Journal of the American Geriatrics Society最新文献

{"title":"Life-space mobility and cognition in community-dwelling late-life women: A cross-sectional analysis","authors":"Kerry M. Sheets MD, MS,&nbsp;Allyson M. Kats MS,&nbsp;Howard A. Fink MD, MPH,&nbsp;Lisa Langsetmo PhD,&nbsp;Kristine Yaffe MD,&nbsp;Kristine E. Ensrud MD, MPH","doi":"10.1111/jgs.19190","DOIUrl":"10.1111/jgs.19190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Life-space mobility captures the daily, enacted mobility of older adults. We determined cross-sectional associations between life-space mobility and cognitive impairment (CI) among community-dwelling women in the 9th and 10th decades of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 1375 (mean age 88 years; 88% White) community-dwelling women enrolled in a prospective cohort of older women. Life-space score was calculated with range 0 (daily restriction to one's bedroom) to 120 (daily trips leaving town without assistance) and categorized (0–20, 21–40, 41–60, 61–80, 81–120). The primary outcome was adjudicated CI defined as mild cognitive impairment or dementia; scores on a 6-test cognitive battery were secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to women with life-space scores of 81–120 and after adjustment for demographics and depressive symptoms, the odds of CI was 1.4-fold (OR 1.36, 95% CI 0.91–2.03) higher for women with life-space scores of 61–80, twofold (OR 1.98, 95% CI 1.33–2.94) higher for women with life-space scores of 41–60, 2.6-fold (OR 2.62, 95% CI 1.71–4.01) higher for women with life-space scores of 21–40, and 2.7-fold (OR 2.71, 95% CI 1.27–5.79) higher for women with life-space scores of 0–20. The association of life-space scores with adjudicated CI was primarily due to higher odds of dementia; the odds of dementia versus normal cognition was eightfold (OR 8.63, 95% CI 3.20–23.26) higher among women with life-space scores of 0–20 compared to women with life-space scores of 81–120. Lower life-space scores were associated in a graded manner with lower mean scores on tests of delayed recall (California Verbal Learning Test-II delayed recall) and language and executive function (phonemic fluency, category fluency, and Trails B). Life-space score was not associated with scores on tests of attention and working memory (forward and backward digit span).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lower life-space mobility is associated in a graded manner with CI among community-dwelling White women in the 9th and 10th decades of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"206-213"},"PeriodicalIF":4.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251627","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":"Association of left atrial function with frailty: The Atherosclerosis Risk in Communities (ARIC) study","authors":"Daokun Sun MPH,&nbsp;Romil R. Parikh MBBS, PhD, MPH,&nbsp;Wendy Wang PhD, MPH,&nbsp;Anne Eaton PhD,&nbsp;Pamela L. Lutsey PhD, MPH,&nbsp;B. Gwen Windham MD, MHS,&nbsp;Riccardo M. Inciardi MD, PhD,&nbsp;Scott D. Solomon MD,&nbsp;Christie M. Ballantyne MD,&nbsp;Amil M. Shah MD, MPH,&nbsp;Lin Yee Chen MD, MS","doi":"10.1111/jgs.19187","DOIUrl":"10.1111/jgs.19187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty is common in people with cardiovascular disease. Worse left atrial (LA) function is an independent risk factor for cardiovascular disease. However, whether worse LA function is associated with frailty is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 3292 older adults from the Atherosclerosis Risk in Communities study who were non-frail at baseline (visit 5, 2011–2013) and had LA function (reservoir, conduit, and contractile strain) measured from two-dimensional speckle-tracking echocardiography. LA stiffness index was calculated as a ratio of E/e′ to LA reservoir strain. Frailty was defined using the validated Fried frailty phenotype. Incident frailty was assessed between 2016 and 2019 during two follow-up visits. LA function was analyzed as quintiles. Multivariable logistic regression examined odds of incident frailty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median (interquartile range [IQR]) age was 74 (71–77) years, 58% were female, and 214 (7%) participants developed frailty during a median (IQR) follow-up of 6.3 (5.6–6.8) years. After adjusting for baseline confounders and incident cardiovascular events during follow-up, the odds of developing frailty was 2.42 (1.26–4.66) times greater among participants in the lowest (vs highest) quintile of LA reservoir strain and 2.41 (1.11–5.22) times greater among those in the highest (vs lowest) quintile of LA stiffness index. Worse LA function was significantly associated with the development of exhaustion, but not the other components of the Fried frailty phenotype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Worse LA function is associated with higher incidence of frailty and exhaustion component independent of LA size and left ventricular function. Future studies are needed to elucidate the underlying mechanisms that drive the observed association.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3810-3823"},"PeriodicalIF":4.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251629","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":"Implementation of delirium screening in the emergency department: A qualitative study with early adopters","authors":"Anita N. Chary MD, PhD,&nbsp;Annika R. Bhananker EMT,&nbsp;Elise Brickhouse BS,&nbsp;Beatrice Torres MPH,&nbsp;Ilianna Santangelo BA,&nbsp;Kyler M. Godwin PhD, MPH,&nbsp;Aanand D. Naik MD,&nbsp;Christopher R. Carpenter MD, MSc,&nbsp;Shan W. Liu MD, SD,&nbsp;Maura Kennedy MD, MPH","doi":"10.1111/jgs.19188","DOIUrl":"10.1111/jgs.19188","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Delirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one-third of cases. Evidence-based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake. Early adopters of ED delirium screening can offer valuable lessons about successful implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews with clinician-administrators leading ED delirium screening initiatives from 20 EDs in the United States and Canada. Interviews focused on experiences of planning and implementing ED delirium screening. Interviews lasted 15 to 50 minutes and were digitally recorded and transcribed. To identify factors that commonly impacted implementation of ED delirium screening, we used constructs from the Consolidated Framework for Implementation Research (CFIR), an Implementation Science framework widely used to evaluate healthcare improvement initiatives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, notable facilitators of successful implementation were having institutional and ED leadership support and designated clinical champions to longitudinally engage and educate frontline staff. We found specific examples of factors affecting implementation drawn from the following seven CFIR constructs: (1) intervention complexity, (2) intervention adaptability, (3) external policies and incentives, (4) peer pressure from other institutions, (5) the implementation climate of the ED, (6) staff knowledge and beliefs, and (7) engaging deliverers of intervention, that is, frontline ED staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Implementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3753-3762"},"PeriodicalIF":4.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184909","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":"Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial","authors":"Victoria A. Sanchez AuD, PhD,&nbsp;Michelle L. Arnold AuD, PhD,&nbsp;Emmanuel E. Garcia Morales PhD,&nbsp;Nicholas S. Reed AuD, PhD,&nbsp;Sarah Faucette AuD, PhD,&nbsp;Sheila Burgard MS,&nbsp;Haley N. Calloway AuD,&nbsp;Josef Coresh MD, PhD,&nbsp;Jennifer A. Deal PhD,&nbsp;Adele M. Goman PhD,&nbsp;Lisa Gravens-Mueller MS,&nbsp;Kathleen M. Hayden PhD,&nbsp;Alison R. Huang PhD,&nbsp;Christine M. Mitchell ScM,&nbsp;Thomas H. Mosley Jr PhD,&nbsp;James S. Pankow PhD,&nbsp;James R. Pike MBA,&nbsp;Jennifer A. Schrack PhD,&nbsp;Laura Sherry AuD,&nbsp;Jacqueline M. Weycker AuD,&nbsp;Frank R. Lin MD, PhD,&nbsp;Theresa H. Chisolm PhD,&nbsp;For the ACHIEVE Collaborative Study","doi":"10.1111/jgs.19185","DOIUrl":"10.1111/jgs.19185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70–84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory—Elderly Screening version (HHIE-S, range 0–40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>HHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of −8.9 (95% CI: −10.4, −7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, −9.3 (95% CI: −10.8, −7.9) to Year 1, −8.4 (95% CI: −9.8, −6.9) to Year 2, and − 9.5 (95% CI: −11.0, −8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3784-3799"},"PeriodicalIF":4.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252189","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":"Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care","authors":"Kaleen N. Hayes PharmD, PhD,&nbsp;Meghan A. Cupp MPH,&nbsp;Richa Joshi MSc,&nbsp;Melissa R. Riester PharmD,&nbsp;Francesca L. Beaudoin MD, PhD,&nbsp;Andrew R. Zullo PharmD, PhD","doi":"10.1111/jgs.19160","DOIUrl":"10.1111/jgs.19160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Appropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post-acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g-formula to standardize for age and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Racial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short- and long-term health outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3730-3741"},"PeriodicalIF":4.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184910","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":"Recurrent pericarditis in older adults: Clinical and laboratory features and outcome","authors":"Emanuele Bizzi MD,&nbsp;Francesco Cavaleri MD,&nbsp;Ruggiero Mascolo MD,&nbsp;Edoardo Conte MD,&nbsp;Stefano Maggiolini MD,&nbsp;Caterina Chiara Decarlini MD,&nbsp;Silvia Maestroni MD,&nbsp;Valentino Collini MD,&nbsp;Ludovico Luca Sicignano MD,&nbsp;Elena Verrecchia MD,&nbsp;Raffaele Manna MD,&nbsp;Massimo Pancrazi MD,&nbsp;Lucia Trotta MD,&nbsp;Giuseppe Lopalco MD,&nbsp;Danilo Malandrino MD,&nbsp;Giada Pallini MD,&nbsp;Sara Catenazzi MD,&nbsp;Luisa Carrozzo MD,&nbsp;Giacomo Emmi MD,&nbsp;George Lazaros MD,&nbsp;Antonio Brucato MD,&nbsp;Massimo Imazio MD","doi":"10.1111/jgs.19150","DOIUrl":"10.1111/jgs.19150","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective of the Study&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Materials and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (&lt;i&gt;p&lt;/i&gt; &lt; 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (&lt;i&gt;p&lt;/i&gt; = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), as well as severe pericardial effusion (&gt;20 mm) (24.1% vs 12.7%, &lt;i&gt;p&lt;/i&gt; = 0.016) and pericardiocentesis (16.5% vs 8.5%, &lt;i&gt;p&lt;/i&gt; = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm&lt;sup&gt;3&lt;/sup&gt; vs 11,208 + 285/mm&lt;sup&gt;3&lt;/sup&gt;, &lt;i&gt;p&lt;/i&gt; = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (&lt;i&gt;p&lt;/i&gt; = 0.003), colchicine in 76.7% versus 87.3% (&lt;i&gt;p&lt;/i&gt; = 0.023), corticosteroids in 49.6% versus 26.8% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and anakinra in 14.3% versus 23.9% (&lt;i&gt;p&lt;/i&gt; = 0.044).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely d","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3467-3475"},"PeriodicalIF":4.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157066","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":"Virtual reality-based cognitive exercise games in geriatric surgical patients: A pilot trial","authors":"Hina Faisal MD,&nbsp;Faisal N. Masud MD,&nbsp;Kim Junhyoung PhD,&nbsp;Kenneth Podell PhD,&nbsp;Jiaqiong Xu PhD,&nbsp;Christina Boncyk MD, MPH,&nbsp;George E. Taffet MD,&nbsp;Malaz A. Boustani MD, MPH","doi":"10.1111/jgs.19181","DOIUrl":"10.1111/jgs.19181","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"293-296"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142243","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":"Association of nursing home antipsychotic reduction policies with antipsychotic use in community dwellers with dementia","authors":"Antoinette B. Coe PharmD, PhD,&nbsp;Tingting Zhang MD, PhD,&nbsp;Andrew R. Zullo PharmD, PhD,&nbsp;Lauren B. Gerlach DO, MS,&nbsp;Lori A. Daiello PharmD, ScM,&nbsp;Hiren Varma MS,&nbsp;Derrick Lo ScM,&nbsp;Richa Joshi MS,&nbsp;Julie P. W. Bynum MD, MPH,&nbsp;Theresa I. Shireman PhD","doi":"10.1111/jgs.19184","DOIUrl":"10.1111/jgs.19184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare &amp; Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among community-dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee-for-service claims using interrupted time series analyses across three periods (“Pre-Partnership”: July 1, 2010 to March 31, 2012; “Post-Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 1,289,401 community dwellers with dementia contributing 26,609,697 person-months. The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (<i>β</i> = −0.06, 95% CI: −0.08, −0.05) and post-Partnership (<i>β</i> = −0.02, 95% CI: −0.02, −0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (<i>β</i> = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community-dwellers with dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"214-222"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147224","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":"Applying difference-in-differences design in quality improvement and health systems research","authors":"Yucheng Hou PhD, MPP,&nbsp;Abdelaziz Alsharawy PhD","doi":"10.1111/jgs.19180","DOIUrl":"10.1111/jgs.19180","url":null,"abstract":"&lt;p&gt;Assessing the effectiveness of a health system intervention when randomized controlled trials (RCTs) are infeasible has long been a challenge for clinicians, health economists, and health service researchers alike. Difference-in-differences (DID) is a quasi-experimental study design that can be particularly appealing in addressing this challenge using observational data. Other nonexperimental study designs, such as regression adjustment or propensity score matching, attempt to examine the impact of an intervention by only accounting for the observed differences between groups. In contrast, an appropriately designed DID study aims to exploit randomness in intervention timing to identify the causal effects of the intervention. The number of published papers applying DID designs in the medical field has been increasing in recent years.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Following this trend, the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt; (JAGS) published 18 studies, mostly since 2018 (original data from the authors), that apply DID designs to examine a wide range of health system interventions that pertain to geriatrics care (Figure 1).&lt;/p&gt;&lt;p&gt;DID designs assess the effect of an intervention (e.g., health policy or program) applied to one or more groups (treated) by comparing their outcomes relative to a group that has never or not yet received the intervention (control) in terms of two differences.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; The first set of differences compares outcomes before and after the timing of the intervention for the treated and control groups, respectively. This process removes the observed and unobserved group-specific factors that do not change over time. Subtracting these differences (i.e., the second difference or difference-in-differences) removes the time-varying trends that are common to both groups. Together, DID identifies the causal effect of the intervention assuming that the treated would have experienced the same trend as the control group in the absence of the intervention (parallel trends).&lt;/p&gt;&lt;p&gt;In the recent issue of JAGS, a study by Burke and colleagues&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; used a DID design to evaluate changes in patient care outcomes following the Age-Friendly health systems recognition in the Veterans Health Administration. The authors incorporated recent advances in DID with staggered treatment timing developed by Sun and Abraham,&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; which is appropriate as the receipt of recognition across the medical sites happened at different times. This approach addresses potential biases in traditional DID estimation—often referred to as two-way fixed effects—when treatment effects are not constant over time and differ by late versus early treated sites.&lt;span&gt;&lt;sup&gt;6-8&lt;/sup&gt;&lt;/span&gt; Given the absence of an RCT in this setting, one of the notable strengths of this study stems from using observational data to measure the effect of recognition for implementing evidence-based care transformations (4Ms: wh","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"8-11"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142215","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 cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study","authors":"Jean-François Huon PharmD, PhD,&nbsp;Chiranjeev Sanyal PhD,&nbsp;Camille L. Gagnon PharmD, MSc,&nbsp;Justin P. Turner PhD,&nbsp;Ninh B. Khuong MSc,&nbsp;Émilie Bortolussi-Courval RN, PhD Student,&nbsp;Todd C. Lee MD, MPH,&nbsp;James L. Silvius MD,&nbsp;Steven G. Morgan PhD,&nbsp;Emily G. McDonald MD, MSc","doi":"10.1111/jgs.19164","DOIUrl":"10.1111/jgs.19164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation-adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3530-3540"},"PeriodicalIF":4.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142242","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}