity as an aging-related domain was impaired for patients that had 3+ comorbidities or one that significantly influenced quality of life [&lt;span&gt;3&lt;/span&gt;]. We previously found that impairment in the comorbidity domain was associated with impairments in functional status and physical performance [&lt;span&gt;4&lt;/span&gt;]; impairments in the functional and physical performance guided rehabilitation recommendations in the COACH intervention [&lt;span&gt;3&lt;/span&gt;]. For this analysis, given the large number of variables that influence functioning and recommendations for rehabilitation services and due to the rather modest sample size, an analytical decision was made to include a composite variable for comorbidities. We agree that future research should strive to understand the individual and cumulative impact of comorbid conditions on rehabilitation referral.&lt;/p&gt;&lt;p&gt;The second recommendation was to classify patients with lymphoma as a single subcategory. Of note, there was no difference by cancer subgroup in outcomes of the original COACH trial [&lt;span&gt;3&lt;/span&gt;]. For this secondary analysis, the number of patients with lymphoma was small (&lt;i&gt;n&lt;/i&gt; = 20) and thus did not allow for a separate analysis. We are not aware of literature to support that patients with solid versus hematologic malignancies differ in terms of uptake of rehabilitation services in older adults with advanced cancer. This is a future direction to be considered in population-based datasets.&lt;/p&gt;&lt;p&gt;The third suggestion was to involve geriatricians in the care of older adults with advanced cancer, as oncologists may have limited knowledge of GA. The original trial provided GA training to all participating oncologists, and primary results showed improved aging-related communication in the intervention arm, demonstrating that the oncologists effectively utilized the GA results in clinical practice [&lt;span&gt;3&lt;/span&gt;]. In the U.S., the availability of geriatricians is quite low; one study reported that in 210 oncology practice groups, geriatricians were available in only 5% of the oncology clinics [&lt;span&gt;5&lt;/span&gt;]. Thus, educating oncologists on the use of GA and how to appropriately apply the intervention recommendations will be critical to support the growing pool of older adults who are diagnosed with cancer.&lt;/p&gt;&lt;p&gt;Fourth, we believe that this study is a necessary first st","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1633-1634"},"PeriodicalIF":4.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076793","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":"Prevalence and Determinants of Sarcopenia Among Older Adults in India: Insights From the Longitudinal Aging Study in India","authors":"Abhijith R. Rao,&nbsp;Manjusha Bhagwasia,&nbsp;Vishwajeet Singh,&nbsp;Swati Bajpai,&nbsp;Sunny Singhal,&nbsp;Prasun Chatterjee,&nbsp;Avinash Chakrawarty,&nbsp;Sharmishtha Dey,&nbsp;Aparajit Ballav Dey","doi":"10.1111/jgs.19373","DOIUrl":"10.1111/jgs.19373","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sarcopenia, characterized by declining muscle mass and function, is a growing concern among India's aging population. This study investigates sarcopenia's prevalence and determinants using the nationally representative LASI dataset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This analysis included 26,780 community-dwelling adults aged 60 and above, with informed consent obtained from all participants. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Demographic, socioeconomic, health, and geriatric factors, including age, sex, living arrangements, economic status, comorbidities, and geriatric syndromes, were examined. Multinomial logistic regression was used to analyze associations with sarcopenia and severe sarcopenia, and results were expressed as relative risk ratios (RRR) with 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of sarcopenia was 43.6% (<i>n</i> = 11,665), and 19.4% (<i>n</i> = 5202) had severe sarcopenia. Sociodemographic factors significantly associated with sarcopenia and severe sarcopenia included being widowed (RRR: 1.24, 95% CI: 1.12–1.37 for sarcopenia; RRR: 1.82, 95% CI: 1.64–2.03 for severe sarcopenia) or divorced (RRR: 1.68, 95% CI: 1.12–2.54 for severe sarcopenia). Additionally, a higher BMI and higher education level were associated with a lower risk of sarcopenia. Among comorbidities, joint and bone diseases were linked to both sarcopenia (RRR: 1.21, 95% CI: 1.07–1.35) and severe sarcopenia (RRR: 1.4, 95% CI: 1.23–1.58), while hypertension (RRR: 1.22, 95% CI: 1.1–1.36), chronic lung disease (RRR: 1.22, 95% CI: 1.02–1.44), and cerebrovascular accident (RRR: 1.5, 95% CI: 1.09–2.08) were specifically associated with severe sarcopenia. Geriatric syndromes such as tooth loss, impaired vision and hearing, history of falls, and depression were significantly associated with increased risk of sarcopenia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study reveals significant associations between sarcopenia and various sociodemographic factors, comorbidities, and geriatric syndromes in older adults in India, suggesting potential areas for targeted intervention. However, further longitudinal studies are needed to validate these findings and clarify the causal relationships of the observed associations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1429-1440"},"PeriodicalIF":4.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070568","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":"Network Analyses to Explore Comorbidities Among Older Adults Living With Dementia","authors":"Samuel Quan,&nbsp;Barret A. Monchka,&nbsp;Philip D. St. John,&nbsp;Malcolm B. Doupe,&nbsp;Maxime Turgeon,&nbsp;Lisa M. Lix","doi":"10.1111/jgs.19336","DOIUrl":"10.1111/jgs.19336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older persons living with dementia (PLWD) often have multiple other chronic health conditions (i.e., comorbidities). Network analyses can describe complex profiles of chronic health conditions through graphical displays grounded in empirical data. Our study compared patterns of chronic health conditions among PLWD residing in and outside of long-term care (LTC) settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Population-based administrative data, including outpatient physician claims, inpatient records, pharmaceutical records, and LTC records, for the study were from the Canadian province of Manitoba. We included PLWD, ages ≥ 67 years, with two or more other chronic health conditions, who resided in Manitoba from 2017 to 2020. A total of 138 chronic health conditions were ascertained using a modification of the open-source Clinical Classification Software. Networks defined by nodes (health conditions) and edges (associations between nodes) were stratified by residence location (in versus outside LTC). Network properties were described, including: density (ratio of number of edges to number of potential edges), and modularity (associations between and within clusters of health conditions), and the median and interquartile range (IQR) for node degree (number of associations per node).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The population comprised 19,672 PLWD, of which 17,534 (89.1%) had two or more chronic health conditions. The median number of co-occurring conditions was similar among PLWD in LTC (median: 6, IQR: 3–10) versus outside LTC (median: 7, IQR: 4–10). Network properties were similar for PLWD and multiple comorbidities residing in versus outside LTC, including node degree (median 11 vs. 12), density (0.15 vs. 0.14), and modularity (0.18 vs. 0.26).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multiple chronic diseases characterize PLWD residing in and outside of LTC. Using network analyses, chronic diseases among PLWD do not form easily distinguishable groups or patterns. This suggests the need for comprehensive clinical assessments, individualized approaches for disease management, and highlights the importance of person-specific care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1168-1178"},"PeriodicalIF":4.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026188","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 PRO-AGE Tool and Its Association With Post Discharge Outcomes in Older Adults Admitted From the Emergency Department","authors":"Inessa Cohen,&nbsp;Pedro K. Curiati,&nbsp;Christian V. Morinaga,&nbsp;Ling Han,&nbsp;Tanish Gandhi,&nbsp;Katy Araujo,&nbsp;Thiago J. Avelino-Silva,&nbsp;Luann M. Bianco,&nbsp;Cynthia A. Brandt,&nbsp;Sandra Capelli,&nbsp;Christopher R. Carpenter,&nbsp;Daniel S. Cruz,&nbsp;Scott M. Dresden,&nbsp;Ivy L. Fishman,&nbsp;Katrina Gipson,&nbsp;Elizabeth Gray,&nbsp;S. Nicole Hastings,&nbsp;William W. Hung,&nbsp;Raymond Kang,&nbsp;Mechelle Lockhart,&nbsp;Daniella Meeker,&nbsp;Ugochi Ohuabunwa,&nbsp;Sierra Ottilie-Kovelman,&nbsp;Timothy F. Platts-Mills,&nbsp;Jacqueline Sandoval,&nbsp;Natalia Sifnugel,&nbsp;Zachary Taylor,&nbsp;Debra F. Tomasino,&nbsp;Camille P. Vaughan,&nbsp;Márlon J. R. Aliberti,&nbsp;Ula Hwang","doi":"10.1111/jgs.19374","DOIUrl":"10.1111/jgs.19374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Existing risk scores assessing geriatric vulnerability in the emergency department (ED) have shown limited predictive power, especially in diverse populations. We investigated the relationship of a quick and easy-to-administer geriatric vulnerability scoring system with functional decline and mortality in older patients admitted to multiple hospitals through the ED in the United States (US) and Brazil (BR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Federated, international, multicenter observational study of hospitalized ED patients aged ≥ 65 from US and BR. The six criteria from the PRO-AGE score (Physical impairment, Recent hospitalization, Older age [≥ 90], Acute mental alteration, Getting thinner, and Exhaustion; 0–8; higher scores = greater vulnerability) were assessed on admission. We used proportional hazards models to investigate the relationships between PRO-AGE score groups and 90-day mortality and functional decline, defined as new dependence in activities of daily living (ADL) and instrumental ADL (IADL), after adjusting for age, sex, race and ethnicity, education, Charlson comorbidity score, and study site. Death was considered a competing event for the functional decline outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1390 patients were included (US = 560; Brazil = 830). The 90-day risk of death was higher for the upper compared with the lower (reference) PRO-AGE group in both cohorts (US: HR = 11.76; 95% confidence interval [CI] = 2.56–54.04; BR: HR = 12.29; 95% CI = 3.54–42.59), whereas the risk of new 90-day ADL disability was higher for upper (HR = 2.08; 95% CI = 1.21–3.56) and middle groups (HR = 2.10; 95% CI = 1.35–3.27) in the US but only the upper group in BR (HR = 1.70; 95% CI = 1.02–2.85).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A higher PRO-AGE score was associated with mortality and functional decline in older ED patients admitted to hospitals in the US and BR, demonstrating its generalizability as a geriatric vulnerability risk score.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1419-1428"},"PeriodicalIF":4.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024812","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":"Food for Thought: Papas Fritas","authors":"Marina Silva Ferreira,&nbsp;Juan Carlos Nunez,&nbsp;Mandi Sehgal","doi":"10.1111/jgs.19343","DOIUrl":"10.1111/jgs.19343","url":null,"abstract":"&lt;p&gt;Mrs. M is an 80-year-old fully dependent, Spanish-speaking woman with severe Alzheimer's dementia seen as an inpatient by Geriatric Medicine for a goals of care discussion.&lt;/p&gt;&lt;p&gt;She was admitted due to septic shock (MRSA bacteremia) and possible endocarditis, requiring a prolonged admission in the intensive care unit (ICU). She was started on pressors and broad-spectrum antibiotics and underwent invasive procedures. Due to her prolonged ICU stay, her clinical status significantly deteriorated, including severe dysphagia. Eventually, she was transferred from the ICU to the general medical floor; however, her severe frailty and dysphagia remained unchanged, and PEG tube placement and other invasive procedures were brought up by the interprofessional admitting team.&lt;/p&gt;&lt;p&gt;Her daughter, who was her health care surrogate (HCS), requested ‘everything to be done,’ including maintaining full code status, a transesophageal echo to confirm endocarditis, and PEG placement, and refused consultation from palliative care. Geriatric medicine was then consulted for a goals of care discussion.&lt;/p&gt;&lt;p&gt;During our consultation, we observed Mrs. M to be a frail person living with severe dementia, whose speech was limited to yes and no answers. We called her daughter and asked if she could join us and her mother in person to identify her concerns and expectations regarding her mother's health.&lt;/p&gt;&lt;p&gt;After a long discussion with Mrs. M's daughter, we identified that one of her biggest fears was that her mother was not able to nourish herself due to dysphagia and, as a result, was getting weaker. This was her reason for wanting a PEG tube to be placed. We took the time to explain the importance of small pleasures at the end of life and that the PEG tube would provide more harm than good at this stage of her mother's illness. We asked what her favorite food was, and her daughter answered ‘papas fritas’ (French fries); see Figure 1: image of Papas Fritas or French Fries. We recommended a liberalized diet, and in the following days her daughter started to give her small amounts of french fries as tolerated. After that, her daughter requested a change of code status to DNR, declined PEG tube placement, and accepted a hospice consultation for her mother.&lt;/p&gt;&lt;p&gt;Mrs. M's story reminds us how important goals of care discussions are to identify &lt;b&gt;what matters most&lt;/b&gt; to our patients and to make sure we work to always honor their wishes, but especially at the end of life. It also reminds us how crucial it is, even more in a setting of the &lt;b&gt;diagnosis of dementia&lt;/b&gt;, to have those conversations early rather than when the disease is already too advanced for them to be able to determine their priorities at the end of life.&lt;/p&gt;&lt;p&gt;Many times, goals of care discussions are avoided due to time restraints, moral barriers, or due to perceived resistance from patients or families. In practice, we do see resistance from patients to talk about this matter, and depending on their indiv","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"993-994"},"PeriodicalIF":4.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018989","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":"How to Communicate What's Important Among the Many Geriatrics Care Models","authors":"Michael L. Malone,&nbsp;Heidi K. White,&nbsp;Jonny Macias Tejada,&nbsp;Marie Boltz","doi":"10.1111/jgs.19370","DOIUrl":"10.1111/jgs.19370","url":null,"abstract":"&lt;p&gt;The chief medical officer of a large health system recently interrupted a presentation by the geriatric medicine leader, saying, “&lt;i&gt;You have too many models for us to discuss today. Just tell me your highest priority and why&lt;/i&gt;.” This feedback came during a meeting focused on shaping the future direction of the health system after four decades of efforts to enhance care for older adults. We are reminded of the importance of clearly describing geriatric models and how those models fit in our health system when reading the scoping review of Ann Dandich et al. in this issue of the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt; [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The challenge described above arose because, over the years, many successful care models for older adults had been developed. However, leadership turnover and heavy reliance on generous donations had left the organization in need of clear priorities. The not-for-profit organization needed to determine which of the many effective models should be prioritized to allocate resources and provide appropriate salary support.&lt;/p&gt;&lt;p&gt;Dadich and colleagues' paper contributes to the geriatric medicine literature by examining numerous geriatric care models and identifying important gaps. According to the authors this analysis yields a call to action for current and future model development to follow consistent definitions and reporting standards, and to incorporate family caregivers and social determinants of health with greater attention to under-represented minorities and rural environments.&lt;/p&gt;&lt;p&gt;Additionally, in the context of other recent evaluations of existing geriatric care models, this report speaks to the current opportunities for shaping healthcare to meet the needs of older adults. Dadich's approach complements McNabney and colleagues who summarized predominant themes in geriatric practice models [&lt;span&gt;3&lt;/span&gt;]. In their evaluation the themes of person-centeredness, interdisciplinary assessment and complex care management predominate among geriatrics care models. Likewise, an essay by Terry Fulmer and her colleagues highlighted six vital steps to improve care across health care settings [&lt;span&gt;4&lt;/span&gt;]. Fulmer et al. described the importance of remediating disparities and inequities in care of older Americans. They described the public support that is needed (i.e., an adequately prepared workforce, financial structures, and public health resources) as we develop, evaluate and implement new health care models. Service line leadership, they argue, should prioritize programs for older adults. Dr. Chad Boult and his colleagues performed a meta-analysis of comprehensive care models for older adults in 2009 concluding that while there was evidence to support multiple models of care, few models were widely adopted across health systems and across the country [&lt;span&gt;5&lt;/span&gt;]. Similarly, an essay by Dr. Mary Tinnetti advocated for broad implementation of core geriatric medicine principles and elements","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1335-1337"},"PeriodicalIF":4.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018995","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":"Models of Care for Older People: A Scoping Review","authors":"Ann Dadich,&nbsp;Angela Lan,&nbsp;Suhasini Shanmugarajan,&nbsp;Sarah Childs,&nbsp;Jennifer Alford,&nbsp;Danielle Ní Chróinín","doi":"10.1111/jgs.19371","DOIUrl":"10.1111/jgs.19371","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>International recognition of the increasing importance of care for older people has seen growing interest in models of care for older people. Yet there is limited information about the scope and breadth of models of care for older people. This article clarifies what is known about models of care for older people by summarizing relevant publications, describing the models depicted in these publications, and synthesizing the outcomes and impact presented in the publications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A scoping review was conducted that involved searching multiple databases to identify relevant publications, published in English, which presented a model of care for older people—specifically, non-Indigenous people aged ≥ 65 years and/or Indigenous people aged ≥ 50 years; and included evidence, broadly defined, about the utility or otherwise of the model. Commentaries, narrative letters, editorials, and reviews were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 21,767 publications, 276 were deemed relevant. From these, four key findings are apparent. First, models of care for older people are understood in disparate ways and are typically devoid of clear stepwise guidance. Second, most of the publications reported on a multidisciplinary approach. Third, they generally failed to involve carers. Fourth, very few publications reported on studies conducted in a rural area, and none involved Indigenous people.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Given the heterogeneity and breadth of models of care for older people, further research is needed to establish: a definition of a model of care for older people; reporting standards; the factors that help or hinder their effectiveness; how to ensure carer involvement; and how to adapt models of care for older people for priority populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1588-1597"},"PeriodicalIF":4.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19371","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018998","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}