Journal of the American Geriatrics Society最新文献

{"title":"Cognitive and functional change in skilled nursing facilities: Differences by delirium and Alzheimer's disease and related dementias","authors":"Jane S. Saczynski PhD, Benjamin Koethe MPH, Donna Marie Fick PhD, Quynh T. Vo MPH, John W. Devlin PharmD, Edward R. Marcantonio MD, Becky A. Briesacher PhD","doi":"10.1111/jgs.19112","DOIUrl":"10.1111/jgs.19112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer's disease related dementias (ADRD) has not been examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare change in cognition and function among short-stay SNF patients with delirium, ADRD, or both.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study using claims data from 2011 to 2013.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Centers for Medicare and Medicaid certified SNFs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>A total of 740,838 older adults newly admitted to a short-stay SNF without prevalent ADRD who had at least two assessments of cognition and function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD-9 codes, and incident ADRD by ICD-9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD-only and delirium-only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among older adults without dementia admitted to SNF for post-acute care following hospitalization, a positive screen for delirium and a new diagnosis ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3501-3509"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019931","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":"Peptic ulcers with ChEIs, NSAIDs","authors":"Jean-Louis Montastruc MD, PhD","doi":"10.1111/jgs.19128","DOIUrl":"10.1111/jgs.19128","url":null,"abstract":"<p>We read with great interest the Szilcz's study showing that the risk of peptic ulcer increased for the combination of cholinesterase inhibitors (ChEIs) and non-steroidal anti-inflammatory drugs (NSAIDs) more than for NSAIDs alone<span><sup>1</sup></span> in patients ≥65 years. Their work was a self-controlled study. Since approaches in pharmacovigilance and pharmacoepidemiology should be multisource,<span><sup>2</sup></span> we investigated this possible drug interaction (DI) using disproportionality analyses<span><sup>3, 4</sup></span> in the global pharmacovigilance database Vigibase®.</p><p>All reports with ChEIs (N06DA following Anatomical Therapeutic Chemical (ATC) classification) and NSAIDs (M01AA butylpyrazolidines, M01AB acetic acid derivatives and related substances, M01AC oxicams, M01AE propionic and derivatives, M01AG fenamates, M01AH coxibs) registered as “suspected/interacting” in Vigibase® between 01/01/1994 and 31/12/2023 in adults (≥65 years) with known age and sex were included. Disproportionality analyses<span><sup>3, 4</sup></span> were performed with cases being reports of “<i>gastrointestinal ulcerations</i> and perforations” (GUP) (HLGT according to Standardized MedDRA Queries classification, excluding anal, rectal, and esophagus ulcers) with the drug(s) of interest and non-cases all other reports with the same drug(s) of interest. Following this case non-case analysis,<span><sup>3, 4</sup></span> results with ChEIs + NSAIDs were compared with NSAIDs alone. To minimize the potential reporting bias and increase the medical meaning, a sensitivity analyses was performed only including reports by physicians. Results are presented as reporting odds ratios (ROR),<span><sup>3, 4</sup></span> a ratio similar in concept to the odds ratio in case–control studies with their 95% confidence interval. The research was performed and paper written according to the READUS-PV consensus statement for drug safety signal detection using Individual case safety reports in pharmacovigilance.<span><sup>5, 6</sup></span></p><p>Among the 7,054,411 reports registered in VigiBase® according to the criteria defined above, 31,494 were GUP with 283 including ChEIs alone (mainly donepezil 49.5%), 9060 NSAIDs alone (mainly propionic drugs like ibuprofen 33.0%) and 29 the combination ChEIs + NSAIDs. Patients were mainly women (57.9% for NSAIDs, 54.1% for ChEIs, 82.8% for combination). Most of them were ≥75 years old (60.0% for NSAIDs, 78.4% for ChEIs, 79.3% for combination).</p><p>Table 1 shows the number of GUP reports. Significant ROR values were found for ChEIs alone, NSAIDs alone and their combination for all reports (whatever the reporter) as well as for reports only coming from physicians. ROR values for the comparison ChEIs + NSAIDs vs NSAIDs alone was 3.24 (2.18–4.81) for all reports and 2.64 (1.56–4.46) for physicians.</p><p>Using a validated method for detecting risk signals,<span><sup>3-6</sup></span> our results are in line with the self-contro","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3609-3611"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019932","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":"Unleashing frailty from laboratory into real world: A critical step toward frailty-guided clinical care of older adults","authors":"Dae Hyun Kim MD, MPH, ScD","doi":"10.1111/jgs.19151","DOIUrl":"10.1111/jgs.19151","url":null,"abstract":"<p>Understanding patients' degree of frailty is crucial for tailoring clinical care for older adults based on their physiologic reserve and health needs (“frailty-guided clinical care”). Two prerequisites for frailty-guided clinical care are: (1) access to frailty information at the point of care and (2) evidence to inform decisions based on frailty information. Recent advancements include web-based frailty assessment tools and their electronic health records integration for time-efficient, standardized assessments in clinical practice. Additionally, database frailty scores from administrative claims and electronic health records data enable scalable assessments and evaluation of the effectiveness and safety of medical interventions across different frailty levels using real-world data. Given limited evidence from clinical trials, real-world database studies can complement trial results and help treatment decisions for individuals with frailty. This article, based on the Thomas and Catherine Yoshikawa Award lecture I gave at the American Geriatrics Society Annual Meeting in Long Beach, California, on May 5, 2023, outlines our group's contributions: (1) developing and integrating a frailty index calculator (Senior Health Calculator) into the electronic health records at an academic medical center; (2) developing a claims-based frailty index for Medicare claims; (3) applying this index to evaluate the effect of medical interventions for patients with and without frailty; and (4) efforts to disseminate frailty assessment tools through the launch of the eFrailty website and the forthcoming addition of the claims-based frailty index to the Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse. This article concludes with future directions for frailty-guided clinical care.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3299-3314"},"PeriodicalIF":4.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019935","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":"Racial and ethnic disparities in potentially inappropriate medication use in patients with dementia","authors":"Carolyn W. Zhu PhD,&nbsp;Justin Choi MEd,&nbsp;William Hung MD,&nbsp;Mary Sano PhD","doi":"10.1111/jgs.19152","DOIUrl":"10.1111/jgs.19152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Racial and ethnic disparities in potentially inappropriate medication (PIM) use among older adults with dementia are unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were drawn from the baseline visits of participants who were ≥60 years old and diagnosed with dementia in the National Alzheimer's Coordinating Center Uniform Data Set (NACCUDS) recruited from National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADCs) throughout the United States. PIM utilization was evaluated using the 2019 American Geriatrics Society Beers Criteria for PIM Use in Older Adults. We estimated the association between race and ethnicity and the following outcomes and estimation models: (1) any PIM use, any PIM in each drug class, and any PIM best avoided in dementia patients using logistic regression models, (2) total number of medications, total number of PIMs, and anticholinergic burden scale (ACBS) using Poisson or negative binomial regression models, and (3) proportion of total medications that were PIMs using generalized linear models (GLM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to White participants, Black, Hispanic, and Asian participants reported taking fewer total medications (incidence rate ratio [IRR] ± standard error[SE] = 0.903 ± 0.017, 0.875 ± 0.021, and 0.912 ± 0.041, respectively, all <i>p</i> &lt; 0.01). Asian participants were less likely to be exposed to any PIM (odds ratio [OR] ± SE = 0.619 ± 0.118, <i>p</i> &lt; 0.05). Compared to White participants, Black participants were less likely to be exposed to benzodiazepine (OR ± SE = 0.609 ± 0.094, <i>p</i> &lt; 0.01) and antidepressant (OR ± SE = 0.416 ± 0.103, <i>p &lt;</i> 0.001) PIMs, but greater antipsychotic (OR ± SE = 1.496 ± 0.204, <i>p</i> &lt; 0.01), cardiovascular (OR ± SE = 2.193 ± 0.255, <i>p</i> &lt; 0.001), and skeletal muscle relaxant (OR ± SE = 2.977 ± 0.860, <i>p &lt;</i> 0.001) PIMs. Hispanic participants were exposed to greater skeletal muscle relaxant PIMs and had lower anticholinergic burden. Asian participants were exposed to fewer benzodiazepine PIMs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Significant racial and ethnic disparities in exposure to PIMs and PIMs by medication category in dementia research participants who have access to dementia experts found in the study suggest that disparities may be wider in the larger community.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3360-3373"},"PeriodicalIF":4.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019933","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":"Factors associated with transfer from assisted living facilities to a nursing home: National Health Aging Trends Study 2011–2019","authors":"Jung Yoen Son MSN, RN, GNP-C,&nbsp;Deanna J. Marriott PhD,&nbsp;Laura M. Struble PhD, RN, GNP-BC,&nbsp;Weiyun Chen PhD,&nbsp;Janet L. Larson PhD, RN, FAAN","doi":"10.1111/jgs.19147","DOIUrl":"10.1111/jgs.19147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time-varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NHATS participants were included in this study if they: (1) resided in ALF from Round 1 (2011) through Round 8 (2018); (2) completed the sample person (SP) interview at baseline; (3) were admitted to ALF at age 65 years or older. We conducted Cox proportional hazards regression to examine candidate predictors (difficulty with basic activities of daily living (ADL), chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, self-reported health, participation in social and physical activity, and sociodemographic) associated with transfer to a nursing home. Employing backward elimination, we built parsimonious final models for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analytic sample included 970 participants of whom 143 transferred to nursing homes over 8 years. Those who had a better physical performance at baseline (HR = 0.83, 95% CI = 0.79–0.88) and were college educated (HR = 0.58, 95% CI = 0.36–0.92) demonstrated a significantly lower risk for transfer to a nursing home over 8 years. Residents who maintained physical activity (HR = 0.56, 95% CI = 0.37–0.86), better physical performance (HR = 0.87, 95% CI = 0.80–0.94), and difficulty with fewer basic ADLs (HR = 1.13, 95% CI = 1.02–1.26) were at lower risk for transfer to a nursing home over 8 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings can be used to identify older adults in ALFs at risk of transfer to a nursing home. Strategies to promote physical function and physical activity could avoid/delay the need to transfer. Helping older residents to age in place will have important health and economic benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3374-3384"},"PeriodicalIF":4.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006200","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 extended impact of the COVID-19 pandemic on long-term care residents in Medicare with frailty or dual Medicaid enrollment","authors":"Sunny C. Lin PhD, MS,&nbsp;Jie Zheng PhD,&nbsp;Arnold Epstein MD, MS,&nbsp;E. John Orav PhD,&nbsp;Michael Barnett MD, MS,&nbsp;David C. Grabowski PhD,&nbsp;Karen E. Joynt Maddox MD, MPH","doi":"10.1111/jgs.19131","DOIUrl":"10.1111/jgs.19131","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although many healthcare settings have since returned to pre-pandemic levels of operation, long-term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre-pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over-dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non-dually enrolled residents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre-pandemic years for all examined subgroups. For example, compared with 2018–2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In 2022, emergency department and hospital utilization rates among long-term residents were lower than pre-pandemic levels and mortality rates were higher than pre-pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3457-3466"},"PeriodicalIF":4.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984257","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":"Associations between hearing loss, peripheral neuropathy, balance, and survival in older primary care patients","authors":"James W. Mold MD, MPH,&nbsp;Frank H. Lawler MD, MSPH,&nbsp;Xiaolan Liao PhD,&nbsp;David E. Bard PhD","doi":"10.1111/jgs.19142","DOIUrl":"10.1111/jgs.19142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Both age-associated hearing loss (AAHL) and peripheral neuropathy (PN) are common in older patients, and both are associated with impaired balance, falls, and premature mortality. The objectives of this study were to document the prevalence and severity of AAHL in older primary care patients, and to explore associations between AAHL, PN, balance, falls, and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed information obtained in 1999 from 793 primary care patients recruited from practices participating in the Oklahoma Longitudinal Assessment of the Health Outcomes of Mature Adults (OKLAHOMA) Studies. Available data included demographic and health information, history of falls and hospitalizations, audiometry, balance testing, examination of the peripheral nerves, 50 foot timed gait, and dates of death up to 22 calendar years and 8106 person-years of follow-up. Proportionate hazards (PH) and structural equation modeling (SEM) were used to examine associations between AAHL, PN, balance, gait time, and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>501 of the 793 participants (63%) had AAHL. Another 156 (20%) had low frequency and 32 (4%) had unilateral deficits. Those with moderate or severe AAHL and the 255 (32%) with PN had impaired balance (<i>p</i> &lt; 0.0001), increased gait time (<i>p</i> = 0.0001), and reduced survival time (p &lt; 0.0001). In the PH model, both AAHL and PN were associated with earlier mortality (H.Rs. [95% C.I.]: 1.36 [1.13–1.64] and 1.32 [1.10–1.59] respectively). The combination of moderate or severe AAHL and PN, present in 24% of participants, predicted earlier mortality than predicted by either deficit alone (O.R. [95% C.I.I] 1.55 [1.25–1.92]). In the SEM models, the impacts of both moderate or severe AAHL and PN on survival were mediated, in part, through loss of balance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hearing loss and PN, both common in older patients, appear to be independently and additively associated with premature mortality. Those associations may be mediated in part by impaired balance. The Mechanisms are likely multiple and complex.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3427-3436"},"PeriodicalIF":4.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984255","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":"Older women's perspectives on the ethics of persuasion in doctor-patient communication","authors":"Nancy L. Schoenborn MD, MHS,&nbsp;Susan M. Hannum PhD,&nbsp;Sarah E. Gollust PhD,&nbsp;Rebekah H. Nagler PhD,&nbsp;Mara A. Schonberg MD, MPH,&nbsp;Craig E. Pollack MD, MHS,&nbsp;Cynthia M. Boyd MD, MPH,&nbsp;Qian-Li Xue PhD,&nbsp;Mary Catherine Beach MD","doi":"10.1111/jgs.19121","DOIUrl":"10.1111/jgs.19121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Public health campaigns have often used persuasive techniques to promote healthy behaviors but the use of persuasion by doctors is controversial. We sought to examine older women's perspectives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews with 20 community-dwelling older women from the Baltimore metropolitan area. We asked whether participants thought it was ethically appropriate for doctors to try to persuade patients and explored their rationales. We probed about commonly used persuasive techniques and two example decisional contexts—stopping mammograms and moving out of one's house after multiple falls. We used qualitative thematic analysis to code the transcripts and summarized results into major themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found mixed views on the ethical appropriateness of persuasion (theme 1); supporters of persuasion were motivated by the potential benefit to patients' health, whereas opponents thought patients should be the ultimate decision-makers. Perspectives depended on the persuasive technique (theme 2), where emotional appeals elicited the most negative reactions while use of facts and patient stories were viewed more positively. Perspectives also varied by the decisional context (theme 3), where higher severity and certainty of harm influenced participants to be more accepting of persuasion. Participants suggested alternative communication approaches to persuasion (theme 4) that emphasized respect for patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that the type of persuasive technique and the decisional context are important considerations in the ethical debate around the use of persuasion. Limiting the use of persuasion to high-stakes decisions and using facts and patient stories rather than emotional appeals are likely more acceptable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3179-3187"},"PeriodicalIF":4.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984256","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":"“What choice do we have?” Reactive and proactive decision-making for aging in place with dementia","authors":"Catherine L. Auriemma MD, MS,&nbsp;Maayra I. Butt MS,&nbsp;Julia McMillan BA,&nbsp;Jasmine A. Silvestri MPH,&nbsp;Carolyn Chow MD,&nbsp;Melanie Bahti MS,&nbsp;Tamar Klaiman PhD, MPH,&nbsp;Kristin Harkins MPH,&nbsp;Jason Karlawish MD,&nbsp;Scott D. Halpern MD, PhD","doi":"10.1111/jgs.19140","DOIUrl":"10.1111/jgs.19140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Promoting options for aging in place (AIP) has broad appeal to policymakers and professionals providing services to persons living with dementia (PWD). However, the benefits or burdens of AIP likely vary among individuals and families. We sought to describe factors influencing decision-making to age in place versus seek a higher level of residential care for PWD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative study was undertaken as part of a larger mixed-methods study utilizing semi-structured interviews with PWD, family care partners, and dementia clinicians. Interview transcripts were analyzed using qualitative content analysis with constant comparison. Sample size was determined by thematic saturation within subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We conducted 74 interviews among 14 PWD, 36 care partners, and 24 clinicians. Preferences for AIP were driven by (1) desire to preserve independence, (2) a sense that the “best care” is delivered by loved ones and in a familiar environment, (3) distrust and fear of care facilities, and (4) caregiver guilt. PWD and care partners frequently considered moving from home as a “last resort” and wanted to avoid planning for future care needs. Many decisions to move were reactive and triggered by patient safety events, physical dependency, or the loss of caregiver. Proactive decision-making was facilitated by (1) prior experience witnessing the challenges of caring for a person with advanced dementia in the home; and (2) having substantial financial resources such that participants could seek major home adaptations or avoid “lower quality” institutions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Decisions regarding care setting for PWD frequently do not feel like a choice and are made under imperfect conditions. Programs using AIP as an outcome measure should recognize the various patient-centered and non-patient-centered factors that influence such choices, and interventions should be designed to promote more informed and equitable decision-making for care setting in dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3398-3412"},"PeriodicalIF":4.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984253","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":"Surviving aging—An assets-based approach","authors":"Brianna E. Morgan PhD, NP,&nbsp;Harriet Mather MD,&nbsp;Daniel David PhD, RN","doi":"10.1111/jgs.19126","DOIUrl":"10.1111/jgs.19126","url":null,"abstract":"&lt;p&gt;Rather than seeking time-bending bodies of water, today's scientists pursue the fountain of youth in older adults who demonstrate younger-than-expected attributes. SuperAgers, for example, exhibit signs of cognitive youth despite advanced age. Researchers seek to extract the fountain of youth from SuperAgers' modifiable risks. A 2020 Lancet Commission report found that addressing 12 modifiable risk factors could potentially prevent 40% of cases of dementia.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; While promising, this approach centers around combating aging rather than building upon its inherent assets and opportunities. In this editorial, we discuss the strengths and weaknesses of contemporary conceptual models of aging, highlight an article published in this issue that characterizes factors associated with SuperAgers in a sample of African Americans, and propose a new model of aging (Table 1). We aim to conceptualize an assets-based approach that incorporates both the strengths and challenges faced by all older adults seeking to survive aging.&lt;/p&gt;&lt;p&gt;SuperAging describes older adults who maintain cognitive function equal to normative middle-aged cohorts and is the guiding framework of the Trammel study. While some heterogeneity exists, SuperAging most frequently characterizes a person who is 80+ years old and performs extremely well on a measure of episodic memory (the Rey Auditory Verbal Learning Task), a single aspect of cognition. SuperAgers resist age-related changes (i.e., display cognitive resilience) and demonstrate neuroanatomical features of adults who are decades younger. The concept of SuperAgers is limited by exclusivity (median—12% of older adults), singular dimension (only episodic memory), and stigmatization for those who fail to meet the criteria.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Despite rising national awareness of racialized disparities in dementia, cognitive resilience in historically underrepresented racial and ethnic groups remains understudied. Using a nationally representative dataset, Trammel et al. explore differences among 1285 African American participants over 80 years old across three cohorts in the National Alzheimer's Coordinating Center dataset—SuperAgers, cognitively intact, and cognitively impaired. After accounting for gender and educational differences, classification as a SuperAger was associated with reduced prevalence of sleep disorders, decreased depression, and moderate alcohol usage. While SuperAgers exhibited vascular comorbidities comparable to non-SuperAgers, they were more likely to report taking medications, including antihypertensives and nonsteroidal anti-inflammatory drugs. Taken together, the results suggest that 80+-year-old African Americans who actively address chronic health conditions are most likely to demonstrate SuperAging status.&lt;/p&gt;&lt;p&gt;Research on SuperAgers has been a focus since 2012.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; It is quite remarkable that a study investigating SuperAgers in African American cohort","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"2965-2968"},"PeriodicalIF":4.3,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972500","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}