Journal of the American Geriatrics Society最新文献

{"title":"Comment on “Association of Left Atrial Function With Frailty: The Atherosclerosis Risk in Communities (ARIC) Study”","authors":"Mehmet Ilkin Naharci","doi":"10.1111/jgs.19476","DOIUrl":"10.1111/jgs.19476","url":null,"abstract":"<p>In a recent issue of the <i>Journal of the American Geriatrics Society</i>, Sun et al. reported that worse left atrial function, even in the absence of symptomatic cardiovascular disease at baseline, is a risk factor for frailty in older adults [<span>1</span>]. When the authors further investigated this relationship according to the frailty criteria, they found that exhaustion and an increase in the number of criteria were associated with a decrease in left atrial function. These results will contribute to attempts to uncover the underlying pathophysiological mechanisms of frailty, and thus, to our understanding of aging. We appreciate that the authors comprehensively adjusted for potential confounders such as comorbidities, echocardiographic measurements, and cardiac and inflammatory biomarkers; however, we would like to discuss other variables such as physical activity and polypharmacy status that may be necessary to elucidate the independent effect of left atrial function in association with frailty.</p><p>Exercise reduces morbidity and mortality by promoting healthy aging in older individuals [<span>2</span>]. In this population, regular physical activity may prevent age-related muscle loss and decline in muscle strength; improve cardiopulmonary fitness, balance, and flexibility; and delay the transition to disability and frailty, thereby promoting long-term independence and preventing falls and fall-related injuries [<span>3</span>]. A recent meta-analysis of 11 randomized controlled trials among non-frail adults aged 60 years and older found that any type or combination of physical exercise could be effective in preventing the onset of frailty [<span>4</span>]. In another meta-analysis of 69 randomized controlled trials, resistance exercise showed the greatest potential for reducing frailty in older persons [<span>5</span>]. These findings confirm that exercise can help older adults avoid frailty onset.</p><p>Our knowledge of the adverse effects of polypharmacy on the onset of physiological decline in older persons has greatly benefited from longitudinal studies evaluating the association between the number of drugs and frailty [<span>6-8</span>]. A study (<i>n</i> = 299) with 6-year follow-up period showed that the proportion of older participants developing frailty was 5.1% in those using five or fewer medications and 22.5% in those using six or more medications [<span>6</span>]. A community-based prospective cohort study (<i>n</i> = 1697) of adults aged ≥ 50 years reported a positive correlation between polypharmacy and incident frailty over 5-year follow-up [<span>7</span>]. Furthermore, at advanced ages, polypharmacy is a risk factor for frailty after 3 years [<span>8</span>]. In support of these results, chronic polypharmacy with increasing drug burden index causes frailty and affects function in old age, according to experimental research [<span>9</span>].</p><p>In conclusion, the adjustment of the multivariable model with physic","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2298-2299"},"PeriodicalIF":4.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056153","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":"Preferences Regarding Clinical Drug Trial Elements: A Nationally Representative Survey of Older Adults With Multimorbidity","authors":"Janice B. Schwartz,&nbsp;Ruey-Ying Liu,&nbsp;John Boscardin,&nbsp;Derjung M. Tarn","doi":"10.1111/jgs.19470","DOIUrl":"10.1111/jgs.19470","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older adults with multimorbidity have been under-represented in clinical drug trials. We sought to determine willingness to enroll in trials and preferences of older adults for learning about clinical trials, visit frequency, travel, locations, and testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional internet and telephone survey of a nationally representative sample of adults ≥ 65 years with ≥ 3 chronic conditions (NORC University of Chicago Foresight 50+ panel) from March–April 2023 to determine acceptability of aspects of clinical trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Surveyed 1318 (1142 Internet, 176 phone), mean age 72.3 ± 6.3 (SD), 52% women; race: 83% White, 10% Black or African American (BLAfrAm), 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Almost half would consider trials of medications for memory problems, hypertension, cancer, chronic pain, diabetes, or high cholesterol. Men and BLAfrAm respondents were the most willing to consider hypertension or diabetes trials. Preferences for where to learn about trials were physician offices (87% overall, 85% of BLAfrAm, 94% of Hispanic); 10% of White respondents considered senior centers versus 30% of BLAfrAm and 20% of Hispanics (<i>p</i> &lt; 0.001). Two-thirds wanted written materials and question and answer sessions (no significant sex or racial differences). Respondents anticipated no difficulty with measuring blood pressure at home, and only respondents &gt; 80 years anticipated difficulty wearing activity monitoring devices. All groups preferred monthly or every 3–4 month visits for physical exams, blood or urine tests vs. less frequently and were willing to travel half an hour in each direction for visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Efforts to increase enrollment of older adults and older adults from previously under-represented racial populations will need increased physician engagement. Pragmatic trials with infrequent participant contact are not likely to increase participation of older adults with multimorbidity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2517-2523"},"PeriodicalIF":4.5,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056074","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":"Antipsychotic Use and Successful Discharge Rates in Heart Failure-Related Hospitalizations","authors":"Mriganka Singh,&nbsp;Thomas A. Bayer,&nbsp;Lan Jiang,&nbsp;Alyssa N. De Vito,&nbsp;Thomas Nubong,&nbsp;Zachary J. Kunicki,&nbsp;John E. McGeary,&nbsp;Catherine M. Kelso,&nbsp;Wen-Chih Wu,&nbsp;Kevin W. McConeghy,&nbsp;Julia W. Browne,&nbsp;James L. Rudolph","doi":"10.1111/jgs.19480","DOIUrl":"10.1111/jgs.19480","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2603-2606"},"PeriodicalIF":4.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059064","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":"CoCare-CI: A Clinical Innovation to Address Behavioral Symptoms in Hospitalized Older Adults With Cognitive Impairment","authors":"David H. Lynch,&nbsp;Elizabeth R. Houston,&nbsp;Anna L. Andrews,&nbsp;Kimberly J. Mournighan,&nbsp;Willow F. Butler,&nbsp;John A. Batsis,&nbsp;Joshua D. Niznik,&nbsp;Jennifer Leeman,&nbsp;Laura C. Hanson","doi":"10.1111/jgs.19479","DOIUrl":"10.1111/jgs.19479","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Behavioral symptoms in hospitalized older adults with cognitive impairment often lead to physical and chemical restraint use, despite associated harms. Patient-centered care models show promise in reducing restraint use but are rarely implemented in routine practice. This project implemented CoCare-CI, a clinical innovation to address behavioral symptoms in hospitalized older adults with cognitive impairment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CoCare-CI was implemented on a 24-bed ACE unit in a 128-bed community hospital from January 2023 to August 2024 by a multidisciplinary team led by a geriatric nurse practitioner (GNP). CoCare-CI emphasized (1) systematic screening and assessment of mentation, and (2) individualized management plans for delirium or dementia. Implementation followed a phased, cyclical approach with champions supporting process improvement. Baseline restraint data (January–August 2023) were compared to intervention data (September 2023–August 2024). Primary outcomes included physical and chemical restraint use; process measures included documentation rates of the Confusion Assessment Method (CAM), CAM-Severity (CAM-S), Six-Item Cognitive Impairment Test (6CIT), and 4Ms checklist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 949 patients (mean age 81.5 years, 59% female, 80.6% White), 34.1% had cognitive impairment at baseline, including 22.6% with dementia and 11.5% with a significant 6CIT score (≥ 8). Documentation rates improved for CAM (68%–86%), CAM-S (0%–79%), 6CIT (0%–89%), and 4Ms checklist (0%–96%). Physical restraint use decreased from 4.3% to 0.7%, and chemical restraint use dropped from 7.6% to 2.3%. Most restraint use (84.2%, 16/19) was deemed potentially avoidable, with root cause analysis revealing that 78.6% (11/14) of patients with restraint orders had moderate to severe dementia with behavioral symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CoCare-CI is associated with reductions in reduced physical and chemical restraint use, demonstrating potential for dissemination within routine clinical practice. Future research should assess sustainability, broader applicability, and integration of additional 4Ms components.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2562-2570"},"PeriodicalIF":4.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039978","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":"Enhancing Advance Care Planning in Primary Care: A Three-Year Implementation Study in Nebraska","authors":"Jungyoon Kim,&nbsp;Valerie Pacino,&nbsp;Thuy Koll,&nbsp;Maria S. Mickles,&nbsp;Jane F. Potter,&nbsp;Jihyun Ma,&nbsp;Paul Estabrooks","doi":"10.1111/jgs.19478","DOIUrl":"10.1111/jgs.19478","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the benefits of discussing patients' preferences on care decisions, the uptake of advance care planning (ACP) in the U.S. is low. This study aimed to (1) identify barriers to ACP implementation, (2) implement two strategies (onsite ACP coordinator and Lightning Report facilitation—a rapid process improvement involving prompt feedback synthesis and timely action), and (3) track ACP outcomes (reach, implementation, and effectiveness).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study took place at two primary care sites participating in the Nebraska Geriatric Workforce Enhancement Program from 2020 to 2023. We conducted a multi-stage evaluation mixed-methods study guided by the Practical, Robust Implementation and Sustainability Model (PRISM). Qualitative data from clinic staff interviews and focus groups were collected to identify implementation barriers, develop an optimal workflow, and educate providers and patients (implementation). Quantitative data from electronic medical records (EMR) were collected at baseline and every six months thereafter to assess ACP outcomes, including reach (patient-provider discussion of ACP) and effectiveness (ACP document completion). We mapped barriers to implementation strategies, mechanisms, and ACP outcomes based on PRISM domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2019 to 2021, ACP outcomes remained consistent: Clinic A (reach: data not available; effectiveness: 20.5%–20.2%) and Clinic B (reach: 2.3%–2.6%; effectiveness: 1.8%–1.9%). After implementing the ACP coordinator and Lightning Report in 2022, moderate-to-high improvements were observed: Clinic A saw a 10-percentage point increase in reach (43.6%–53.6%) and a 2.5 increase in effectiveness (20.2%–22.8%). Clinic B experienced a significant 25.3-percentage point increase in reach (2.6%–27.9%) and a 16.5 increase in effectiveness (1.9%–18.4%). We also updated the clinic workflow to integrate the ACP initiative into standard practice (implementation).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The introduction of an ACP coordinator, along with the Lightning Report approach, may enhance ACP reach, effectiveness, and implementation in primary care settings for older patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2553-2561"},"PeriodicalIF":4.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059072","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":"Psychometric Properties of Patient-Reported Quality Measures for Community-Based Serious Illness Care","authors":"Anagha Tolpadi,&nbsp;Feifei Ye,&nbsp;Joan M. Teno,&nbsp;Melissa A. Bradley,&nbsp;Rebecca Anhang Price","doi":"10.1111/jgs.19472","DOIUrl":"10.1111/jgs.19472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Quality measures from the Serious Illness Survey for Home-based Programs have been endorsed by the Centers for Medicare &amp; Medicaid Services's consensus-based entity for use in initiatives to promote quality improvement and accountability of home-based serious illness care. However, no patient-reported quality measures have been endorsed for assessment of serious illness care across a range of outpatient settings and providers. To address this gap and create quality measures for use by Medicare Advantage (MA) organizations or other entities responsible for care of seriously ill individuals, we adapted and field-tested the survey among MA enrollees.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We refined the previously validated survey by removing questions specific to home-based services, adapting question wording, and adding new items to inform quality improvement. Following cognitive interviews among 20 seriously ill individuals to ensure consistent interpretation of survey items, we finalized the survey and field-tested it among a sample of seriously ill enrollees from a state-wide MA plan. Using the 1412 survey responses, we assessed item performance, used factor analysis to construct composite quality measures, evaluated item-scale correlations, and examined validity by calculating the degree to which quality measures predicted respondents' overall ratings of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall survey response rate was 41.5%. Cronbach's alpha estimates for proposed composite measures assessing communication, care coordination, help for symptoms, planning for care, and understanding own health ranged from 0.673 to 0.864, indicating adequate internal consistency in assessing their underlying constructs. Together, the composites explained 42.0%–44.3% of the variance in respondents' overall ratings of their care. Communication and care coordination were the strongest predictors of overall ratings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patient-reported measures derived from the Serious Illness Survey for Community-based Care can be used to inform quality improvement, monitor care over time, and assess the effectiveness of new initiatives for seriously ill individuals receiving care across a range of community settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2196-2203"},"PeriodicalIF":4.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19472","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063663","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":"Defining and Evaluating the Impact of Physician Commitment to Nursing Home Practice: A Population-Level Cross-Sectional Study","authors":"Darly Dash,&nbsp;David Kirkwood,&nbsp;Henry Yu-Hin Siu,&nbsp;Paul R. Katz,&nbsp;Aaron T. Jones,&nbsp;Bahram Rahman,&nbsp;Nathan M. Stall,&nbsp;Peter Tanuseputro,&nbsp;Benoît Robert,&nbsp;Andrew P. Costa","doi":"10.1111/jgs.19464","DOIUrl":"10.1111/jgs.19464","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medical care of complex nursing home (NH) residents in Canada is primarily managed by physicians. While physician commitment to NH practice is assumed to impact care quality, its influence on resident outcomes is inconsistent. This study quantifies commitment among NH physicians in Ontario, Canada, and its association with the quality of care among NH residents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cross-sectional study using multiple linked health administrative databases in 2022. We describe the practice patterns of the most responsible physician (MRP) of NH residents. We assessed three measures of commitment, including the proportion of NH practice based on residents, years in NH practice, and the number of NHs a physician worked in. Pearson-scaled Poisson and negative binomial regression models examined the relationship between commitment and resident outcomes, including medication prescriptions, emergency department (ED) visits, hospitalizations, and death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study identified 1368 NH MRPs practicing in 628 NHs and caring for 84,914 residents in Ontario. One hundred and fourteen (8.3%) had a ≥ 80% practice commitment to NH. The MRP cohort was generally male, had less than full-time practice, worked in more urban settings, and practiced in various settings beyond NH. We observed mixed associations between measures of commitment and resident outcomes, with some evidence suggesting that higher commitment could be beneficial. Residents receiving care from an MRP with ≥ 80% practice commitment had a reduced rate of ED visits (RR 0.90; 95% CI 0.83–0.99).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our work is the first to explore the impact of commitment in NH MRPs on resident care quality in Ontario, Canada. While commitment may be a factor, it is not the sole determinant of care quality. Further research is needed to refine how commitment is defined and measured and to consider additional factors beyond the physician, such as infrastructure, NH staff, and team collaboration, in how they influence care quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2057-2069"},"PeriodicalIF":4.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19464","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004337","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":"Towards a Balanced View of Benefits and Harms in Deprescribing Trials","authors":"Kenneth Lam,&nbsp;Tyson Garfield,&nbsp;Timothy S. Anderson","doi":"10.1111/jgs.19473","DOIUrl":"10.1111/jgs.19473","url":null,"abstract":"&lt;p&gt;A friend's nonagenarian mother recently experienced a probable adverse drug withdrawal event (ADWE). She had increasing weakness, exhaustion, and falls. Her new geriatrician, following a “less is more” philosophy, raised concerns about hypotension and frailty and enthusiastically stopped several medications because of concerns polypharmacy was causing her symptoms. The geriatrician deprescribed several antihypertensives and a diuretic. She also deprescribed dronedarone—an anti-arrhythmic used for rhythm control in atrial fibrillation. Within weeks, the friend's mother became weaker and more tired rather than less. She developed a rapid heart rate, leg swelling, and shortness of breath. She was readmitted to the hospital in atrial fibrillation and decompensated heart failure, and after unsuccessful attempts at diuresis as an inpatient, she unfortunately died.&lt;/p&gt;&lt;p&gt;ADWEs are (i) physiological withdrawal reactions (e.g., flu-like symptoms when stopping serotonergic antidepressants) or (ii) the re-emergence of symptoms of underlying disease (e.g., depressive symptoms) when discontinuing or reducing the dose of a drug [&lt;span&gt;1&lt;/span&gt;]. In this issue of &lt;i&gt;JAGS&lt;/i&gt;, Lee et al. [&lt;span&gt;2&lt;/span&gt;] raise concerns that we are inadequately monitoring for ADWEs in deprescribing research. In their systematic review of 139 randomized controlled trials (RCTs) of deprescribing interventions, they found less than 1 in 10 reported on ADWEs. Of the few studies reporting ADWEs, they found ADWEs were slightly more likely to occur in participants receiving a deprescribing intervention. Their results suggest we may be systematically overlooking and underestimating the harms of deprescribing.&lt;/p&gt;&lt;p&gt;Why this oversight in research and, in our case, clinical practice? One possibility is the natural bias to believe that what we do helps. This also happens in drug initiation trials, where it is well documented that researchers neglect harms too [&lt;span&gt;3&lt;/span&gt;]. This bias motivated recommendations by the CONSORT group (Consolidated Standards of Reporting Trials) in 2004 for reporting harms in clinical trials [&lt;span&gt;4&lt;/span&gt;]. They suggested researchers explicitly declare if they are studying (i) benefits &lt;i&gt;and&lt;/i&gt; harms or (ii) benefits &lt;i&gt;only&lt;/i&gt;. If studying harms, researchers should explicitly describe how data on harms are collected, define and classify expected versus unexpected harms by severity, and consider whether a study is powered to detect a meaningful difference. The statement also recommended researchers try to determine if participants left the study because of adverse events (AEs); for deprescribing trials, this would mean collecting data on whether participants restarted medications and why. In other words, proof that deprescribing is safe requires that researchers consider, collect, and analyze data about possible harms with the same rigor as they treat possible benefits.&lt;/p&gt;&lt;p&gt;Yet another explanation for this oversight is that we lack clarity in how we","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1671-1673"},"PeriodicalIF":4.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19473","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035116","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":"Creating a Mammography Conversation Aid for Shared Decision-Making Between Clinicians and Women Aged 75 and Older","authors":"Mara A. Schonberg,&nbsp;Natasha K. Stout,&nbsp;Sarah Stein,&nbsp;Matthew Corey,&nbsp;Jessica Jushchyshyn,&nbsp;Ria Shah,&nbsp;Emily Wolfson,&nbsp;Jeanne S. Mandelblatt,&nbsp;Victor M. Montori,&nbsp;Ilana Richman,&nbsp;Daniel Matlock,&nbsp;Clyde B. Schechter,&nbsp;Russell Harris,&nbsp;Barbara LeStage,&nbsp;Jinani Jayasekera,&nbsp;Nancy L. Schoenborn","doi":"10.1111/jgs.19466","DOIUrl":"10.1111/jgs.19466","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines recommend primary care practitioners (“PCPs”) engage women ≥ 75 years in shared decision-making (SDM) around mammography screening. Therefore, we aimed to develop a web-based conversation aid about mammography screening for women ≥ 75 using output from established simulation models to provide screening outcomes based on &gt; 23,000 combinations of individual women's health and breast cancer risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used an end-user centered design approach to develop a prototype web-based conversation aid incorporating feedback. From July 2023 to April 2024, 10 PCPs from a Boston-area health system and a safety-net hospital used the prototype aid during encounters with women ≥ 75 without breast cancer or dementia (<i>n</i> = 30; 1–5 patients per PCP). We observed aid use and assessed clinician effort to involve patients in SDM using OPTION5 (assesses five components of SDM, scores range 0–100). We surveyed PCPs and patients about the aid's acceptability. Patients completed the SDM-process scale (scores range 0–4) to rate the SDM quality experienced. Participants' comments were subject to thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 10 PCP-participants, seven were female and four were community-based. Of 30 patient-participants, 22 (73%) were non-Hispanic White, 9 (30%) had ≥ 2 Charlson comorbidities and mean age was 78.5 years (SD 2.8). Nine PCPs agreed that the aid helped them with SDM and was easy-to-use; six felt it had too much information; and seven planned to continue using the aid. Patients rated the SDM-process highly (scores = 3.0 [SD 0.9]) and we observed high SDM (mean OPTION5 = 77.9 [SD 20.6]). Participants felt the aid was “empowering” and “helpful for decision-making.” After SDM discussions, seven patients intended to stop screening, nine to screen less frequently, and 14 to continue screening regularly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We developed a novel conversation aid that supports SDM about mammography screening with women ≥ 75 years. Lessons learned will guide revisions of a final tool for testing in a clinical trial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2188-2195"},"PeriodicalIF":4.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056071","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 and Implementation of a Pharmacist-Led Aspirin Deprescribing Algorithm in Older Adults","authors":"Ugene Sano,&nbsp;Marissa Uricchio,&nbsp;Theresa Redling,&nbsp;Noam Zeffren,&nbsp;Jessica Bente","doi":"10.1111/jgs.19474","DOIUrl":"10.1111/jgs.19474","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent literature has demonstrated that low-dose aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older adults has been associated with a higher incidence of bleeding events without additional benefit compared to standard prevention strategies. This study evaluated the impact of an aspirin deprescribing algorithm on inappropriate aspirin use in patients older than 70 years across two primary care offices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This institutional review board-approved, pre- and post-interventional study included patients 70 years and older on low-dose aspirin with office visits scheduled from April 1, 2023–March 30, 2024. An aspirin deprescribing algorithm was developed by an interdisciplinary team to guide prescribers with deprescribing. The pharmacist screened patients eligible for deprescribing via chart review of visits from April 2023–October 2023. Patients eligible for deprescribing in the pre-implementation phase were included as the interventional group of the post-implementation phase (November 2023–March 2024). Follow-up was 5 months total. The primary endpoint was incidence of inappropriate aspirin use, defined as patients taking aspirin without documented diagnosis of ASCVD in patients’ electronic health record. A subgroup analysis was performed on patients who were eligible for deprescribing and monitored safety endpoints such as incidence of major and minor bleeds based on the International Society on Thrombosis and Hemostasis criteria, major cardiovascular events, and cardiovascular-related hospitalizations. Duration of follow-up for secondary endpoints was 5 months during the post-implementation period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four-seventy four patients were included. The incidence of inappropriate aspirin use in the pre-implementation group was 24.9% and 118 patients were eligible for deprescribing. For the post-implementation group, 22 patients had aspirin deprescribed, resulting in 20.3% inappropriate aspirin use (<i>p</i> &lt; 0.01). In the subgroup analysis, no difference of major and minor bleeds, major cardiovascular events, and cardiovascular-related hospitalizations were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A deprescribing algorithm was associated with a statistically significant reduction in inappropriate aspirin use in older adults for the indication of primary ASCVD prevention. Algorithm-based deprescribing can reduce bleeding risk and polypharmacy in older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2081-2087"},"PeriodicalIF":4.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039980","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}