Journal of the American Geriatrics Society最新文献

{"title":"Deprescribing is associated with reduced readmission to hospital: An updated meta-analysis of randomized controlled trials","authors":"Todd C. Lee MD, MPH, FIDSA, Émilie Bortolussi-Courval RN, Lisa M. McCarthy PharmD, MSc, Emily G. McDonald MD, MSc","doi":"10.1111/jgs.19166","DOIUrl":"10.1111/jgs.19166","url":null,"abstract":"<p>A recent systematic review and meta-analysis of inpatient studies<span><sup>1</sup></span> found that medication reviews coupled with deprescribing interventions were associated with a small but significant reduction in rehospitalizations. The authors reported a hazard ratio (HR) of 0.92 (95% CI 0.85 to 0.99) derived from 19 randomized controlled trials (RCTs) and observational studies with outcomes measured between 1 and 12 months. That analysis provided much needed evidence in support of inpatient deprescribing initiatives. However, there are two key points for discussion. First, some important RCT data were not included by the search and selection strategy. Second, the inclusion of non-randomized data may increase bias. To increase the strength of the findings, we performed a sensitivity analysis restricted to RCTs and incorporated additional data.</p><p>The MedSafer Study<span><sup>2</sup></span> was an 11 center cluster RCT of deprescribing decision support paired with medication reconciliation versus medication reconciliation alone. The primary outcome was adverse drug events within 30 days post-discharge and a key secondary outcome was hospital readmission. A total of 5698 participants were enrolled with 4989 surviving to hospital discharge who were followed for readmission within 30-days.</p><p>Although the search strategy by Carollo et al. captured this study, it was subsequently excluded (reason not specified). We reanalyzed the 30-day hospital readmission data from the MedSafer Study using a time-to-event approach. Patient survival time was censored at 30 days, readmission to hospital, or death (whichever occurred first). Patients who were readmitted on the day of discharge were excluded (<i>n</i> = 14). In keeping with the trial's statistical analysis plan, we used a mixed-effects exponential proportional hazards regression model with adjustment for age, biological sex, the presence of moderate or severe frailty, residing in a nursing home at the time of admission, the number of potentially inappropriate medications at baseline, and the temporal period. Cluster was included as a random effect.</p><p>Carollo et al.<span><sup>1</sup></span> analyzed 10,136 RCT patients including duplicated control patients. Our updated analysis contained 14,201 unique patients including 4975 from McDonald et al. and 695 from Franchi et al.<span><sup>6</sup></span> (Figure 1). Though the effect size was more modest, deprescribing remained statistically associated with a reduced hazard of readmission at 1–3 months (HR 0.84; 95% CI 0.73 to 0.97). When all durations of follow-up were included, the probability that readmission was reduced remained high, but this was no longer statistically significant (HR 0.94; 95%CI 0.87 to 1.01).</p><p>A meta-analysis restricted to RCTs and adding 5670 unique patients of additional data added substantial credibility to the finding of a reduction in the hazard of short-term readmission from inpatient deprescribing interv","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"302-305"},"PeriodicalIF":4.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142217","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: Deprescribing is associated with reduced readmission to hospital: An updated meta-analysis of randomized controlled trials","authors":"Andrea Fontana MSc, Massimo Carollo MD, Salvatore Crisafulli MSc, Gianluca Trifirò PhD","doi":"10.1111/jgs.19169","DOIUrl":"10.1111/jgs.19169","url":null,"abstract":"<p>We would like to thank Lee and colleagues for their interest in our study.<span><sup>1</sup></span> In their Letter,<span><sup>2</sup></span> they raised two key points for discussion: (1) the lack of inclusion of some RCT data in the systematic review and the following meta-analysis; (2) the inclusion of data coming from nonrandomized studies. Accordingly, they conducted a sensitivity analysis on rehospitalization rates restricted to RCTs only, incorporating additional data from two RCTs.<span><sup>3, 4</sup></span></p><p>Concerning the first point, we did not include the MedSafer Study<span><sup>3</sup></span> in the meta-analysis because it did not meet our selection criteria. Specifically, we restricted inclusion criteria to older patients hospitalized in geriatric or internal medicine wards, while excluding those studies that evaluated specifically deprescribing in other specialized settings (e.g., cardiology wards, benzodiazepines deprescribing in psychiatric wards as well as general practice settings). In the Supplementary Material of the abovementioned Canadian study, it was reported that the study was carried out in medical units and, as such, we assumed that also wards other than geriatrics and internal medicine were included. Studies excluded for similar reasons are shown in Table 1. On the other hand, we did not include the study by Franchi et al.<span><sup>4</sup></span> as it did not explicitly report the number of events (e.g., rehospitalization), while Lee and colleagues included this study only based on estimates employing a Kaplan–Meier tails method.</p><p>The second raised issue is the inclusion of nonrandomized data in the meta-analysis. While Lee and colleagues indicated that we also included observational studies, we included only experimental and quasi-experimental studies,<span><sup>5</sup></span> in agreement with previously published meta-analyses.<span><sup>6</sup></span> We did not include observational prospective cohort studies.</p><p>We agree that meta-analyses of RCTs only may yield more robust results; however, we also decided to include quasi-experimental studies in our meta-analysis, as our risk of bias assessments of selected RCTs highlighted limitations concerning randomization and patient allocation. For instance, in the study conducted by Wehling et al.<span><sup>7</sup></span> the authors noted that the main reason for heterogeneity between control and intervention groups was related to randomization restrictions due to limited availability of beds in the included wards. Furthermore, we included only six quasi-experimental studies, which overall had a low weight in our meta-analysis.</p><p>Based on the considerations above, we further extended the sensitivity analysis conducted by Lee and colleagues by including quasi-experimental studies and reporting each study-specific estimate as a hazard ratio (HR), carefully re-evaluating reported estimates from the studies by Nielsen et al., Gallagher et al., and ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"306-311"},"PeriodicalIF":4.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142219","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":"Population-based estimates of major forms of housing insecurity among community-living older Americans","authors":"Lucero G. Paredes MD,&nbsp;Yi Wang PhD,&nbsp;Danya E. Keene PhD,&nbsp;Thomas M. Gill MD,&nbsp;Robert D. Becher MD, MS","doi":"10.1111/jgs.19167","DOIUrl":"10.1111/jgs.19167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The number of older adults struggling to maintain adequate housing is growing. Prior studies have used various criteria to measure housing insecurity; however, no standardized definition exists to date. Using a multidimensional approach, our study sought to calculate population-based estimates of various forms of housing insecurity among community-living older Americans and determine how these estimates differ across key characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study utilized data from the 2011 round of the National Health and Aging Trends Study (NHATS), a prospective longitudinal study of Medicare beneficiaries aged 65 years or older. Three key forms of housing insecurity were operationalized: poor housing affordability (PHA), poor housing quality (PHQ), and poor neighborhood quality (PNQ). Population-based estimates of these forms of housing insecurity were calculated using analytic sampling weights and stratified by age, gender, race and ethnicity, frailty status, and dementia status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Totally 6466 participants were included in the analysis, representing 29,848,119 community-living older Americans. The mean (standard deviation) age was 77.3 (7.7) years; by weighted percentages, 56.0% identified as female, 81.3% as White, 8.2% Black, and 7.1% Hispanic. At least one form of housing insecurity was identified in 38.5% of older Americans. Individually, the prevalence of PHA was 14.8%, PHQ 24%, and PNQ 12.5%. The prevalence of at least one form of housing insecurity was higher among persons of color (62.9% Black and 66% Hispanic vs White; <i>p</i> &lt; 0.001), those with frailty (40.9% pre-frail and 49.4% frail vs robust; <i>p</i> &lt; 0.001), and those with cognitive impairment (48.1% possible and 51% probable dementia vs no dementia; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Nearly one in three community-living older Americans experience at least one form of housing insecurity. This was most common among vulnerable subgroups. Our multidimensional approach to defining various forms of housing insecurity can be used for future studies focused on improving social determinants of health among high-risk older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3773-3783"},"PeriodicalIF":4.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127771","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":"Protection against influenza hospitalizations from enhanced influenza vaccines among older adults: A systematic review and network meta-analysis","authors":"J. M. Ferdinands PhD, MSc,&nbsp;L. H. Blanton MPH,&nbsp;E. Alyanak MPH,&nbsp;J. R. Chung MPH,&nbsp;L. Trujillo MPH,&nbsp;J. Taliano MA, MLS,&nbsp;R. L. Morgan PhD, MPH,&nbsp;A. M. Fry MD, MPH,&nbsp;L. A. Grohskopf MD, MPH","doi":"10.1111/jgs.19176","DOIUrl":"10.1111/jgs.19176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Influenza vaccines are available to help protect persons aged ≥65 years, who experience thousands of influenza hospitalizations annually. Because some influenza vaccines may work better than others, we sought to assess benefit of high-dose (HD), adjuvanted (ADJ), and recombinant (RIV) influenza vaccines (“enhanced influenza vaccines”) compared with standard-dose unadjuvanted influenza vaccines (SD) and with one another for prevention of influenza-associated hospitalizations among persons aged ≥65 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library to identify randomized or observational studies published between January 1990 and October 2023 and reporting relative vaccine effectiveness (rVE) of HD, ADJ, or RIV for prevention of influenza-associated hospitalizations among adults aged ≥65 years. We extracted study data, assessed risk of bias, and conducted random-effects network meta-analysis and meta-regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 32 studies with 90 rVE estimates from five randomized and 27 observational studies (71,459,918 vaccinated participants). rVE estimates varied across studies and influenza seasons. Pooled rVE from randomized studies was 20% (95% CI −54 to 59) and 25% (95% CI −19 to 53) for ADJ and HD compared with SD, respectively; rVE was 6% (95% CI −109 to 58) for HD compared with ADJ; these differences were not statistically significant. In observational studies, ADJ, HD, and RIV conferred modestly increased protection compared with SD (rVE ranging from 10% to 19%), with no significant differences between HD, ADJ, and RIV. With enhanced vaccines combined, rVE versus SD was 18% (95% CI 3 to 32) from randomized and 11% (95% CI 8 to 14) from observational evidence. Meta-regression of observational studies suggested that those requiring laboratory confirmation of influenza reported greater benefit of enhanced vaccines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HD, ADJ, and RIV provided stronger protection than SD against influenza hospitalizations among older adults. No differences in benefit were observed in comparisons of enhanced influenza vaccines with one another.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3875-3889"},"PeriodicalIF":4.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127772","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":"Medical director presence and time in U.S. nursing homes, 2017–2023","authors":"Eric L. Goldwein MPH,&nbsp;Richard J. Mollot JD,&nbsp;Mary Ellen Dellefield PhD, RN,&nbsp;Michael R. Wasserman MD, CMD,&nbsp;Charlene A. Harrington PhD, RN","doi":"10.1111/jgs.19161","DOIUrl":"10.1111/jgs.19161","url":null,"abstract":"<p>See related editorial by Zwahlen and Luxenberg in this issue.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"29-38"},"PeriodicalIF":4.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121451","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":"Kathleen T. Unroe MD, MHA, MS,&nbsp;Debra Saliba MD, MPH, AGSF,&nbsp;Susan E. Hickman PhD,&nbsp;Sheryl Zimmerman PhD,&nbsp;Cari Levy MD, PhD,&nbsp;Jerry Gurwitz MD","doi":"10.1111/jgs.17869","DOIUrl":"https://doi.org/10.1111/jgs.17869","url":null,"abstract":"<p><b>Cover caption</b>: Key elements for successful nursing home clinical trials. See the related article by Unroe et al., pages 2951–2956.\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":"72 9","pages":"C1"},"PeriodicalIF":4.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.17869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142123134","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":"Identifying priority challenges of older adults with COPD: A multiphase intervention refinement study","authors":"Anand S. Iyer MD, MSPH,&nbsp;Rachel D. Wells PhD, MSN, RN,&nbsp;Avery C. Bechthold PhD, BSN, RN,&nbsp;Margaret Armstrong MSN, MEd, RN,&nbsp;Ronan O'Beirne EdD,&nbsp;Jun Y. Byun PhD, MSN,&nbsp;Jazmine Coffee-Dunning MA, Ed,&nbsp;J. Nicholas Odom PhD, RN,&nbsp;Russell G. Buhr MD, PhD,&nbsp;Angela O. Suen MD,&nbsp;Ashwin A. Kotwal MD, MS,&nbsp;Leah J. Witt MD,&nbsp;Cynthia J. Brown MD, MSPH,&nbsp;Mark T. Dransfield MD,&nbsp;Marie A. Bakitas DNSc, NP-C","doi":"10.1111/jgs.19158","DOIUrl":"10.1111/jgs.19158","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;Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well-being and independence.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: &lt;span&gt;E&lt;/span&gt;mpowering &lt;span&gt;P&lt;/span&gt;eople to &lt;span&gt;I&lt;/span&gt;ndependence in &lt;span&gt;C&lt;/span&gt;OPD).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Multiphase study guided by Baltes Theory of Successful Aging and the 5Ms Framework: &lt;i&gt;Phase 1&lt;/i&gt;: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. &lt;i&gt;Phase 2&lt;/i&gt;: Rapid qualitative analysis. &lt;i&gt;Phase 3&lt;/i&gt;: Intervention mapping and refinement.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Ambulatory, virtual.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders.&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;NGT sessions were conducted by constituency group with 37 participants (&lt;i&gt;n&lt;/i&gt; = 7 patients, &lt;i&gt;n&lt;/i&gt; = 6 family caregivers, &lt;i&gt;n&lt;/i&gt; = 8 clinic staff, &lt;i&gt;n&lt;/i&gt; = 9 clinicians, &lt;i&gt;n&lt;/i&gt; = 7 health system leaders) (&lt;i&gt;Phase 1&lt;/i&gt;). Participants generated 92 statements across five themes (&lt;i&gt;Phase 2&lt;/i&gt;): (1) “Barriers to care”, (2) “Family caregiver needs”, (3) “Functional status and mobility issues”, (4) “Illness understanding”, and (5) “COPD care complexities”. Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized “Functional status and mobility issues”, family caregivers prioritized “Family caregiver needs”, and clinicians and health system leaders prioritized “COPD care complexities”. Intervention mapping (&lt;i&gt;Phase 3&lt;/i&gt;) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities.&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;Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, e","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3346-3359"},"PeriodicalIF":4.3,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116613","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 sex, race/ethnicity, and age and the initiation of chronic high-risk medication in US older adults","authors":"Katharina Tabea Jungo PhD,&nbsp;Niteesh K. Choudhry MD, PhD,&nbsp;Alexander Chaitoff MD, MPH,&nbsp;Julie C. Lauffenburger PharmD, PhD","doi":"10.1111/jgs.19173","DOIUrl":"10.1111/jgs.19173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High-risk medication use is associated with an increased risk of adverse events, but little is known about its chronic utilization by key demographic groups. We aimed to study the associations between age, sex, and race/ethnicity with new chronic use of high-risk medications in older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, we analyzed data from older adults aged ≥65 years enrolled in a national health insurer who started a high-risk medication between 2017 and 2022 across 16 high-risk medication classes. We used generalized estimating equations to estimate the associations between sociodemographic classifications and the onset of chronic high-risk medication use after initiation (≥90 days' supply across ≥2 fills within 180 days). We adjusted the analyses for sociodemographic and clinical patient characteristics and added three-way interaction terms for race/ethnicity, sex, and age to explore whether the outcome varied across different subgroups of race/ethnicity, age, and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across 2,751,069 patients (mean age: 74 years [SD = 7], 72% White, 60% Female), 406,075 (15%) became new chronic users of ≥1 high-risk medication. Compared to White older adults, Asian (RR = 0.81, 95% CI: 0.79–0.84), Black (RR = 0.92, 95% CI: 0.90–0.94), and Hispanic (RR = 0.85, 95% CI: 0.83–0.86) older adults had a lower risk of becoming new chronic users. Men had a higher risk compared to women (RR = 1.09, 95% CI: 1.08–1.10). Age was not significantly associated with new chronic high-risk medication use (≥75 years: RR = 1.00, 95% CI: 1.00–1.01). We observed differences across some medication classes, like benzodiazepines, first-generation antihistamines, and antimuscarinics for which non-White older adults were at a higher risk. The joint presence of specific age, sex, and race/ethnicity characteristics decreased the risk of becoming a new chronic user (e.g., Hispanic/Female/65–74 years: RR = 0.96, 95% CI: 0.94–0.99).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>New chronic high-risk medication use varied across older adults by sociodemographic characteristics, suggesting the need to individualize medication optimization approaches and better understand how systematic barriers in access to health care may influence differences in high-risk medication use in older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3705-3718"},"PeriodicalIF":4.3,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116610","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":"Qualitative evaluation of the SHARING Choices trial of primary care advance care planning for adults with and without dementia","authors":"Sydney M. Dy MD,&nbsp;Daniel L. Scerpella MPH,&nbsp;Valecia Hanna MS,&nbsp;Kathryn A. Walker PharmD,&nbsp;Danetta H. Sloan PhD,&nbsp;Chase Mulholland Green MPH,&nbsp;Valerie Cotter PhD,&nbsp;Jennifer L. Wolff PhD,&nbsp;Erin Rand Giovannetti PhD,&nbsp;Maura McGuire MD,&nbsp;Naaz Hussain MD,&nbsp;Kelly M. Smith PhD,&nbsp;Martha Abshire Saylor PhD","doi":"10.1111/jgs.19154","DOIUrl":"10.1111/jgs.19154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Primary care can be an important setting for communication and advance care planning (ACP), including for those with dementia and their families. The study objective was to explore experiences with a pragmatic trial of a communication and ACP intervention, SHARING Choices, in primary care for older adults with and without dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method<b>s</b></h3>\u0000 \u0000 <p>We conducted qualitative interviews using tailored semi-structured guides with three groups: ACP facilitators who conducted the intervention; clinicians, managers, and administrators from sites randomized to the intervention; and patients and families who met with ACP facilitators. We used thematic analysis to identify and synthesize emergent themes based on key Consolidated Framework for Implementation Research concepts and Proctor's Implementation Outcomes, triangulating the three groups' perspectives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified five key themes. For <i>acceptability</i>, perceptions of the intervention were mostly positive, although some components were not generally implemented. For <i>adoption</i>, respondents perceived that ACP facilitators mainly focused on conducting ACP, although facilitators often did not implement the ADRD and family engagement aspects with the ACP. For <i>relational connections</i>, ACP facilitator—practice and clinician communication and engagement were key to how the intervention was implemented. For <i>adaptability</i>, ACP facilitators and health systems adapted how the ACP facilitation component was implemented to local preferences and over time, given the pragmatic nature of the trial. And, for <i>sustainability</i>, ACP facilitators and clinicians/managers/facilitators were positive that the intervention should be continued but noted barriers to its sustainability. Patients and families generally did not recall the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ACP facilitators and clinicians, managers, and administrators had positive perceptions of the ACP facilitator component of the intervention in this pragmatic trial with adaptation to local preferences. However, engaging those with dementia and families was more challenging in the implementation of this intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3413-3426"},"PeriodicalIF":4.3,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116618","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":"More than dollars: Healthcare utilization among spouses of persons with dementia","authors":"Molly J. Horstman MD, MS","doi":"10.1111/jgs.19174","DOIUrl":"10.1111/jgs.19174","url":null,"abstract":"&lt;p&gt;Being the spouse of a person with dementia can be a significant source of strain and can negatively impact one's health.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although not all spouses serve as the primary caregiver, many spouses provide physical or emotional support to the person with dementia. Studies have shown that spouses of persons with dementia are more likely to have depression, anxiety, and sleep disturbances compared with spouses of persons who do not have dementia.&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; Identifying opportunities to improve health among spouses of persons with dementia is essential. In the United States, families provide most of the long-term care to persons with dementia.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Family members need to maintain sufficient health to fulfill caregiving roles and responsibilities to sustain this system. Spouses of a person with dementia may have less time and fewer financial resources to participate in recommended health behaviors and receive healthcare services, which, over time, may impact their ability to care for the person with dementia.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this issue, &lt;i&gt;Ingraham&lt;/i&gt; et al. present the results of a matched study examining Medicare Fee-for-Service expenditures for spouses of persons living with dementia compared with spouses of persons without dementia in the 5 years after the person with dementia was diagnosed with dementia.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Using the Health and Retirement Study with linked Medicare Claims, the authors measured three categories of health utilization costs: (1) inpatient or hospital expenditures; (2) outpatient or ambulatory expenditures, which included emergency room visits if a hospitalization did not follow the visit; and (3) skilled nursing facility, hospice, and home health expenditures. In the adjusted analysis, there was no difference in total Medicare expenditures between spouses of persons with dementia and spouses of persons without dementia in the 5 years after dementia was diagnosed. However, in Year 5, there was an increase in total Medicare expenditures among spouses of persons living with dementia driven by an increase in inpatient expenditures, with a total difference of $2748 (95% CI $321–$5447).&lt;/p&gt;&lt;p&gt;The results of this study differ from prior matched studies examining healthcare expenditures among spouses of persons living with dementia.&lt;span&gt;&lt;sup&gt;3, 4, 7, 8&lt;/sup&gt;&lt;/span&gt; As the authors note, prior studies had relied on claims data to identify persons with dementia, while the methods used by &lt;i&gt;Ingraham&lt;/i&gt; et al. for identifying incident diagnoses of dementia from the Health and Retirement Study identified adults at an earlier stage of the disease. However, several other differences existed between this study and prior published studies. These include the methods by which spouses were identified, the type of insurance the spouse had, and the types of expenditures included in the total expenditures.&lt;span&gt;&lt;sup&gt;3, 4, 7, 8&lt;/sup&gt;&lt;/span&gt; In addition, &lt;i&gt;","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"2969-2971"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116615","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}