Journal of the American Geriatrics Society最新文献

{"title":"Humility and Medicine, Lessons Learned: Perhaps the Fifth Ethics Principle","authors":"Michael Gordon","doi":"10.1111/jgs.19538","DOIUrl":"10.1111/jgs.19538","url":null,"abstract":"<p>There are many qualities necessary to be an effective and compassionate physician. In the modern era, much of medical education focuses on the complex pathophysiology of disease and clinical presentation. This is the current challenge of the necessary investigations and therapeutic interventions. What I have learned after almost 50 years of practice is that a hefty dose of humility is necessary to complete the prescription for humane and empathetic medicine. As well, for physicians, the principles of medical ethics are very important, and perhaps humility should be added as the fifth principle to the traditional four principles of autonomy, beneficence, non-maleficence, and justice.</p><p>I recall vividly how Dr. William Walker, the physician who was one of my teachers in Dundee who moved to Aberdeen, where I followed him for a house job (internship) communicated to the head nurse (sister) who joined us on ward rounds. When a suggestion as to a treatment or investigation was expressed, he invariably would turn to her and say, “what do you think sister (term for head nurse)?” If she had any reservation, he would consider it carefully before planning. My other great model was Dr., Barnard Berris, whose chief resident I became in 1974 at Toronto's Mt. Sinai Hospital. When a politician patient was being seen by him with his team which included me and an intern the patient remarked that he only wanted Dr. Berris and none of the “students”. Berris replied, “In this teaching hospital, the only way you can see me is with them. That is how I learned to be a doctor and now it is my duty to help train them to be good doctors as well.” That was the end of that conversation.</p><p>While working at a memory clinic, I saw an 83-year-old gentleman with a chief complaint of decreased recall and a tendency to repeat himself. He was still working as the director of a large and successful construction company. He was independent in his activities of daily living. He scored 22/30 on his MOCA (Montreal Cognitive Assessment), with demonstrated problems in recall and in the Trails B part of the examination, but otherwise he performed well. [<span>1</span>] His MRI revealed atrophy and microangiopathy. I was concerned about whether he might be a candidate for Donepezil therapy and was concerned about his driving. I explained to him the MOT (Ministry of Transport) reporting requirements and the risk of insurance problems should he have an accident and the insurer questioning why he was still driving. With a modicum of resistance, he agreed to take the on-road driving assessment but turned down the cholinesterase inhibitor. Several months later he passed the driving test and was pleased but still had memory problems.</p><p>He sold his company but remained on the board of directors and on the board of his condominium. His family wished for another opinion, and he saw a behavioral neurologist (I am a geriatrician) who sent him for another driving test and told him and his","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2956-2957"},"PeriodicalIF":4.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045435","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 Piano Lesson","authors":"Biren B. Kamdar","doi":"10.1111/jgs.19546","DOIUrl":"10.1111/jgs.19546","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2598-2599"},"PeriodicalIF":4.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060003","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":"Emergency Department Utilization Among Co-Residing Family Caregivers of Persons Living With Dementia","authors":"Pei-Chun Cha, Craig Rothenberg, Anita N. Chary, Justine Seidenfeld, Ula Hwang, Terri Fried, Joan K. Monin, Arjun K. Venkatesh, Cameron J. Gettel","doi":"10.1111/jgs.19522","DOIUrl":"10.1111/jgs.19522","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2920-2922"},"PeriodicalIF":4.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033046","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":"Development of an Annual Mobility Screen for Preclinical Mobility Limitation: Test Selection and Interpretation Guidelines","authors":"Michelle M. Lusardi,&nbsp;Victoria Hamby,&nbsp;Sterling Eckert,&nbsp;Jason Dring","doi":"10.1111/jgs.19521","DOIUrl":"10.1111/jgs.19521","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preclinical mobility limitation (PCML) is an emerging public health issue in the United States. A standardized assessment to identify those with PCML has not been established. A Task Force of the American Physical Therapy Association's Academy of Geriatric Physical Therapy (APTA Geriatrics) developed an evidence-based protocol for an Annual Mobility Screen (AMS) with the potential to meet this gap in practice. Early identification of PCML increases the potential for remediation, improved function, and a slower rate of decline. Because mobility is key for independence and quality of life, aging adults would value access to mobility screening. Physical therapists, experts in movement, are uniquely qualified to provide this service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This report reviews decision-making for the selection of test/measures and the development of an interpretation rationale for an AMS. Test selection criteria included ratio level measures (time, distance, repetition), time or equipment requirements, ability to predict adverse health events, and availability of reference values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four performance-based measures met inclusion criteria: self-selected and fast walking speed (overall mobility and functional reserve), 30 s Chair Stand (lower extremity muscle performance), Four Square Step test (dynamic balance stepping over low obstacles and changing direction), and Timed Up Go cognitive (ability to dual task while moving). Classification of mobility was based on normal distribution of performance across the population of aging adults as follows: PCML unlikely (at or above—0.5 SD or more from mean for age/gender), PCML likely (between −0.5 SD and − 1.0 SD from mean), and impending mobility limitation (−1 SD below the mean).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The AMS was developed to identify older adults with PCML. The reliability and validity of the AMS and its interpretation strategies will be evaluated as the screening protocol is piloted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2839-2845"},"PeriodicalIF":4.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061372","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":"Support and Internet Use in Navigating Medicare Plans Among Older Americans","authors":"Lianlian Lei,&nbsp;Kierstdea Petzold,&nbsp;Julie Strominger,&nbsp;Donovan T. Maust","doi":"10.1111/jgs.19516","DOIUrl":"10.1111/jgs.19516","url":null,"abstract":"&lt;p&gt;U.S. counties offer an average of 42 Medicare Advantage plans [&lt;span&gt;1&lt;/span&gt;] and 14 stand-alone prescription drug plans [&lt;span&gt;2&lt;/span&gt;], which vary in benefits, provider networks, operations (e.g., prior authorizations), and quality. Insurance decision-making may be particularly challenging for older adults given their complex health needs [&lt;span&gt;3&lt;/span&gt;]. Insurance decision-making tools and resources are available online, but older adults may have limited access or comfort [&lt;span&gt;4, 5&lt;/span&gt;]. To support older adults' enrollment choices—critical decisions with enormous financial and health implications—it is important to understand the resources they use to make insurance-related decisions.&lt;/p&gt;&lt;p&gt;We used the 2015–2023 National Health and Aging Trends Study (NHATS), a nationally representative, longitudinal survey of Medicare beneficiaries aged 65 or older. Surveys were fielded between May and December each year except in 2023 (March 2023–April 2024), with response rates of 50.8%–96.0%. Respondents were asked whether they changed Medicare plans (i.e., supplemental, prescription drug, Medicare Advantage) in the past year and, if so, whether anyone helped. Respondents were also asked whether they used the internet to handle Medicare insurance matters (e.g., comparing plans, looking up coverage, filing claims).&lt;/p&gt;&lt;p&gt;From 2015 to 2023, we examined prevalences of two outcomes: receiving help changing Medicare plans and using the internet for insurance matters. For cohort comparability across years, we limited the analysis each year to respondents aged 71 or older. We tested the trend using a linear probability model with year included as a continuous variable and additional binary indicators for years 2021, 2022, and 2023 to allow for deviations from the 2015 to 2020 linear trend during the COVID-19 pandemic; we did not include an additional binary indicator for the year 2020 since the survey asked about respondents' receipt of help and internet use in the past year. Then we used logistic regression to examine factors associated with each outcome, adjusting for respondent characteristics (Table 1). For this analysis, we used the 2022 survey and included respondents aged 65 or older to generate nationally representative estimates for older adults of all ages, calculating predicted probabilities and marginal effects. We used NHATS analytic weights, adjusted for complex survey design. Statistical significance was set at two-tailed &lt;i&gt;p&lt;/i&gt; &lt; 0.05; analyses were performed using Stata, version 18.0 (StataCorp LLC).&lt;/p&gt;&lt;p&gt;The proportion of respondents (&lt;i&gt;N&lt;/i&gt; = 44,467 respondent-years) who changed Medicare plans was stable at 10%–12% each year from 2015 to 2022 and increased slightly to 13.5% in 2023 (&lt;i&gt;p&lt;/i&gt; = 0.01; Figure 1). Among those who changed, approximately 50% received help until 2020, but this dropped to 40% by 2022 (&lt;i&gt;p&lt;/i&gt; = 0.02). The proportion of respondents who used the internet for insurance matters slowly increased to 15% b","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2923-2927"},"PeriodicalIF":4.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015467","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":"Home- and Community-Based Service Use Among Veterans: The National Landscape","authors":"Katherine E. M. Miller,&nbsp;Megan Price,&nbsp;Katherine O'Malley,&nbsp;Sooyeon Song,&nbsp;Melissa M. Garrido","doi":"10.1111/jgs.19492","DOIUrl":"10.1111/jgs.19492","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Veteran population is aging rapidly, with already higher rates of disability compared to non-Veteran peers. Consequently, demand for home- and community-based long-term services and supports (HCBS) is increasing. Understanding who needs and uses HCBS is particularly important in the Veterans Health Administration (VHA)—a payer for HCBS. Our objective is to describe the characteristics of Veterans who use HCBS, how Veterans who use HCBS differ from those who do not use HCBS, and how Veterans who use different types of HCBS differ from each other.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We use administrative data for VHA-provided and VHA-purchased care for 2021–2023 in a cohort of Veterans aged 65+. We describe Veteran HCBS users versus nonusers, services used, and the association of Veteran demographic characteristics, health status, and prior health care use on the probability of receiving HCBS using generalized estimating equations with binomial family, logit link, and exchangeable correlation structure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One in 10 older Veterans uses at least one HCBS service, and this share is growing over time. Veterans use home health care and homemaker/home health aide services the most. Most Veterans receive one service. We find that Veterans who are female, Black, or diagnosed with dementia are more likely to use HCBS, while Veterans residing in rural areas are less likely.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Like the challenges facing the aging civilian population, the VHA faces the test of meeting the growing demand for HCBS. Understanding these dynamics is essential to ensuring that HCBS is both accessible and effective in supporting Veterans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1884-1894"},"PeriodicalIF":4.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061221","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":"Post-Discharge COVID-19 Symptoms Predict 1-Year Functional Decline, Falls, and Emergency Department Visits: A Cohort Study","authors":"Murilo Bacchini Dias,&nbsp;Thiago J. Avelino-Silva,&nbsp;Eduardo Ferriolli,&nbsp;Leandro Utino Taniguchi,&nbsp;Wilson Jacob-Filho,&nbsp;Claudia Kimie Suemoto,&nbsp;Márlon Juliano Romero Aliberti,&nbsp;the CO-FRAIL Study Group for the COVID HCFMUSP Study Group","doi":"10.1111/jgs.19490","DOIUrl":"10.1111/jgs.19490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospitalization frequently results in persistent symptoms among older adults, raising concerns about the long-term impacts of acute events—a problem amplified by COVID-19. We investigated the effects of persistent symptoms on functional decline and unplanned events over 1 year in older patients recovering from COVID-19 hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective cohort included patients aged ≥ 50 years who survived COVID-19 hospitalization between March and December 2020 as part of the CO-FRAIL study at Brazil's largest academic medical center. Persistent symptoms were defined as those reported at admission and continuously present at one-, three-, six-, nine-, and 12-month post-discharge, covering 16 symptoms. Outcomes included functional decline in basic activities of daily living (ADL), mobility activities, instrumental activities of daily living (IADL), number of falls, emergency department (ED) visits, and hospital readmissions. Associations between persistent symptoms and outcomes were examined using mixed-effects negative binomial regression models adjusted for sociodemographic, clinical, hospitalization-related factors, and post-discharge rehabilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1019 patients (mean age = 65 ± 10 years; women = 45%; White = 62%), 324 (32%) experienced persistent symptoms throughout the year. Fatigue (28%), myalgia (19%), and dyspnea (13%) were the most common. Patients with ≥ 2 symptoms had an increased risk of functional decline in mobility activities (IRR = 2.11; 95% CI = 1.50–2.96), IADL (IRR = 2.00; 95% CI = 1.44–2.79), falls (IRR = 2.56; 95% CI = 1.14–5.75), and ED visits (IRR = 2.69; 95% CI = 1.27–5.70), but not readmissions. Among women, ≥ 1 persistent symptom was associated with a twofold increased risk of ADL decline. One year after discharge, patients with ≥ 2 persistent symptoms developed 1.27 more new disabilities (3.26 vs. 1.99 on a 15-point functional scale) and had 31 more unplanned events per 100 person-years (54.3 vs. 23.2) than those without symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Persistent symptoms after hospitalization are common and contribute to functional decline, falls, and ED visits in older COVID-19 survivors. These findings suggest that greater attention to symptom burden may support risk identification and improve post-discharge care planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1722-1732"},"PeriodicalIF":4.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035115","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":"Disease and Race-Based Differences in Inpatient Palliative Care Consultation in Cancer and Noncancer Serious Illnesses","authors":"Emily E. Moin,&nbsp;Brian Bayes,&nbsp;Vanessa Madden,&nbsp;Scott D. Halpern,&nbsp;Katherine R. Courtright","doi":"10.1111/jgs.19509","DOIUrl":"10.1111/jgs.19509","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines recommend timely palliative care consultation (PCC) for hospitalized patients with serious illness, but adherence to such guidelines and variability in access are not well described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective cohort study from March 21, 2016 to August 8, 2018 during the usual care period of a cluster-randomized trial at 11 hospitals in 8 US states. We included adults age 45 and older with cancer, chronic obstructive pulmonary disease (COPD), dementia, heart failure, or kidney failure. Exposures included diagnoses, demographics, and hospital characteristics, and outcomes included predicted probability and timing of PCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 40,074 inpatient encounters (median age 72 years [IQR 62–82], 46.9% male, 22.7% Black, 4.6% Hispanic), the most common serious illness was heart failure (66.0%), followed by COPD (39.3%), kidney failure (12.4%), cancer (12.3%), and dementia (11.6%). The overall rate of PCC was 11.6% (95% CI 11.3%–11.9%), ranging across hospitals from 4.2% (95% CI 3.3%–5.3%) to 23.3% (95% CI 19.6%–27.4%). Patients with dementia (20.6%, 95% CI 19.4%–21.7%) and cancer (19.5%, 95% CI 18.5%–20.7%) received PCC the most, and those with kidney failure the least (8.2%, 95% CI 7.5%–9.0%). Median time to PCC after admission was 3 days (IQR 1–6); patients with heart failure, COPD, and kidney failure received PCC 1 day later at the median compared to cancer and dementia. Predictors of increased odds of receiving PCC included being Black or Asian (aOR 1.12, 95% CI 1.02–1.23; aOR 1.67, 95% CI 1.31–2.12, respectively) and being admitted to a hospital with a higher overall rate of PCC orders (aOR 1.11, 95% CI 1.08–1.13).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PCC was underutilized overall and varied substantially in frequency and timing across hospitals, diseases, and patient race. These findings underscore the need to implement standardized approaches to improve adherence to guideline-recommended PCC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2155-2165"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19509","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061220","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 Proposed Universal “Home Time” Quality of Life Measure for Older Adults","authors":"Courtney H. Van Houtven,&nbsp;Nathan A. Boucher,&nbsp;Kasey Decosimo,&nbsp;Chelsea L. Whitfield,&nbsp;Paul A. Dennis,&nbsp;Valerie A. Smith,&nbsp;Karen M. Stechuchak,&nbsp;Brystana G. Kaufman,&nbsp;S. Nicole Hastings,&nbsp;Semra Ozdemir,&nbsp;Nina R. Sperber","doi":"10.1111/jgs.19506","DOIUrl":"10.1111/jgs.19506","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Researchers and insurers use “home time,” or an individual's time at home compared to time in different health care settings, as a population-level quality of life (QoL) or quality of care measure. With varying definitions, it is unknown which components of a home time measure most closely reflect QoL. Our objective is to develop a person-centered universal home time measure agnostic to condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used an iterative, structured approach based on Delphi methods to obtain expert input on what a measure should include, using qualitative and quantitative evidence from prior work. A total of 28 expert panelists, including Veterans Affairs (VA) leaders, clinician researchers, and non-clinician researchers, participated. In the first round, panelists voted on components (settings, weights, timeframes) to include in a home time measure. In the second round, panelists discussed results. The third round was final voting and explanations of choices and caveats.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Qualitative and quantitative data suggested that emergency department, inpatient care, and post-acute care settings all affect older adults' QoL in different ways, supporting inclusion; 75% of the experts endorsed all settings, and discussion suggested that future work should limit ED days to visits resulting in an inpatient admission. Our data did not reveal a clear indication for weighting settings: 56% of the expert panel suggested continuing to explore the use of weights to arrive at values that would reflect qualitative differences in settings, and 44% did not support the use of any weights. Our 6-month models resulted in QoL outcomes for all settings, and 30% of experts endorsed a 6-month timeframe, while 65% said that timeframe would depend on the situation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A “1.0” universal person-centered home time measure that reflects QoL should include days in the emergency department, inpatient care, and post-acute care. Expert input revealed domains of agreement and disagreement. Future validation efforts that incorporate expert input are needed to iterate and arrive at the optimal measure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2366-2375"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063359","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":"Attitudes About Clinical Trials of Medications in Older Hispanic/Latino Adults With Multimorbidity","authors":"Ruey-Ying Liu,&nbsp;Janice B. Schwartz,&nbsp;Bruno Renero-Hannan,&nbsp;Irene Del Mastro N,&nbsp;Derjung M. Tarn","doi":"10.1111/jgs.19495","DOIUrl":"10.1111/jgs.19495","url":null,"abstract":"&lt;p&gt;Hispanic/Latino individuals represent a rapidly growing segment of the US population, yet older Hispanic/Latino adults remain underrepresented in clinical trials of new medications [&lt;span&gt;1, 2&lt;/span&gt;]. Since people of different ages, races, or ethnicities may respond differently to therapeutic agents [&lt;span&gt;3-5&lt;/span&gt;], this gap raises concerns about medication efficacy and safety. This study explores barriers and facilitators of clinical trial participation among older Hispanic/Latino adults with multiple chronic conditions.&lt;/p&gt;&lt;p&gt;We conducted focus groups between February and September 2023 with adults aged 65 years and older who self-identified as Hispanic/Latino of Mexican origin and reported taking five or more prescription medications. Participants were recruited from senior centers in Los Angeles and San Francisco through information sessions and flyers and from UCLA and UCSF through electronic health record data extractions and email invitations. Respondents were sampled based on their preferred language (English or Spanish) and previous participation in research studies (Supporting Information Figure S1).&lt;/p&gt;&lt;p&gt;Focus groups were conducted in person or via Zoom, moderated by a Spanish-English bilingual researcher using a semi-structured guide to investigate participants' perspectives of clinical trial participation. Participants received compensation for their participation. Focus groups were analyzed in ATLAS.ti 23 using thematic analysis [&lt;span&gt;6&lt;/span&gt;]. Theoretical saturation [&lt;span&gt;7&lt;/span&gt;] was achieved. The UCSF Institutional Review Board (IRB) approved the study protocol.&lt;/p&gt;&lt;p&gt;We conducted 14 focus groups with 93 participants (Table 1): nine with 61 participants without previous research experience and five with 32 participants with previous research experience, including 7 who had participated in clinical trials. The mean age was 72.1 years (SD = 5.4); 55 (59.1%) were female, and 51 (54.8%) opted for Spanish-speaking groups. See Supporting Information Tables S1 and S2 for additional participant characteristics. We identified major themes concerning clinical trial participation (Table 2).&lt;/p&gt;&lt;p&gt;Our findings reveal key barriers to clinical trial participation among older Hispanic/Latino adults. While participants expressed general concerns about medication safety and logistical burdens, limited awareness and culturally specific barriers—especially mistrust—were particularly prominent. To build trust, involving physicians and family members in recruitment may be critical, as both were identified as influential in enrollment decisions.&lt;/p&gt;&lt;p&gt;Our results align with existing recommendations of providing linguistically and culturally appropriate engagement to enhance clinical trial participation among ethnic minority groups [&lt;span&gt;5, 9, 10&lt;/span&gt;]. However, participants also emphasized within-group diversity, including Spanish dialects, country of origin, and generational differences, which should be considered when developing inter","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2607-2612"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061363","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}