Journal of the American Geriatrics Society最新文献

{"title":"Clinician Perspectives on Increased Gabapentinoid Prescribing in Nursing Homes","authors":"Jonathan D. Winter, J. William Kerns, Danya M. Qato, Katherine M. Winter, Nicole Brandt, Linda Wastila, Christopher Winter, Yu-Hua Fu, Eposi Elonge, Alex H. Krist, Sarah R. Reves, Rebecca S. Etz","doi":"10.1111/jgs.19381","DOIUrl":"10.1111/jgs.19381","url":null,"abstract":"<p>Gabapentinoid use in nursing homes (NHs) is rapidly increasing, though the reasons for this evolving trend remain opaque [<span>1, 2</span>]. To bridge this knowledge gap, we conducted two iterative surveys of NH prescribing clinicians. The first survey focused on why gabapentinoids are prescribed in NHs; the second assessed the magnitude of prescribing for each identified indication. Both explored provider perspectives on factors influencing gabapentinoid increases and barriers to deprescribing [<span>3</span>]. These surveys revealed that gabapentinoids are increasingly applied off-label not only for all neuropathic pain but also for every form of pain. Most clinicians also perceive gabapentinoids as helpful in moderating behavioral and psychological symptoms, and neuropsychiatric treatment goals influence prescribing. Furthermore, clinicians directly linked gabapentinoid gains with opioid and psychotropic reduction policies as gabapentinoids are viewed as reasonable but unmonitored alternatives to these medications [<span>3</span>]. In addition to these structured responses, results also included 111 clinician free-text responses, offering granular insights into gabapentinoid prescribing practices unobtainable by descriptive statistics alone. This qualitative analysis of that free-text response data deepens our understanding of NH prescribers' increasing reliance on gabapentinoids.</p><p>In October 2023 and May 2024, we used SurveyMonkey to anonymously survey NH clinicians about their gabapentinoid prescribing practices, exploring the indications for use and the factors driving prevalence gains. The first survey inventoried why gabapentinoids are prescribed in NHs, the second iteratively quantified the relative scope of such prescribing [<span>3</span>]. A multidisciplinary team developed the surveys, grounding them in existing literature and emerging data [<span>4-6</span>]. We employed convenience sampling through crowdsourcing, engaging with NH clinician networks to reach a diverse range of clinicians. Participants had four opportunities to provide open-ended insights to enrich responses. Both surveys included the open-ended question “Is there anything else you feel is important for us to know about your use of gabapentin or the challenges of managing behavioral symptoms related to dementia?” Two additional questions also allowed free responses, “I would use gabapentin less if…,” and “I use pregabalin (Lyrica) less often than gabapentin because….” From these observations, themes were identified through an iterative process of immersive crystallization using codes that emerged during data collection and early immersion/crystallization, with differences reconciled by team consensus [<span>7</span>]. Both survey instruments and additional methodological detail are available as online supplements.</p><p>One-hundred-eighty-seven NH clinicians participated in the surveys of which 78 provided 111 free responses. All major geographic regions in ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1953-1956"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191682","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":"Around the EQUATOR With Clin-STAR: AI-Based Randomized Controlled Trial Challenges and Opportunities in Aging Research","authors":"Betsy Yang,&nbsp;Caroline Park,&nbsp;Steven Lin,&nbsp;Vijaytha Muralidharan,&nbsp;Deborah M. Kado","doi":"10.1111/jgs.19362","DOIUrl":"10.1111/jgs.19362","url":null,"abstract":"<p>The CONSORT 2010 statement is a guideline that provides an evidence-based checklist of minimum reporting standards for randomized trials. With the rapid growth of Artificial Intelligence (AI) based interventions in the past 10 years, the CONSORT-AI extension was created in 2020 to provide guidelines for AI-based randomized controlled trials (RCT). The Clin-STAR “Around the EQUATOR” series features existing reported standards while also highlighting the inherent complexities of research involving research of older participants. In this work, we propose that when designing AI-based RCTs involving older adults, researchers adopt a conceptual framework (CONSORT-AI-5Ms) designed around the 5Ms (Mind, Mobility, Medications, Matters most, and Multi-complexity) of Age-Friendly Healthcare Systems. Employing the 5Ms in this context, we provide a detailed rationale and include specific examples of challenges and potential solutions to maximize the impact and value of AI RCTs in an older adult population. By combining the original intent of CONSORT-AI with the 5Ms framework, CONSORT-AI-5Ms provides a patient-centered and equitable perspective to consider when designing AI-based RCTs to address the diverse needs and challenges associated with geriatric care.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1365-1375"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191680","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":"Use and Discontinuation Rates of Long-Acting Injectable Antipsychotics Between Race/Ethnicity in Older Adults Using Medicaid Databases","authors":"Christopher M. Cassara,&nbsp;Jianing Xu,&nbsp;Daniel B. Hall,&nbsp;Xianyan Chen,&nbsp;Henry N. Young,&nbsp;Joshua Caballero","doi":"10.1111/jgs.19386","DOIUrl":"10.1111/jgs.19386","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The primary objective of this study was to assess the prescribing patterns of long acting injectable (LAI) antipsychotics in an older adult population. Secondary objectives were to determine if there were differences in treatment discontinuation rates between different LAI agents and race/ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Merative MarketScan Multi-State Medicaid Databases (2017–2021) were used to identify patients 65 years or older who were prescribed a LAI antipsychotic. Pharmacy claims for LAI antipsychotics were referenced via National Drug Code (NDC) by brand/generic name and dose. International Classification of Diseases, 10th edition (ICD-10) codes were used to identify older adults diagnosed with schizophrenia, schizotypal or schizoaffective disorders. Those with dementia or related disorders were censored. Conditional associations between race/ethnicity and generation of LAI antipsychotics were investigated using logistic regression controlling for age, sex, and health plan. Cox proportional hazard regression was used to compare the distribution of time until treatment discontinuation among older adults across LAI antipsychotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 526 older adults (59% female) with an average age of 70.4 ± 5.5 years met inclusion for analysis. The most commonly used LAI antipsychotics included paliperidone palmitate-1 month formulation (~35%), haloperidol decanoate (~24%), and risperidone microspheres (~15%). Overall, approximately 32% received LAI first-generation antipsychotics and 68% received LAI second generation antipsychotics. Blacks (<i>n</i> = 204) received LAI first-generation antipsychotics more often than Whites (<i>n</i> = 283); (OR: 1.74, 95% [1.18, 2.56], <i>p</i> &lt; 0.01). When controlling for age, sex, and race/ethnicity, LAI first-generation antipsychotics showed earlier discontinuation rates compared to LAI second-generation antipsychotics (HR: 2.12, 95% CI [1.45, 3.10], <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LAI first-generation antipsychotics showed treatment discontinuation significantly earlier compared to LAI second-generation antipsychotics. Furthermore, Blacks were prescribed LAI first-generation antipsychotics at a higher rate than Whites, which may contribute to poorer health outcomes. Futures studies are needed to establish a causal relationship.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1454-1461"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191684","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":"“By the Time We Knew …”: Poetic Analysis of End-of-Life Caregiving Experiences for Rapidly Progressive and Slower-Duration Dementia Syndromes","authors":"Krista L. Harrison,&nbsp;Brianna E. Morgan,&nbsp;Juliana Friend,&nbsp;Sarah B. Garrett,&nbsp;David Looi,&nbsp;Madina Halim,&nbsp;Jennifer E. James,&nbsp;Nicole D. Boyd,&nbsp;Joni Gilissen,&nbsp;Michael D. Geschwind,&nbsp;Christine S. Ritchie,&nbsp;Alexander K. Smith","doi":"10.1111/jgs.19382","DOIUrl":"10.1111/jgs.19382","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>One in three older adults in the United States dies with or from dementia. Little is known about whether end-of-life caregiving experiences differ by dementia diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a secondary analysis of two qualitative studies. Participants included caregivers of decedents with “rapid-type” sporadic Creutzfeldt–Jakob Disease (sCJD, survival prognosis of &lt; 1 year) or “slow-type” Alzheimer's disease and related dementias (survival prognosis of 5–20 years). We used reflexive thematic analysis and a novel method, poetic analysis, to compare end-of-life caregiving experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>“Rapid-type” caregivers (<i>n</i> = 12) had a median age of 59 (range 45–73) years; 6 were female, and 9 were spouses. “Slow-type” caregivers (<i>n</i> = 15) had a median age of 69 (45–82) years; 9 were female, and 11 were spouses. We identified three main areas of differential experience that were influenced by syndrome rarity and participation in research yet hinged on <i>time</i>. <i>Time enables preparation</i>: Due to the rarity of sCJD, “rapid-type” caregivers struggled to obtain accurate diagnoses, which prevented preparation for end-of-life care. Weeks or months before death, specialists simultaneously disclosed sCJD diagnoses and recommended hospice. In contrast, for “slow-type” dementia, preparation began years before death. <i>Time complicates conflict</i>: Most “rapid-type” caregivers described <i>conflicts</i>, rarely resolved before death, about code status, treatment, or care location decisions. Fewer “slow-type” caregivers experienced such conflicts, and these were typically resolved before death; instead, they experienced conflict between needs and what the care system provides. <i>Postmortem experience contrasts with perimortem</i>: For “rapid-type” dementia, short perimortem periods contrasted with elongated and often intense postmortem logistics and grief. For “slow-type” caregivers, preparation and perimortem grieving typically led to shorter duration and minimally intrusive postmortem logistics and grief.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>End-of-life care for dementia should attend to and support axes of differential experience based on diagnosis and rarity, time since symptom onset (affecting preparation and conflict resolution), and participation in research studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1406-1418"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191667","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 of Accelerometer-Measured Physical Activity With Dementia, Anxiety, and Depression Among Older Adults","authors":"Eric L. Stulberg,&nbsp;Lin-Na Chou,&nbsp;Shweta Gore,&nbsp;Molly B. Conroy,&nbsp;Jennifer J. Majersik,&nbsp;Katherine J. Hunzinger,&nbsp;Alexander LaPoint,&nbsp;Mandeep Kaur Sandhu,&nbsp;Andrea L. C. Schneider,&nbsp;Amit Kumar","doi":"10.1111/jgs.19383","DOIUrl":"10.1111/jgs.19383","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Higher physical activity (PA) is associated with better neuropsychiatric health, but prior studies have been limited by cross-sectional designs, self-reported PA measures, and small numbers of older individuals. We examined associations between baseline and changes in accelerometer-measured moderate-vigorous PA (MVPA) with neuropsychiatric health among individuals aged ≥ 70 years in the National Health and Aging Trends Study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the average daily minutes of accelerometer-measured MVPA above a validated threshold of 2184 counts per minute as a continuous measure at baseline for the exposure variable. For longitudinal analyses, we categorized change in MVPA as follows: an increase of &gt; 20 min/day over 1 year, a decrease of &gt; 20 min/day over 1 year, and staying within 20 min/day over 1 year. Our outcomes were possible/probable dementia and anxiety or depression. Associations were estimated using confounder-adjusted logistic regressions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In our survey-weighted analytic sample of 639 individuals aged ≥ 70 years, 56% were ≥ 75 years, and 53% were female. After adjusting for confounders, a 20-min/day higher baseline MVPA was significantly associated with lower odds of possible/probable dementia 1 year later (odds ratio [OR] = 0.89, 95% confidence interval [CI] = 0.83–0.96) but not with depression and anxiety symptoms. Compared to no change in PA over 1 year, an increase in MVPA by &gt; 20 min/day was associated with decreased odds of depression and anxiety symptoms (OR = 0.06, 95% CI = 0.03–0.14) but not with possible/probable dementia. Compared to no change in MVPA over 1 year, a decrease in MVPA by &gt; 20 min/day was associated with higher odds of possible/probable dementia (OR = 3.82, 95% CI = 1.34–10.87) but not with depression and anxiety symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher and increasing MVPA over time is associated with better neuropsychiatric health in individuals aged ≥ 70 years. Future studies should prioritize evaluating detailed PA trajectories to better understand how different doses, intensities, and modalities of PA impact neuropsychiatric decline in older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1870-1876"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19383","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191681","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":"Implementing in VA CLCs Is Complex, We Know!","authors":"Rhonda L. Toms,&nbsp;Courtney A. Huhn,&nbsp;Scotte R. Hartronft","doi":"10.1111/jgs.19380","DOIUrl":"10.1111/jgs.19380","url":null,"abstract":"&lt;p&gt;In the report of Mor et al. [&lt;span&gt;1&lt;/span&gt;] entitled “Implementing INTERACT in Veterans Health Administration Community Living Centers: A Pragmatic Randomized Trial”, the study found that INTERACT did not reduce rates of all-cause hospitalizations. This study offers valuable insights into improving care for our nation's Veterans in long-term care settings.&lt;/p&gt;&lt;p&gt;The INTERACT program represents a novel and commonsense approach to reducing potentially avoidable hospitalizations among nursing home residents. It includes four basic components: quality improvement, communication, decision support and advance care planning [&lt;span&gt;2&lt;/span&gt;]. In this article, they highlight the “stop and watch” methodology which encourages all employees to increase situational awareness of potential Veteran changes and use Situation, Background, Assessment, and Recommendation (SBAR) to communicate observations and changes in conditions across disciplines. In the day-to-day care of nursing home residents, the trees can obscure the view of the forest. INTERACT reminds us that all team members have a view and should participate in identifying resident changes.&lt;/p&gt;&lt;p&gt;At the Veterans Health Administration (VHA), our sacred duty is to care for those “who have borne the battle” [&lt;span&gt;3&lt;/span&gt;]. At Community Living Centers (CLCs), we care for those who have survived the battle and compounded with the added changes of age, disability, and disease. CLC residents are among our most vulnerable and are often more complex than those in Community Nursing Homes because of higher comorbidity, concurrent mental health conditions, and increased social needs [&lt;span&gt;4, 5&lt;/span&gt;]. The CLC provides transitional care, long term care, and hospice care.&lt;/p&gt;&lt;p&gt;The authors found (a) a high rate of all cause readmission with a lower rate of inappropriate readmission and (b) difficulty implementing INTERACT. These findings highlight the challenges of caring for complex Veterans in an integrated health system. As an integrated health system, where CLCs are often co-located with inpatient hospitals, CLCs play a role in decompressing the system. For example, a Veteran with advanced cancer and low social supports might reside in the CLC between rounds of hospital-based chemotherapy. Readmissions are anticipated and scheduled with the Veteran's goals as the driving force. We understand the difficulty of implementing tools such as the INTERACT methods firsthand.&lt;/p&gt;&lt;p&gt;For background, VHA implemented the CLCs Ongoing National Center for Enhancing Resources and Training (CONCERT) program in 2017 with a train the trainer approach [&lt;span&gt;6&lt;/span&gt;]. CONCERT implements the LOCK bundle, a set of practices based on relational coordination theory, to create high-functioning, relationship-based teams [&lt;span&gt;7&lt;/span&gt;]. Such an implementation required significant investment from CLCs (personnel time, cultural shifts), regional (training, coordination), and national (expertise, phone support, webinars, and coordin","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"682-684"},"PeriodicalIF":4.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19380","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191683","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":"Vestibular Suppressant Utilization and Subsequent Falls Among Patients 65 Years and Older With Dizziness in the United States","authors":"Schelomo Marmor,&nbsp;Pinar Karaca-Mandic,&nbsp;Meredith E. Adams","doi":"10.1111/jgs.19377","DOIUrl":"10.1111/jgs.19377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Falls pose a significant public health threat to older adults. Due to potential fall risk, guidelines recommend against the routine prescription of several medications commonly used for vestibular suppression, including meclizine and benzodiazepines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to determine the factors associated with vestibular suppressant utilization among patients with dizziness ≥ 65 years of age and subsequent falls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A retrospective longitudinal database of US commercial insurance and Medicare beneficiaries was used to study medical claims data (January 1, 2006, through December 31, 2015). Of 190,348 individuals ≥ 65 years old who presented with dizziness, 60,658 (32%) filled a vestibular suppressant prescription (27% anti-emetics, 73% anxiolytics), of which 20,448 were women (34%) within a month after their dizziness diagnosis. Of those individuals using suppressants, 8% experienced a fall resulting in a medical encounter within 60 days of filling the prescription. After adjusting for sociodemographics and comorbidity, individuals with dizziness who received vestibular suppressants were more likely to experience recorded fall incidents (hazard ratio (HR) 3.33, confidence interval (CI) 1.93–5.72, <i>p</i> &lt; 0.0001), than those who did not receive vestibular suppressants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although vestibular suppressants may provide immediate relief from symptoms during an acute vestibular crisis, use is incongruent with guideline-concordant care for most vestibular diagnoses and is also potentially counterproductive and injurious. Multi-faceted interventions that engage clinicians and patients are needed to improve the value of care for patients with vestibular disorders to de-implement the routine use of suppressants for dizziness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1398-1405"},"PeriodicalIF":4.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191686","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 Comprehensive, Home-Based, Fall Prevention Initiative: Preliminary Data From the Raise'Age Program","authors":"Amal Aïdoud,&nbsp;Jaques-Alexis Nkodo,&nbsp;Wassim Gana,&nbsp;Camille Debacq,&nbsp;Natacha Michel,&nbsp;Pierre Deneau,&nbsp;Calyssa Trézy,&nbsp;Nicolas Guyot,&nbsp;Matthieu Coulongeat,&nbsp;Bertrand Fougère","doi":"10.1111/jgs.19350","DOIUrl":"10.1111/jgs.19350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although falls among older adults pose substantial health risks and are often preventable, many fallers do not seek medical care. The Raise'Age program addresses this challenge by offering proactive fall prevention for older adults who require “lift assistance” but are not taken to hospital. The program includes (i) screening by emergency medical services (EMSs), (ii) referrals for a comprehensive geriatric assessment, (iii) in-home evaluations by a mobile geriatric team (MGT), and (iv) referrals to primary care physicians (PCPs). Here, we outline the program's design, development, and implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The program's activity in 2023 was assessed with regard to the number of EMS fall reports, the reports' completeness, the program's eligibility, and acceptance by physicians and patients, in-home assessments, adherence to geriatric follow-up programs, and coordination delays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2023, the Raise'Age program received 959 reports, accounting for 48% of lift assistances by paramedics. Of these, 37% of the reports were reviewed for eligibility. Reports were often archived due to irrelevance, a recent hospital stay, or difficulty contacting PCPs. Among eligible reports, 77% were approved for in-home evaluations, and the remainder were referred to a geriatrician or scheduled for hospital admission. The median processing time was 26 days. Of 228 patients eligible for home visits, 150 accepted the intervention. Visit acceptance rates were higher when a PCP endorsed the program. Follow-up was provided to 36% of the patients- primarily via teleconsultation. Finally, 15.6% of the patients for whom a lift assistance report was sent to the MGT completed the Raise'Age program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Raise'Age program demonstrates that EMS screening and collaboration with MGTs are feasible, although some patients may decline the services offered. Continuous evaluations and interventions by MGTs and referrals to community-based medical and social services effectively address the needs of older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1895-1905"},"PeriodicalIF":4.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Differences in Low-Value Care Among Older Adults in a Large Statewide Health System","authors":"Carlos Irwin A. Oronce,&nbsp;Ray Pablo,&nbsp;Susi Rodriguez Shapiro,&nbsp;Phyllis Willis,&nbsp;Ninez Ponce,&nbsp;John N. Mafi,&nbsp;Catherine Sarkisian","doi":"10.1111/jgs.19369","DOIUrl":"10.1111/jgs.19369","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As value-based payment models incorporate both measures of health equity and low-value care (LVC), understanding how LVC varies by race is vital for interventions. Therefore, we measured racial differences in LVC in a contemporary sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional analysis of claims from adults ≥ 55 years receiving care at five academic medical centers in California from 2019 to 2021. Our sample included patients who received a service that could be classified as LVC. The primary outcome was whether a service was classified as LVC. Secondary outcomes included clinical categories of LVC (preventive screening, diagnostic testing, prescription drugs, and preoperative testing). We examined associations between race/ethnicity with outcomes using multivariable regression models adjusted for patient characteristics and medical center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 15,720 members who received potentially LVC, non-Hispanic White older adults comprised 59% of the sample, followed by Asian (17%), unknown race (8%), Latino (8%), non-Hispanic Black (5%), other race (2%). In adjusted models, Asian (−4.9 percentage points [pp]; 95% CI −5.9, −3.8 pp), Black (−5.4 pp; 95% CI −8.0, −2.7 pp), and Latino (−2.5 pp; 95% CI −4.6, −0.4 pp) older adults were less likely to receive LVC compared to White older adults, specifically preventive and preoperative services. Asian, Black, and Latino older adults, however, were more likely to receive low-value prescriptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These diverging racial patterns in LVC across different measures likely reflect differential mechanisms, underscoring the need to use clinically specific measures rather than composite measures, which obscure underlying heterogeneity and could lead to potentially harmful and inequity-producing interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"900-909"},"PeriodicalIF":4.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082897","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":"Aligning Medications With What Matters Most: Conversations Between Pharmacists, People With Dementia, and Care Partners","authors":"Ariel R. Green,&nbsp;Rosalphie Quiles Rosado,&nbsp;Andrea E. Daddato,&nbsp;Aleks Wec,&nbsp;Kathy Gleason,&nbsp;Tobie Taylor McPhail,&nbsp;Jessica Merrey,&nbsp;Linda Weffald,&nbsp;Meghan Swarthout,&nbsp;Scott Feeser,&nbsp;Cynthia M. Boyd,&nbsp;Jennifer L. Wolff,&nbsp;Marcela D. Blinka,&nbsp;Elizabeth A. Bayliss,&nbsp;Rebecca S. Boxer","doi":"10.1111/jgs.19379","DOIUrl":"10.1111/jgs.19379","url":null,"abstract":"<p>See related editorial by Gurwitz et al. in this issue.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1189-1197"},"PeriodicalIF":4.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082872","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}