Journal of the American Geriatrics Society最新文献

{"title":"Moderate Impairment in Binocular Contrast Sensitivity Predicts Faster Mobility Decline in Cognitively Unimpaired Older Adults","authors":"Ashley Wells,&nbsp;Michael E. Miller,&nbsp;Haiying Chen,&nbsp;Paul J. Laurienti,&nbsp;Stephen B. Kritchevsky,&nbsp;Atalie C. Thompson","doi":"10.1111/jgs.19526","DOIUrl":"10.1111/jgs.19526","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Impaired contrast sensitivity (CS) commonly occurs in older adults but has been largely overlooked as a contributing factor to functional impairment and decline. We examined if CS impairment predicts decline in performance on the expanded short physical performance battery (eSPPB) over 30 months of follow-up in cognitively healthy older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single center prospective cohort study of 192 cognitively unimpaired older adults with good visual acuity and self-reported visual function. Linear mixed models examined the difference in the association of moderately impaired baseline CS (logCS &lt; 1.55) with performance on the eSPPB and its components–balance, 4 m gait speed, narrow walk, and chair pace–over 30 months. Multivariable models adjusted for the effect of age, race, and sex on the slopes over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, the mean participant age was 76.5 ± 4.7 years, with 56.5% (<i>N</i> = 108) female and 9.4% (<i>N</i> = 18) black. Participants with moderately impaired CS at baseline had a significantly faster decline in eSPPB over a 30-month period (Beta: −0.115, 95% CI (−0.180, −0.050), <i>p</i> &lt; 0.001) compared with those with normal CS (Beta: −0.022, 95% CI (−0.044, −0.001), <i>p</i> = 0.042). There was a difference in slopes of −0.093 units/year ((95% CI, −0.161, −0.024), <i>p</i> = 0.009) between groups. This difference in slopes remained significant after adjusting for the effect of age, sex, and race (difference in slopes −0.086, 95% CI (−0.155, −0.016), <i>p</i> = 0.016). Impaired CS predicted significantly greater declines in balance over 30 months (difference in slopes −3.512 (−6.826, −0.199), <i>p</i> = 0.0378), but the differences in gait speed, narrow walk, and chair pace were not significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In cognitively intact older adults with good visual acuity, moderately impaired CS was associated with a significantly faster decline in eSPPB, especially balance, over 30 months of follow-up. A relatively simple test of vision may identify a subset of older adults without cognitive dysfunction who are at risk for mobility decline.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1772-1778"},"PeriodicalIF":4.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103396","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":"Geriatricians: Maximizing Impact Now While Aiming for a Stronger Future","authors":"Thiago J. Avelino-Silva,&nbsp;Sei J. Lee","doi":"10.1111/jgs.19504","DOIUrl":"10.1111/jgs.19504","url":null,"abstract":"&lt;p&gt;The global shortage of geriatricians poses a dilemma: older adults are living longer, often with multiple chronic conditions, but the workforce of specialists in geriatrics remains insufficient [&lt;span&gt;1&lt;/span&gt;]. In this issue of the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt;, Wong et al. present a modeling study that explores how best to deploy the limited number of geriatricians for maximum cost-effectiveness [&lt;span&gt;2&lt;/span&gt;]. By testing different staffing scenarios and situating geriatricians performing comprehensive geriatric assessments (CGAs) in acute care, outpatient clinics, or rehabilitation units, they conclude that prioritizing geriatricians in acute care and rehabilitation settings may yield the greatest benefits when geriatrician coverage in all settings is not feasible.&lt;/p&gt;&lt;p&gt;CGA is widely regarded as central to geriatric medicine [&lt;span&gt;3&lt;/span&gt;]. It is defined as a structured, multidimensional approach to evaluating the medical, psychosocial, and functional challenges in older adults. Conceptually, CGAs focus on addressing an older adult's overall clinical context rather than a single diagnosis. Meta-analyses indicate that CGA can raise the odds of remaining at home, reduce admissions to nursing homes, and improve functional status [&lt;span&gt;4, 5&lt;/span&gt;]. Thus, while geriatricians may positively affect older adults in many ways, focusing on CGAs is a reasonable first-pass approach to quantify how they can improve the lives of this population.&lt;/p&gt;&lt;p&gt;To help guide decisions about allocating the limited number of geriatricians, Wong et al. used a two-dimensional microsimulation model to examine the costs and outcomes (as measured by Quality Adjusted Life Months or QALMs) from geriatrician-led CGA in three settings: acute care hospitals, rehabilitation units, and community clinics. Each potential deployment (i.e., geriatricians in one, two, or all three locations) is contrasted with a “usual care” scenario, where fewer older adults receive CGA. Their results were twofold. First, assigning geriatricians to acute care and rehabilitation emerged as an “undominated” strategy, meaning it lowered costs and improved health outcomes relative to several other possible configurations. Second, if additional staffing is available, extending CGA to community-based clinics remained cost-effective. In practical terms, the study suggests that, when forced to choose, placing geriatricians in hospitals and rehabilitation settings may lead to the greatest improvement in outcomes at the lowest cost. In addition, if sufficient geriatricians are available, staffing community clinics can also improve outcomes at modest cost.&lt;/p&gt;&lt;p&gt;Several factors can help place these results into broader context. Below, we focus on (1) the uncertainty of model results, (2) the sensitivity of the results to modeling choices such as cycle length, and (3) the cost-effectiveness of geriatricians compared to other available interventions for older adults.&lt;/p&gt;&lt;p&gt;Cost-effect","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2003-2005"},"PeriodicalIF":4.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103386","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":"Artificial Nutrition Preferences Among California Nursing Home Residents","authors":"Lee A. Jennings,&nbsp;Li-Jung Liang,&nbsp;Neil S. Wenger,&nbsp;David Powell,&nbsp;Punam Parikh,&nbsp;Jose J. Escarce,&nbsp;David Zingmond","doi":"10.1111/jgs.19536","DOIUrl":"10.1111/jgs.19536","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of feeding tubes has shown no benefit in persons with advanced dementia and has declined over the last decade in this population. However, racial disparities in feeding tube placement have persisted. To better understand disparities in feeding tube use among nursing home residents, we examined artificial nutrition preferences over 6 years among all California nursing home residents, including differences by race, ethnicity, and cognition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the CMS Long-term Care Minimum Data Set (MDS) and the California MDS Section S, which reports completion and contents of POLST (Physician Orders for Life Sustaining Treatment) for California nursing home residents, from 2011 to 2016. For each year, we created a cross-sectional cohort and examined racial and ethnic differences in artificial nutrition preferences stratified by resident length of stay, cardiopulmonary resuscitation preference, and degree of cognitive impairment using logistic mixed-effects regression, adjusted for resident and nursing home characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 762,659 unique individuals in California nursing homes from 2011 to 2016, 160,160 completed a POLST in 2011 and 233,868 in 2016. Resident preferences for artificial nutrition did not change substantively over time. Among long-stay residents, the preference for receipt of artificial nutrition was higher among residents with CPR orders, varied by race and ethnicity, and increased as cognitive impairment worsened. This was most pronounced among long-stay residents with severe cognitive impairment and DNR orders, where the preference for receipt of artificial nutrition was lowest among White, non-Hispanic residents (adjusted predicted probability 0.22, 95% 0.21, 0.24) and higher among Black (adjusted difference in probability: +0.22, 95% CI: 0.19–0.26), Hispanic (+0.19, 95% CI: 0.16–0.22), and Asian/Pacific Islander (+0.24, 95% CI: 0.21–0.27) residents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Racial and ethnic differences in POLST orders for feeding tube use persist among long-term care nursing home residents with dementia and may reflect disparities in end-of-life care quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2441-2446"},"PeriodicalIF":4.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096476","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":"Tooth Loss and 12-Year Mortality Risk in 8494 Older Adults From Ireland","authors":"Lewis Winning,&nbsp;Siobhan Scarlett,&nbsp;Mark Ward,&nbsp;Michael Crowe,&nbsp;Rose Anne Kenny,&nbsp;Brian O'Connell","doi":"10.1111/jgs.19539","DOIUrl":"10.1111/jgs.19539","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate whether tooth loss is associated with all-cause and cause-specific mortality in older Irish adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 8494 participants from The Irish Longitudinal Study on Ageing (TILDA) were included. Survey data were linked to death registration records, covering individuals who participated in TILDA Wave 1 (2009/2010) and died by 31st January 2022. Cox proportional hazards regressions and competing risk survival analyses were employed to examine the longitudinal relationship between tooth loss and both all-cause and cause-specific mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of participants at baseline was 63.2 years (SD 10.2). Among the cohort, 3951 (46.5%) were categorized as “Dentate, no denture,” 3041 (35.8%) as “Dentate, with denture(s),” and 1502 (17.7%) as “Edentulous.” Over a median follow-up of 12 years, 1430 (16.8%) participants died. After adjusting for confounders, edentulous participants had a significantly higher hazard ratio (HR) for all-cause mortality compared to dentate participants with no dentures (HR = 1.42, 95% CI 1.23–1.65, <i>p</i> &lt; 0.001). For cause-specific mortality, edentulism had the greatest sub-distribution hazard ratio (SHR) with respiratory mortality (SHR = 1.57, 95% CI 1.03–2.41, <i>p</i> = 0.04), followed by cancer mortality (SHR = 1.31, 95% CI 1.01–1.71, <i>p</i> = 0.04). There was a nonsignificant association with cardiovascular mortality (SHR = 1.25, 95% CI 0.96–1.63, <i>p</i> = 0.10).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Edentulism was independently associated with all-cause mortality in a cohort of 8494 men and women from Ireland. Edentulism was significantly associated with respiratory and cancer mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2431-2440"},"PeriodicalIF":4.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19539","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096489","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":"Hospice Visits and Perceived Hospice Quality Among Assisted Living Residents","authors":"Wenhan Guo,&nbsp;Shubing Cai,&nbsp;Yue Li,&nbsp;Brian E. McGarry,&nbsp;Thomas V. Caprio,&nbsp;Helena Temkin-Greener","doi":"10.1111/jgs.19532","DOIUrl":"10.1111/jgs.19532","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospice services are widely used by assisted living residents at the end of life, yet concerns exist about the adequacy and quality of hospice care in this setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants and Setting</h3>\u0000 \u0000 <p>This cohort study analyzed Medicare claims data from 51,303 assisted living residents who received hospice care and died in 2018–2019. Data were linked to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey to evaluate perceived hospice quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The primary exposure was the number of hospice staff visits in the last 3 days of life, categorized as clinical (physicians, nurses) or nonclinical (social workers, hospice aides, chaplains, bereavement counselors). The primary outcome was hospice quality ratings from the CAHPS Hospice Survey. Multivariable regression models were used to examine associations between hospice staff visits and quality ratings, adjusting for resident and hospice characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 51,303 assisted living residents, the average CAHPS rating was 80.83. Increased hospice clinical staff visits were associated with improvements in emotional support (0.04-point increase per visit, <i>p</i> &lt; 0.001), family rating of hospice (0.03-point increase, <i>p</i> &lt; 0.001), willingness to recommend (0.03-point increase, <i>p</i> &lt; 0.001), and feeling respected (0.02-point increase, <i>p</i> &lt; 0.001). Increased nonclinical staff visits had stronger associations, including a 0.14-point increase in emotional support (<i>p</i> = 0.01), a 0.28-point increase in willingness to recommend (<i>p</i> &lt; 0.001), and a 0.18-point increase in average scores (<i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher frequency of hospice staff visits was associated with better perceived hospice quality. Policies supporting greater hospice staff engagement, including nonclinical staff, may enhance end-of-life care experiences for assisted living residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2212-2219"},"PeriodicalIF":4.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19532","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096482","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":"Making It Count Twice: A Single Age-Friendly Deprescribing Workshop for Either Medical Residents or Geriatric Fellows","authors":"Chelsea E. Hawley,&nbsp;Laura K. Triantafylidis,&nbsp;Andrew A. Swanner,&nbsp;Sarah C. Phillips,&nbsp;Ryan Chippendale,&nbsp;Andrea Wershof Schwartz","doi":"10.1111/jgs.19529","DOIUrl":"10.1111/jgs.19529","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1989-1991"},"PeriodicalIF":4.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096485","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":"Reply to: Comment on: The Halo Effect: Perceptions of Information Privacy Among Healthcare Chatbot Users","authors":"Matthew DeCamp,&nbsp;Jessica R. Ellis","doi":"10.1111/jgs.19544","DOIUrl":"10.1111/jgs.19544","url":null,"abstract":"&lt;p&gt;We thank Drs. Daungsupawong and Wiwanikit for their comments [&lt;span&gt;1&lt;/span&gt;] on our paper [&lt;span&gt;2&lt;/span&gt;], which found sociodemographic differences in how patients perceive information privacy related to information they shared with a patient-facing chatbot that was linked to the electronic health record (EHR).&lt;/p&gt;&lt;p&gt;Drs. Daungsupawong and Wiwanikit express concern that our study's sampling method could have affected our results. We agree and appreciate the opportunity to expand on this point. Our study enrolled existing chatbot users within a single large, multi-site healthcare system. The perspectives of those who have never used the chatbot, or who might not want to use the chatbot because of privacy concerns, are necessarily not included. This is why we were particularly cautious in interpreting our findings regarding race or ethnicity. Other studies—for example, in biobanking—have found that race or ethnicity and mistrust may result in greater privacy concerns among certain people, such as Black or African-American individuals in the United States [&lt;span&gt;3&lt;/span&gt;]. The fact that our findings contradict other research led us to conclude that this finding should be the subject of future study within more generalizable samples or with specific attention to recruiting individuals who may avoid chatbot interactions altogether.&lt;/p&gt;&lt;p&gt;As a result, we agree with Drs. Daungsupawong and Wiwanikit about the need for additional research in more generalizable settings. Nevertheless, our findings also suggest caution in interpreting findings from surveys of the general public abstracted from the health systems where they receive medical care. If the “halo effect” is a true phenomenon, it would be incomplete to ask patients about generic, patient-facing chatbots delinked from their own health system; or, at the very least, it would require accounting for where patients receive care and for mistrust in health systems [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Regarding our study's representativeness of older adults, we also emphasize that older adults' experiences with chatbots and their preferences for privacy are not homogenous. Another group recently reported on older adults' preferences for a caregiving chatbot and stressed that older adults are not homogenously unfamiliar with or resistant to technology [&lt;span&gt;5&lt;/span&gt;]. Rather than estimate a definitive preference for privacy among such a large and diverse group, our study describes an explanation for older adults who associate these chatbots with a particular health system.&lt;/p&gt;&lt;p&gt;One point deserves clarification. Our study found that individuals who reported higher educational attainment were more concerned about privacy, not less—this was incorrectly reported in the abstract but was correct in the manuscript body. The abstract was corrected online at the Journal of the American Geriatrics Society on April 4, 2025. Nevertheless, we hope that our study's findings motivate more generalizable and more inclusive resea","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2941-2942"},"PeriodicalIF":4.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19544","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082899","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":"Engaging Community Reviewers: The Geriatric Emergency Care Applied Research (2.0)—Advancing Dementia Care Network Approach","authors":"Angela Gifford,&nbsp;Chelsea McClellan,&nbsp;Morgan Daven,&nbsp;Michael Ellenbogen,&nbsp;Beverly Foster,&nbsp;Heidi Gil,&nbsp;Jerry Johnson,&nbsp;Deborah Jobe,&nbsp;Christopher R. Carpenter,&nbsp;Scott M. Dresden,&nbsp;Andrea Gilmore-Bykovskyi,&nbsp;Ula Hwang,&nbsp;Manish N. Shah","doi":"10.1111/jgs.19515","DOIUrl":"10.1111/jgs.19515","url":null,"abstract":"<p>A core tenant of the Geriatric Emergency care Applied Research Network 2.0—Advancing Dementia Care (GEAR 2.0-ADC) is the inclusion of community members during all stages of clinical research. As such, we deliberately integrated and supported patient and public involvement in the evaluation and selection of GEAR 2.0-ADC Pilot Research Grants by developing and adapting traditional grant application review structures, with input from community members, to create the GEAR 2.0-ADC Community Review Committee approach. Community members, including persons living with dementia, effectively participated in all three rounds of research grant application review and selection, complementing the traditional scientific review process. The structure and flexibility of the GEAR 2.0-ADC Community Review Committee approach serve as a model for patient and public grant application review involvement with strong potential for applications across grant reviews in other medical specialties.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2678-2684"},"PeriodicalIF":4.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082897","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":"A Large Language Model Approach to Identifying Preoperative Frailty Among Older Adults From Clinical Notes","authors":"Ying Qiu Zhou,&nbsp;Onkar Litake,&nbsp;Minhthy N. Meineke,&nbsp;Jeffrey L. Tully,&nbsp;Nicole Xu,&nbsp;Waseem Abdou,&nbsp;Rodney A. Gabriel","doi":"10.1111/jgs.19545","DOIUrl":"10.1111/jgs.19545","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with frailty have a higher risk of major postoperative mortality and morbidity. Identifying frailty from the medical record, however, is not straightforward since it is a multifactorial state based on multiple organ systems and a sum of factors accumulated over time. The objective of this study was to develop a large language model-based binary classifier using accurately phenotyped datasets to identify preoperative frailty from clinical notes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We trained various large language models to identify frailty from anesthesia preoperative clinic notes. There were two development datasets used: (1) patients undergoing spine surgery whose frailty was characterized by patient responses to the Vulnerable Elders-13 Survey (VES-13); and (2) patients undergoing surgery whose frailty was characterized by their calculated electronic frailty index (eFI) score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>When trained on our VES-13 development set and tested on our VES-13 validation set, the area under the receiver operating characteristics curve (AUC) for the RoBERTa, BERT, BioBERT, and PubMedBERT models was 0.99, 0.64, 0.67, and 0.73, respectively. When tested on the eFI validation set, the AUCs were 0.63, 0.83, 0.87, and 0.87, respectively. Models trained on the eFI development dataset did not discriminate frailty adequately when tested on the VES-13 validation set.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We report the development and validation of a classifier that detects older adults at risk for preoperative frailty from preoperative anesthesia clinical notes. Large language models can be used to accurately identify a difficult-to-quantify and multifactorial characteristic such as frailty in patients by using readily available unstructured information from clinical notes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2422-2430"},"PeriodicalIF":4.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082891","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":"Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials","authors":"Lajjaben Patel,&nbsp;Matthew W. Segar,&nbsp;Muhammad S. Usman,&nbsp;Ritika Dhruve,&nbsp;Neil Keshvani,&nbsp;Alexander Postalian,&nbsp;Amgad Mentias,&nbsp;Craig D. Rubin,&nbsp;Kershaw V. Patel,&nbsp;Dharam J. Kumbhani,&nbsp;Subhash Banerjee,&nbsp;Ambarish Pandey","doi":"10.1111/jgs.19508","DOIUrl":"10.1111/jgs.19508","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (<i>P</i>\u0000 _interactionfrailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (<i>P</i>\u0000 _interactionfrailty × intervention arm &lt; 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2376-2385"},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015466","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}