Journal of the American Geriatrics Society最新文献

{"title":"Precision medicine and patient-centered outcomes: Learning from APOE for prevention clinical trials in older adults","authors":"Nicholas M. Pajewski PhD","doi":"10.1111/jgs.19097","DOIUrl":"10.1111/jgs.19097","url":null,"abstract":"<p>For conditions that often entail significant impairment, such as Alzheimer's disease or stroke, there is an established standard in clinical trials to adopt outcome measures that integrate function in both cognitive and physical domains, such as the Clinical Dementia Rating Scale<span><sup>1</sup></span> and the modified Rankin Scale.<span><sup>2</sup></span> What is perhaps a newer direction is adopting a similar paradigm, blending the brain and the body, within the context of prevention. Several recent trials including ASPREE (Aspirin in Reducing Events in the Elderly),<span><sup>3</sup></span> STAREE (Statins in Reducing Events in the Elderly),<span><sup>4</sup></span> and PREVENTABLE (Pragmatic Evaluation of Events and Benefits of Lipid-Lowering in Older Adults)<span><sup>5</sup></span> have adopted a primary composite outcome of survival free of dementia and disability, integrating the incidence of all-cause dementia, persistent disability in activities of daily living, and all-cause mortality. The appeal of this outcome is that it is inherently patient-centric, focused on the foundational goal of maintaining functional independence in aging populations. However, as with anything new, there are still a myriad of questions that need to be explored before adopting survival free of dementia and disability as the default outcome choice for prevention trials in older adults. Does it conform, in theory and in practice, to recommendations for adopting composite outcomes?<span><sup>6</sup></span> What interventions might be most likely to prevent both incident disability and cognitive impairment? What risk factors should one consider in trying to optimize inclusion and exclusion criteria, as well as event rates? What role does precision medicine have with such an endpoint?</p><p>In this issue of the <i>Journal of the American Geriatrics Society</i>, Clocchiatti-Tuozzo et al. begin to examine the latter two questions through the lens of genetics, evaluating the association of apolipoprotein E (<i>APOE</i>) genotypes with the incidence of dementia, disability, and all-cause mortality in the Health and Retirement Study.<span><sup>7</sup></span> Among 14,527 older adults (median age 55 years, 58% female, >70% of European ancestry, 25% carriers of at least one <i>APOE</i> ε4 allele), without dementia or disability at baseline followed for a median of 18 years, carriers of the <i>APOE</i> ε4 allele had an increased incidence of the composite outcome of incident dementia, disability, or death (adjusted hazard Ratio (aHR) = 1.15, 95% CI: 1.09–1.21), while being a carrier of the <i>APOE</i> ε2 genotype was associated with a non-statistically significant decrease in risk for that outcome (aHR = 0.94, 95% CI: 0.87–1.01). In looking at the individual components of the composite outcome, carrying the <i>APOE</i> ε4 allele was associated with increased risk of dementia and mortality, but not disability (aHR = 0.98, 95% CI: 0.89–1.08). In secondary analyses ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"2961-2964"},"PeriodicalIF":4.3,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141622017","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":"Beyond flashing lights and sirens: Community paramedicine as health safety nets for older adults","authors":"Alexander J. Ulintz MD, Carmen E. Quatman MD, PhD","doi":"10.1111/jgs.19087","DOIUrl":"10.1111/jgs.19087","url":null,"abstract":"<p>Providing unscheduled, acute, and longitudinal care to older adults who are aging in place is a critical, yet largely unsolved, health system challenge. A large gap exists between the times and places where older adults need care and the resources available to address those needs.<span><sup>1</sup></span> Despite efforts to increase older adults' access to in-home care through home-based primary care, telemedicine, and workforce development, persistent gaps prompted recent calls by the American Geriatrics Society and the American Association of Geriatric Psychiatry to expand the “team based geriatric physician and health professional workforce by nontraditional means.”<span><sup>2, 3</sup></span> This creates an opportunity for innovative, multidisciplinary, patient-centered teams to bridge the gap.</p><p>Emergency medical services (EMS) agencies and clinicians are often called upon to fill this gap: they are accessible, mobile, and a trusted source of care in communities across the nation.<span><sup>4</sup></span> Though originally designed for emergency treatment and transportation of the critically ill and injured, EMS clinicians are increasingly embracing roles that span community outreach, prevention, and chronic disease management in a model of care known as “community paramedicine.”<span><sup>5</sup></span> Community paramedicine is designed to fill the space between fixed medical system resources and dynamic community needs by leveraging availability, accessibility, and versatile skills of EMS clinicians working as part of physician-led or multidisciplinary team. This model of care is of clear importance to older adults who are aging in place.</p><p><i>JAGS</i> has been at the forefront of rigorous examination of the community paramedicine model of care for older adults. As early as 1968, Mel Spear advocated for the concept of a physician-led, team-based, patient-centered approach to physical, emotional, and social well-being of older adults in “Paramedical Services for Older Adults.”<span><sup>6</sup></span> More recently, <i>JAGS</i> authors have described an array of community paramedicine programs tailored to the needs of older adults, including providing urgent, in-home, integrated evaluation and treatment to avoid unnecessary EMS transportation of medically complex older adults,<span><sup>7, 8</sup></span> facilitating the ED-to-home care transition,<span><sup>9</sup></span> using 9-1-1 calls as a sentinel event to prompt fall prevention intervention,<span><sup>10, 11</sup></span> and integrating community paramedics into home-based primary care practices to extend telehealth geriatrician reach and efficiency.<span><sup>12</sup></span> Additional program examples support the feasibility, effectiveness, and short-term health outcomes of community paramedicine for older adults.<span><sup>13-15</sup></span> However, limited data describe patient safety, process and health outcomes, and sustainable financial models for community para","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2640-2643"},"PeriodicalIF":4.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617853","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":"Managing medications among individuals with mild cognitive impairment and dementia: Patient-caregiver perspectives","authors":"Rachel O'Conor PhD, MPH, Andrea M. Russell PhD, Allison Pack PhD, MPH, Dianne Oladejo BA, Sarah Filec MPH, Emily Rogalski PhD, Darby Morhardt PhD, Lee A. Lindquist MD, MPH, MBA, Michael S. Wolf PhD, MPH","doi":"10.1111/jgs.19065","DOIUrl":"10.1111/jgs.19065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With changing cognitive abilities, individuals with mild cognitive impairment (MCI) and dementia face challenges in successfully managing multidrug regimens. We sought to understand how individuals with MCI or dementia and their family caregivers manage multidrug regimens and better understand patient-to-caregiver transitions in medication management responsibilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted qualitative interviews among patient–caregiver dyads. Eligibility included: patients with a diagnosis of MCI, mild or moderate dementia, managing ≥3 chronic conditions, ≥5 prescription medications, who also had a family caregiver ≥18 years old. Semi-structured interview guides, informed by the Medication Self-Management model, ascertained roles and responsibilities for medication management and patient-to-caregiver transitions in medication responsibilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 32 patient–caregiver dyads. Older adults and caregivers favored older adult autonomy in medication management, and individuals with MCI and mild dementia largely managed their medications independently using multiple strategies (e.g., establishing daily routines, using pillboxes). Among individuals with moderate dementia, caregivers assumed all medication-related responsibilities except when living separately. In those scenarios, caregivers set up organizers and made reminder calls, but did not observe family members taking medications. Patient-to-caregiver transitions in medication responsibilities frequently occurred after caregivers observed older adults making errors with medications. As caregivers sought to assume greater responsibilities with family members' medicines, they faced multiple barriers. Most barriers were dyadic; they affected both the older adult and the caregiver and/or the relationship. Some barriers were specific to caregivers; these included caregivers' competing responsibilities or inaccurate perceptions of dementia, while other barriers were related to the healthcare system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To ease medication management transitions, balance must be sought between preservation of older adult autonomy and early family caregiver involvement. Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate.</p>\u0000 </section>\u0000 ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3011-3021"},"PeriodicalIF":4.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617857","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 single item screen for clinically significant insomnia symptoms in community-living older adults","authors":"Lucy Webster PhD, Joshua Hobbs BS, Shelli Farhadian MD, PhD, Thomas M. Gill MD, Brienne Miner MD, MHS","doi":"10.1111/jgs.19086","DOIUrl":"10.1111/jgs.19086","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3604-3606"},"PeriodicalIF":4.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617852","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":"Commentary on: Cost-effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults","authors":"Melissa K. Andrew MD, PhD","doi":"10.1111/jgs.19079","DOIUrl":"10.1111/jgs.19079","url":null,"abstract":"<p>Pneumococcal illness, including both invasive disease and pneumonia, is especially relevant for older adults. Notably, the burden of disease increases with age, as does the risk of adverse outcomes which include both short- and long-term sequalae.<span><sup>1-8</sup></span> Several pneumococcal vaccines are currently available, including conjugate (PCV) and polysaccharide (PPV) vaccines covering different numbers of pneumococcal serotypes chosen to represent those causing the greatest burden of severe illness. Current both ACIP (the US Advisory Committee on Immunization Practices) and NACI (Canada's National Advisory Committee on Immunization) recommend PCV20 (or PCV15 + PPV23) for adults aged 65+ or with certain high-risk conditions.<span><sup>9, 10</sup></span></p><p>Despite older adults being among the groups most in need of protection, the benefit they derive from vaccines to date has been suboptimal, because of two issues: (1) suboptimal vaccine effectiveness (VE) in older adults due to immune dysregulation (in which efforts to tailor vaccine product composition, e.g. dose and adjuvants, and their delivery, e.g. dosing intervals, and number of doses, may be helpful) and (2) suboptimal uptake of vaccines that are recommended and available.<span><sup>11</sup></span> Targets for vaccine coverage in adults vary by jurisdiction, but a target of 80% is often put forth for pneumococcal vaccine coverage in older adults and adults with high-risk conditions.</p><p>When we further explore the suboptimal immunization coverage seen for all older adults, people in population groups facing historical and present social and structural disadvantage, and those in racialized groups, tend to experience compounded barriers in access and uptake to preventative interventions including vaccination.<span><sup>12-14</sup></span> It is therefore important to consider whether programs developed with and for these communities will be beneficial in achieving better vaccination uptake.</p><p>In the current issue, Wateska et al. present a study examining cost-effectiveness of pneumococcal vaccination for older adults and targeted programs to increase its uptake.<span><sup>15</sup></span> They used Markov decision analysis models comparing hypothetical one-year age band cohorts of Black and non-Black US adults aged 65 years and compared strategies of no vaccination, vaccination per current ACIP/CDC guidelines, and vaccination plus implementation of a program aiming to increase vaccine uptake.</p><p>They found that adult pneumococcal programs using PCV20 or PCV15 + PPV23 targeting a cross-sectional single year cohort of older adults 65 years of age are unlikely to be cost-effective, with all options having Incremental Cost-Effectiveness Ratios (ICERs) of more than $200,000 per Quality Adjusted Life Year (QALY). The authors conducted probabilistic sensitivity analyses varying many of the model assumptions and still found that these were unlikely to be cost-effective at thr","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 8","pages":"2299-2302"},"PeriodicalIF":4.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617854","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":"State home- and community-based services spending and unmet care needs by living arrangements and cognitive impairment status","authors":"Yulin Yang PhD, Ah-Reum Lee PhD, Elena Portacolone PhD, Thomas Rapp PhD, Jacqueline M. Torres PhD","doi":"10.1111/jgs.19088","DOIUrl":"10.1111/jgs.19088","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3598-3600"},"PeriodicalIF":4.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617858","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":"Providing better care for dually insured Medicare/Medicaid beneficiaries with advanced chronic illness","authors":"Peter Boling MD, George Taler MD, Bruce Kinosian MD","doi":"10.1111/jgs.19085","DOIUrl":"10.1111/jgs.19085","url":null,"abstract":"<p>Kim et al.<span><sup>1</sup></span> have reported one of the few published large-scale, multi-state evaluations of the impact of enrolling patients in Fully-Integrated Dual Eligible (FIDE) Special Needs Plan (SNP) insurance models available to Medicare and Medicaid beneficiaries, compared with enrolling in standard SNP duals plans (D-SNPs). The authors found no overall impact of increased financial integration at the plan level on a range of outcomes that integration of care at the patient-provider level have impacted.<span><sup>2, 3</sup></span> However, for two higher-risk dual subgroups, either those using home- and community-based services or those meeting modified Independence at Home high needs qualifying criteria,<span><sup>4</sup></span> Kim et al. found FIDE beneficiaries were likely to have lower hospitalization rates, compared to patients in dually eligible insurance models with less required integration.</p><p>It is dispiriting to see essentially no overall difference in service use patterns between individuals enrolled in FIDE plans, where Medicaid funds that support Long Term Services and Supports (LTSS) are managed by the same legal entity as Medicare funds, and other D-SNPs which have variable levels of coordination between Medicare and Medicaid services. This finding follows a decade when D-SNP growth reached 40% of eligible Duals, and FIDE SNP growth 8% of D-SNP enrollees. This finding is in line with other work by several of the study's authors, for example, noting a modest increase in Home and Community Based Services (HCBS) services but little impact on outcomes in Pennsylvania's effort to integrate care in its managed LTSS program, Community Health Choices.<span><sup>5</sup></span> The finding of limited impacts suggests that a more robust, better targeted, intervention is needed than simply merging the pools of dollars and encouraging health plans to find ways to integrate care. Still, the strategy of combining Medicare and Medicaid funding under a <i>single private sector insurer</i>, hopefully lessening the artificial separation of medical care and community-based supports, continues to be favored by many subject experts and legislators as a means of reducing care fragmentation and blunting the cost curve for the most vulnerable and costly US citizens.<span><sup>6-9</sup></span></p><p>While funding may be integrated at the plan level in these new models, the Medicare and Medicaid benefits are often structurally separate, or are operationally separate due to organizational culture. Due to data limitations, the authors were unable to test the effects of different organizational cultures or structures on outcomes, nor the strength of the integration in some obvious ways, such as testing whether FIDE plans were better able to substitute less expensive Medicaid HCBS services for more expensive Medicare services and institutional long-term care. Ultimately, we still lack insight into how well the top-level financial integrat","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2635-2639"},"PeriodicalIF":4.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592502","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 association between social risks and days at home for older veterans","authors":"Josephine C. Jacobs PhD,&nbsp;Liberty Greene MS, MEd,&nbsp;Mayuree Rao MD, MS,&nbsp;Valerie A. Smith DrPH,&nbsp;Courtney H. Van Houtven PhD,&nbsp;Matthew L. Maciejewski PhD,&nbsp;Donna M. Zulman MD, MS","doi":"10.1111/jgs.19064","DOIUrl":"10.1111/jgs.19064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Many health systems are trying to support the ability of older adults to remain in their homes for as long as possible. Little is known about the relationship between patient-reported social risks and length of time spent at home. We assessed how social risks were associated with days at home for a cohort of older Veterans at high risk for hospitalization and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective cross-sectional study using a 2018 survey of 3479 high-risk Veterans aged ≥65 linked to Veterans Health Administration data. Social risks included measures of social resources (i.e., no partner present, low social support), material resources (i.e., not employed, financial strain, medication insecurity, food insecurity, and transportation barriers), and personal resources (i.e., low medical literacy and less than high school education). We estimated how social risks were associated with days at home, defined as the number of days spent outside inpatient, long-term care, observation, or emergency department settings over a 12-month period, using a negative binomial regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Not having a partner, not being employed, experiencing transportation barriers, and low medical literacy were respectively associated with 2.57, 3.18, 3.39, and 6.14 fewer days at home (i.e., 27% more facility days, 95% confidence interval [CI] 8%–50%; 42% more facility days, 95% CI 7%–89%; 34% more facility days, 95% CI 7%–68%; and 63% more facility days, 95% CI 27%–109%). Experiencing food insecurity was associated with 2.62 more days at home (i.e., 24% fewer facility days, 95% CI 3%–59%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings suggest that screening older Veterans at high risk of community exit for social risks (i.e., social support, material resources, and medical literacy) may help identify patients likely to benefit from home- and community-based health and social services that facilitate remaining in home settings. Future research should focus on understanding the mechanisms by which these associations occur.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3035-3045"},"PeriodicalIF":4.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602391","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":"A scoping review of geriatric emergency medicine research transparency in diversity, equity, and inclusion reporting","authors":"Anita N. Chary MD PhD,&nbsp;Michelle Suh MD,&nbsp;Edgardo Ordoñez MD,&nbsp;Lauren Cameron-Comasco MD,&nbsp;Surriya Ahmad MD,&nbsp;Alexander Zirulnik MD, MPH,&nbsp;Angela Hardi MLIS, AHIP,&nbsp;Alden Landry MD,&nbsp;Vivian Ramont MPH,&nbsp;Tracey Obi MPH,&nbsp;Emily H. Weaver PhD,&nbsp;Christopher R. Carpenter MD","doi":"10.1111/jgs.19052","DOIUrl":"10.1111/jgs.19052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The intersection of ageism and racism is underexplored in geriatric emergency medicine (GEM) research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a scoping review of research published between January 2016 and December 2021. We included original emergency department-based research focused on falls, delirium/dementia, medication safety, and elder abuse. We excluded manuscripts that did not include (1) original research data pertaining to the four core topics, (2) older adults, (3) subjects from the United States, and (4) for which full text publication could not be obtained. The primary objective was to qualitatively describe reporting about older adults' social identities in GEM research. Secondary objectives were to describe (1) the extent of inclusion of minoritized older adults in GEM research, (2) GEM research about health equity, and (3) feasible approaches to improve the status quo of GEM research reporting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After duplicates were removed, 3277 citations remained and 883 full-text articles were reviewed, of which 222 met inclusion criteria. Four findings emerged. First, race and ethnicity reporting was inconsistent. Second, research rarely provided a rationale for an age threshold used to define geriatric patients. Third, GEM research more commonly reported sex than gender. Fourth, research commonly excluded older adults with cognitive impairment and speakers of non-English primary languages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Meaningful assessment of GEM research inclusivity is limited by inconsistent reporting of sociodemographic characteristics, specifically race and ethnicity. Reporting of sociodemographic characteristics should be standardized across different study designs. Strategies are needed to include in GEM research older adults with cognitive impairment and non-English primary languages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3551-3566"},"PeriodicalIF":4.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592500","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":"Peripheral neuropathy, gait speed, and lower extremity function in community-dwelling older adults with and without diabetes","authors":"Katherine M. McDermott MD,&nbsp;Dan Wang MS,&nbsp;B. Gwen Windham MD, MHS,&nbsp;Jennifer A. Schrack PhD, MS,&nbsp;Elizabeth Selvin PhD, MPH,&nbsp;Caitlin W. Hicks MD, MS","doi":"10.1111/jgs.19072","DOIUrl":"10.1111/jgs.19072","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3242-3245"},"PeriodicalIF":4.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592501","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}