Journal of the American Geriatrics Society最新文献

{"title":"Response to Dr. Ouslander's Editorial on Antipsychotic Use in Nursing Home Residents","authors":"Jiska Cohen-Mansfield","doi":"10.1111/jgs.19404","DOIUrl":"10.1111/jgs.19404","url":null,"abstract":"<p>My esteemed colleague, Dr. Joseph G. Ouslander, MD, has written a thought-provoking editorial [<span>1</span>] with which I respectfully disagree. Specifically, I take issue with his statements: “For some nursing home residents, not just those who have a well-documented exclusionary diagnosis, antipsychotics can be an essential therapeutic intervention,” and “Here is the rub: some of these individuals are in fact psychotic, and the use of antipsychotics IS appropriate to prevent danger to themselves or others, to make essential care feasible to perform, to treat intense psychological distress, and to prevent major declines in function and quality of life.”</p><p>Dr. Ouslander illustrates his points with an example of a patient “admitted from the hospital with moderately advanced dementia and residual delirium who was verbally agitated and resisting care because she wanted to see her mother.” According to his description, she said something to the effect of, “… the people who work here killed her and now they want to kill me.” This, however, is NOT a clear example of a patient in whom antipsychotic use would be appropriate, nor is “paranoid delusions” the correct diagnosis [<span>2, 3</span>]. A person with moderately advanced dementia, recently transferred from the hospital, is likely to have difficulty articulating her perception of the situation. The words she used were the only means at her disposal to convey her sense of being endangered, scared, and alone. Rather than resorting to antipsychotic medication, this patient needs reassurance that she is being cared for and that staff members will be doing everything possible to make her comfortable. A female staff member, speaking in a soft, calm voice, should attempt to comfort her, offering light physical touch—if the patient is open to it—and providing a drink or other calming gestures. Non-threatening, compassionate care should be the response, not the administration of an antipsychotic medication that could expose her to potential harmful side effects.</p><p>There are many other ways to soothe persons like this woman, including visual, vocal, musical, verbal, and physical approaches, as well as social and recreational activities. After patience and attention are devoted to her comfort, she is likely to begin to experience a decline in her sense of danger and to reframe her expression thereof. A case study by Cohen-Mansfield and Parpura-Gill (2007) [<span>4</span>] offers an illustrative example.</p><p>Another “proof” favoring this non-pharmacological approach is the other example in Dr. Ouslander's editorial, which involves a resident referred to as “Mama O,” who, 2 days after admission to a nursing home for postsurgical rehabilitation, became extremely agitated, scratching and hitting staff members during routine care. Mama O reportedly said, “… last night the police came in and took me to the basement and assaulted me. I'm afraid they will do it again.” This, again, is not a delusion bu","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1960-1961"},"PeriodicalIF":4.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to “Response to Dr. Ouslander's Editorial on Antipsychotic Use in Nursing Home Residents”","authors":"Joseph G. Ouslander","doi":"10.1111/jgs.19399","DOIUrl":"10.1111/jgs.19399","url":null,"abstract":"<p>I appreciate and respect Dr. Cohen-Mansfield's comments [<span>1</span>] on my editorial discussing the use of antipsychotics in nursing home residents [<span>2</span>]. She is a passionate advocate for nursing home residents with dementia and behavioral symptoms, and she has contributed seminal research to this critical and challenging area of clinical Geriatrics practice.</p><p>I agree with many of her comments. Antipsychotics have been frequently used inappropriately and have served as “chemical restraints” among nursing home residents with dementia for many decades. Antipsychotics are not benign drugs and have many potentially severe adverse effects including an association with increased mortality that has resulted in black box warnings for their use, as illustrated in Figure 1 of my editorial. Thus, the risks of these adverse effects must be carefully weighed against the potential benefits for individual nursing home residents. I also agree that there has been considerable research demonstrating the benefits of a variety of non-pharmacological interventions. These interventions should be used as the treatment of first choice for nursing home residents with dementia and bothersome behavioral symptoms. The challenge, however, is that low staffing levels and related time constraints in many nursing homes complicate the feasibility of using them. Moreover, training nursing home staff members to perform some of these interventions can be time consuming due to high nursing home staff turnover, and many nursing home staff does not have the background and education that are required for effectively implementing the non-pharmacological strategies while being responsible for other aspects of care for residents with disruptive behaviors. It would be ideal to have multiple staff members with Teepa Snow's abilities [<span>3</span>], but that is not realistic given the current staffing situation in many US nursing homes.</p><p>I do, however, strongly disagree with some of Dr. Cohen-Mansfeld's assertions. First, she does not consider the clinical scenarios I used, including the one involving my own mother, delusions. They were in fact delusions as defined by the DSM-5-TR: “fixed beliefs that are not amenable to change in light of conflicting evidence.” [<span>4</span>] More importantly, she states “…the use of antipsychotic medications for individuals with dementia who do not have a prior diagnosis of schizophrenia constitutes an inhumane chemical restraint in all, or at least most, cases.” This is a blanket statement that illustrates naivete about the realities of clinical practice and the provision of person-centered care—which in my view is the essence of caring for older people [<span>5</span>]. I stand by my recommendations and believe that the vast majority of experienced geriatricians and geropsychiatrists who practice clinical Geriatrics would agree with them: IF a nursing home resident/patient is in fact psychotic (including paranoid delusions","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1962-1963"},"PeriodicalIF":4.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660056","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":"Integrating Social Determinants of Health and Established Risk Factors to Predict Cardiovascular Disease Risk Among Healthy Older Adults","authors":"Achamyeleh Birhanu Teshale,&nbsp;Htet Lin Htun,&nbsp;Mor Vered,&nbsp;Alice J. Owen,&nbsp;Joanne Ryan,&nbsp;Kevan R. Polkinghorne,&nbsp;Monique F. Kilkenny,&nbsp;Andrew Tonkin,&nbsp;Rosanne Freak-Poli","doi":"10.1111/jgs.19440","DOIUrl":"10.1111/jgs.19440","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent evidence underscores the significant impact of social determinants of health (SDoH) on cardiovascular disease (CVD). However, available CVD risk assessment tools often neglect SDoH. This study aimed to integrate SDoH with traditional risk factors to predict CVD risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The data was sourced from the ASPirin in Reducing Events in the Elderly (ASPREE) longitudinal study, and its sub-study, the ASPREE Longitudinal Study of Older Persons (ALSOP). The study included 12,896 people (5884 men and 7012 women) aged 70 or older who were initially free of CVD, dementia, and independence-limiting physical disability. The participants were followed for a median of eight years. CVD risk was predicted using state-of-the-art machine learning (ML) and deep learning (DL) models: Random Survival Forest (RSF), Deepsurv, and Neural Multi-Task Logistic Regression (NMTLR), incorporating both SDoH and traditional CVD risk factors as candidate predictors. The permutation-based feature importance method was further utilized to assess the predictive potential of the candidate predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among men, the RSF model achieved relatively good performance (C-index = 0.732, integrated brier score (IBS) = 0.071, 5-year and 10-year AUC = 0.657 and 0.676 respectively). For women, DeepSurv was the best-performing model (C-index = 0.670, IBS = 0.042, 5-year and 10-year AUC = 0.676 and 0.677 respectively). Regarding the contribution of the candidate predictors, for men, age, urine albumin-to-creatinine ratio, and smoking, along with SDoH variables, were identified as the most significant predictors of CVD. For women, SDoH variables, such as social network, living arrangement, and education, predicted CVD risk better than the traditional risk factors, with age being the exception.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SDoH can improve the accuracy of CVD risk prediction and emerge among the main predictors for CVD. The influence of SDoH was greater for women than for men, reflecting gender-specific impacts of SDoH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1797-1807"},"PeriodicalIF":4.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19440","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652836","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":"Age-Related Cataract Extraction Is Associated With Decreased Falls, Fractures, and Intracranial Hemorrhages in Older Adults","authors":"Caitlin M. Hackl,&nbsp;Brady P. Moore,&nbsp;Imanouel M. Samai,&nbsp;Brian R. Wong","doi":"10.1111/jgs.19441","DOIUrl":"10.1111/jgs.19441","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cataract extraction with intraocular lens insertion (CEIOL) is among the most frequently performed surgeries in the United States and is indicated for individuals with age-related cataracts causing visual impairment. The association between CEIOL and falls and hip fractures has been described, but there is a paucity of literature describing the association between CEIOL and various other common morbidity and mortality-increasing age-related traumatic injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study utilized TriNetX, a health database, to access de-identified electronic medical records. Cohorts of patients aged 60 years and older were identified using diagnostic and procedural codes. Cohort 1 was defined as patients with age-related cataracts who underwent CEIOL within 10 years of documented diagnosis of cataracts. Cohort 2 was defined as patients with age-related cataracts who did not undergo CEIOL within 10 years of documented diagnosis of cataracts. Propensity score matching for demographics and other relevant comorbidities was completed. Chi-square analysis was performed, and data were reported as odds ratios with 95% confidence intervals. Outcomes analyzed included proximal humerus fracture, distal radius fracture, hip fracture, ankle fracture, fall, subdural hemorrhage, and epidural hemorrhage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients who underwent CEIOL demonstrated significantly lower odds of falls (<i>p</i> &lt; 0.0001), proximal humerus fracture (<i>p</i> = 0.016), distal radius fracture (<i>p</i> = 0.0004), hip fracture (<i>p</i> &lt; 0.0001), ankle fracture (<i>p</i> = 0.0002), subdural hemorrhage (<i>p</i> &lt; 0.0001), and epidural hemorrhage (<i>p</i> = 0.006) as compared to patients with a documented diagnosis of age-related cataract without CEIOL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CEIOL was significantly associated with decreased falls and reductions in major fall-related injuries among patients with age-related cataracts. These findings strongly support improved screening protocols to detect vision loss secondary to age-related cataracts, as this may decrease the incidence of common major fall-related injuries among patients with age-related cataracts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1779-1786"},"PeriodicalIF":4.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660031","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":"Functional Trajectories After COVID-19 Hospitalization Among Older Adults","authors":"Jim Q. Ho,&nbsp;Gail J. McAvay,&nbsp;Terrence E. Murphy,&nbsp;Denise Acampora,&nbsp;Katy Araujo,&nbsp;Mary Geda,&nbsp;Thomas M. Gill,&nbsp;Alexandra M. Hajduk,&nbsp;Andrew B. Cohen,&nbsp;Lauren E. Ferrante","doi":"10.1111/jgs.19420","DOIUrl":"10.1111/jgs.19420","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Little is known about functional trajectories among older adults who survive hospitalization for coronavirus disease 2019 (COVID-19). We characterized these trajectories over 6 months following discharge and evaluated the associations of potential risk factors with trajectory membership.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were community-dwelling adults ≥ 60 years of age hospitalized for COVID-19 from June 2020 to June 2021. Interviews completed at 1, 3, and 6 months after discharge included assessments for disability in 15 functional activities. Functional trajectories were identified using latent class analysis. Factors associated with trajectory membership were evaluated using multinomial regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>311 participants (mean age 71.3 years) were included. Four different functional trajectories were identified: no (43%), mild (16%), moderate (23%), and severe (18%) disability. The pre-admission count of disabilities was independently associated with membership in each non-reference trajectory. Additional factors independently associated with the moderate trajectory included in-hospital delirium (OR 4.12 [95% CI 1.11–15.4]), frailty (OR 1.67 [95% CI 1.12–2.50]) and number of comorbidities (OR 1.41 [95% CI 1.12–1.79]) and with the severe trajectory included in-hospital delirium (OR 12.4 [95% CI 1.93–79.4]), frailty (OR 2.01 [95% CI 1.11–3.62]), number of comorbidities (OR 1.59 [95% 1.11–2.28]), severity of illness (OR 1.46 [95% CI 1.09–1.95]), and age (OR 1.10 [95% CI 1.02–1.18]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older survivors of COVID-19 hospitalization experience distinct functional trajectories. Our findings may help inform shared medical decision-making during and after hospitalization and stimulate further research into modifiable risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1733-1741"},"PeriodicalIF":4.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover","authors":"Mahip Acharya PhD,&nbsp;Corey J. Hayes PharmD, PhD, MPH,&nbsp;Cari A. Bogulski PhD,&nbsp;Mir M. Ali PhD,&nbsp;Hari Eswaran PhD","doi":"10.1111/jgs.18432","DOIUrl":"https://doi.org/10.1111/jgs.18432","url":null,"abstract":"<p><b>Cover caption</b>: Trend and Trajectories of Remote Patient Monitoring (RPM) Use for Hypertension Management in Medicare Fee-For-Service Data (2018–2021). For full details, see “Attrition of remote patient monitoring use for hypertension management in Medicare fee-for-service beneficiaries (2018–2021)” on page 966.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"C1"},"PeriodicalIF":4.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622415","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":"Psychological Resilience and Physical Function in Veterans With Chronic Kidney Disease: A Brief Report","authors":"Brett T. Burrows,&nbsp;Maren K. Olsen,&nbsp;Theodore S. Z. Berkowitz,&nbsp;Battista Smith,&nbsp;Heather E. Whitson,&nbsp;Nicole DePasquale,&nbsp;Virginia Wang,&nbsp;Matthew L. Maciejewski,&nbsp;Steven D. Crowley,&nbsp;C. Barrett Bowling","doi":"10.1111/jgs.19422","DOIUrl":"10.1111/jgs.19422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Psychological resilience has been characterized as the ability to recover from stressful life events. Not well studied is whether self-reported measures of psychological resilience are associated with physical function recovery. Therefore, we examined the association of self-reported psychological resilience with longitudinal physical function before and after an acute care encounter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This analysis includes a national cohort (<i>n</i> = 272) of Veterans (≥ 70 years) with advanced chronic kidney disease who had physical function measures before and after an acute care encounter (emergency department visit, hospitalization). At enrollment, self-reported psychological resilience was assessed via the Brief Resilience Scale (BRS) (range 1–5, higher scores indicate greater resilience). BRS scores were categorized as Low, Moderate, and High psychological resilience. Physical function was ascertained at enrollment, approximately every 8 weeks, and immediately following an acute care encounter using the Life-Space Assessment (LSA) (range 0–120, higher scores reflect greater mobility). Linear models for longitudinal data were used to estimate differences in physical function over time by psychological resilience group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Physical function levels differed by resilience group both before and after the acute care encounter. Although all resilience groups had the lowest LSA scores immediately following the acute care encounter, differences were seen by resilience group (Low: 38.5, Moderate: 44.9, High: 52.5). Differences remained during recovery at the first post-encounter follow-up (Low: 43.6, Moderate: 49.0, High: 57.5). At the second post-encounter follow-up, only the High resilience group displayed a continued increase in physical function (estimated mean difference of 11.6 (95% CI 1.5, 21.8, <i>p</i> = 0.02) vs. Moderate and 17.7 (95% CI 4.2, 31.3, <i>p</i> = 0.01) vs. Low).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Self-reported psychological resilience was associated with physical function levels before and after an acute care encounter. The BRS may be a useful tool to identify older adults who are less likely to recover after an acute health event.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1877-1883"},"PeriodicalIF":4.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627292","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":"Pulling Back the Curtain on Deprescribing Interventions","authors":"Jerry H. Gurwitz","doi":"10.1111/jgs.19408","DOIUrl":"10.1111/jgs.19408","url":null,"abstract":"&lt;p&gt;Older adults living with dementia commonly experience polypharmacy and exposure to high-risk medications [&lt;span&gt;1, 2&lt;/span&gt;]. According to findings from the National Health and Aging Trends Study, among people with dementia, 1 in 5 believe that they may be taking one or more medicines they no longer need, nearly 9 in 10 are willing to stop one or more of their medications, and half are uncomfortable taking five or more medications [&lt;span&gt;3&lt;/span&gt;]. This underscores the need for tailored medication optimization strategies, including carefully designed, evidence-based deprescribing interventions.&lt;/p&gt;&lt;p&gt;ALIGN (Aligning Medications with What Matters Most) was a pragmatic, pharmacist-led telehealth deprescribing pilot study to support primary care providers in addressing polypharmacy in people living with dementia, who were age ≥ 65 and who were prescribed &gt; 7 medications [&lt;span&gt;4, 5&lt;/span&gt;]. The intervention consisted of a deprescribing educational brochure, a telehealth visit by a pharmacist with the patient-care partner dyad to discuss the patient's medications in the context of their goals and preferences, and deprescribing recommendations from the pharmacist conveyed to the primary care provider via the electronic health record. The primary goal of the intervention was to reduce total medication burden and regimen complexity by focusing on what matters most to patients and care partners. With the primary care provider's approval, the pharmacist was able to implement recommended medication changes. The intervention pharmacists held PharmD degrees with board certification in Geriatric Pharmacy. Pharmacist recommendations could include both stopping medications and starting medications; 73% of patients received a recommendation to stop a medication, or reduce the dose or frequency, while 42% received a recommendation to start a medication, or increase the dose or frequency.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt;, Green and colleagues complement the findings of the ALIGN study by reporting on an analysis of audio-recorded conversations between the intervention pharmacists and the patient-care partner dyads [&lt;span&gt;5&lt;/span&gt;]. By characterizing these conversations, the authors aimed to provide new insights to guide the future development of deprescribing interventions. This qualitative study specifically focused on how elicitation of medication-related priorities from people with dementia and their care partners shaped discussions with the pharmacists.&lt;/p&gt;&lt;p&gt;Importantly, the investigator team has described what actually happened during the telehealth visits with patients and their care partners, including the actual language used by the pharmacists to explain their recommendations. This is a refreshing step forward beyond the usual “sterile” results reported out from most deprescribing intervention trials, which rarely ever extend beyond tables and figures summarizing mean total numbers of medications in the i","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1002-1004"},"PeriodicalIF":4.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627226","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":"What Comes Next for Vitamin D Supplementation and Trials in Older Adults?","authors":"Jatupol Kositsawat,&nbsp;Ariela Orkaby","doi":"10.1111/jgs.19390","DOIUrl":"10.1111/jgs.19390","url":null,"abstract":"&lt;p&gt;Vitamin D, or calciferol, is a fat-soluble hormone essential to many body functions. Naturally, it is present in some foods though it is largely synthesized endogenously through ultraviolet rays from sunlight exposure. Vitamin D deficiency has become increasingly common, and research studies have been undertaken to prove the benefits of vitamin D supplementation. However, benefits of vitamin D supplements have not been supported in rigorously conducted randomized controlled trials (RCTs) and meta-analyses [&lt;span&gt;1-5&lt;/span&gt;]. Three recent RCTs have examined the role of vitamin D supplementation in community dwelling, generally healthy older adults: the American based VITAL (&lt;b&gt;VIT&lt;/b&gt;amin D and Omeg&lt;b&gt;A&lt;/b&gt;-3 Tria&lt;b&gt;L&lt;/b&gt;), European DO-HEALTH (Vitamin&lt;b&gt;D&lt;/b&gt;3-&lt;b&gt;O&lt;/b&gt;mega3-&lt;b&gt;H&lt;/b&gt;ome &lt;b&gt;E&lt;/b&gt;xercise-He&lt;b&gt;ALTH&lt;/b&gt;y Aging and Longevity Trial) [&lt;span&gt;6&lt;/span&gt;], and Australian D-Health trial [&lt;span&gt;7&lt;/span&gt;]. Each trial has been largely null for the role of supplemental vitamin D for primary outcomes of cardiovascular disease, cancer, fractures, and other health outcomes.&lt;/p&gt;&lt;p&gt;In this issue of the Journal, Eggimann et al. report post hoc findings from DO-HEALTH, a 2 × 2 × 2 factorial design RCT of vitamin D supplementation, omega-3 fatty acid supplementation, and home-based exercise programs for the prevention of incident sarcopenia and muscle loss in ambulatory community-dwelling healthy adults aged 70 years and older. Similar to the primary findings that supplementation with vitamin D did not impact incident nonvertebral fractures, functional decline, blood pressure, cognition, or infections, this secondary analysis did not find a protective effect of supplemental vitamin D on sarcopenia or muscle loss. Despite this, this study makes significant contributions to continue moving the field forward for research in this area and geriatric practice.&lt;/p&gt;&lt;p&gt;The results of this study have several implications for ongoing research in this area. First, even though epidemiological evidence has repeatedly demonstrated that low vitamin D levels are associated with multiple medical chronic conditions, including musculoskeletal health [&lt;span&gt;8-11&lt;/span&gt;], results from RCTs have been disappointing. Are we targeting the wrong population, or must we provide higher dosages? Notably, currently established normal 25-hydroxyvitamin D (25(OH)D) levels may not apply to various population groups with different characteristics. The data remain unclear for specific populations such as those with obesity and Black Americans [&lt;span&gt;12&lt;/span&gt;], populations requiring higher doses of vitamin D for adequate replenishment. Like any other trial, this study used one vitamin D supplementation dosage in all participants. However, heterogeneity in vitamin D responsiveness may dictate different dosages needed to show the benefits of vitamin D replacement in all study participants.&lt;/p&gt;&lt;p&gt;Another consideration regarding the benefits of vitamin D is the role of inflammation. Given long","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1005-1007"},"PeriodicalIF":4.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627330","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":"Is Frailty the Geriatric Troponin?","authors":"Jacqueline M. McMillan,&nbsp;Julian Falutz","doi":"10.1111/jgs.19423","DOIUrl":"10.1111/jgs.19423","url":null,"abstract":"&lt;p&gt;The incorporation of serum highly sensitive cardiac troponin (hs-cTn) testing into diagnostic strategies identifying persons with a high probability of an acute coronary event is effective for risk stratification of chest pain syndromes [&lt;span&gt;1&lt;/span&gt;]. Similarly, in older adults, given the heterogeneity of health status based on chronologic age alone, various tools have been investigated for their utility as risk stratifiers [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Frailty is a familiar term in geriatric medicine. It describes a state of vulnerability causing an impaired ability to maintain homeostasis due to reduced physiologic reserve. Frailty is associated with disability, multimorbidity, cognitive impairment, institutionalization, and mortality [&lt;span&gt;3&lt;/span&gt;]. Analogous to troponin testing, frailty assessment has been used to risk stratify older adults.&lt;/p&gt;&lt;p&gt;The utility of assessing frailty beyond the field of geriatrics has been carefully investigated in other areas, including surgery [&lt;span&gt;4&lt;/span&gt;], general internal medicine, and several of its subspecialties. In the United Kingdom, the National Health Service (NHS) requires persons ≥ 65 to be assessed for frailty by their primary care providers [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Given the increasing interest and understanding of frailty, it is opportune to update its role in the care of selected older persons. The recent narrative review by Singh and colleagues summarizes the current range of frailty integration into various internal medicine subspecialties and highlights knowledge gaps to guide future research supporting its integration into clinical care. Across all subspecialties, the authors note a bidirectional association between particular diseases and frailty. Frailty assessment is integrated into the assessment of candidate patients for transthoracic aortic valvuloplasty, candidates for liver transplantation, and persons over 65 with malignancies [&lt;span&gt;6-8&lt;/span&gt;]. They demonstrate that in various medical conditions, frailty is associated with impaired clinical status, poorer response to usual management, and increased risk of treatment-related toxicities.&lt;/p&gt;&lt;p&gt;Their findings support frailty as both a risk stratifier and prognosticator. In chronic obstructive pulmonary disease, frailty is associated with reduced exercise capacity, quality of life, and mortality [&lt;span&gt;9&lt;/span&gt;]. In cardiology, frailty predicts cardiac events and adverse outcomes after invasive procedures [&lt;span&gt;10&lt;/span&gt;]. In rheumatology, frailty is associated with organ damage, disability, and mortality [&lt;span&gt;11&lt;/span&gt;]. In end-stage renal disease, frail patients on dialysis have a twofold increased risk of death [&lt;span&gt;12&lt;/span&gt;]. In gastroenterology, frailty is a predictor of rehospitalization and mortality in inflammatory bowel disease [&lt;span&gt;13&lt;/span&gt;]. In oncology, frail older adults demonstrate lower treatment tolerance, greater treatment discontinuation, increased health care use, shorter progression-free survival, and ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"999-1001"},"PeriodicalIF":4.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607511","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}