Journal of the American Geriatrics Society最新文献

{"title":"Documentation of hearing difficulty by providers amidst cognitive concerns: A study of the Medicare Annual Wellness Visit","authors":"Danielle S. Powell AuD, PhD, M. J. Wu MS, Stephanie Nothelle MD, Kelly Gleason PhD, RN, Jamie M. Smith PhD, RN, Danielle Peereboom MPH, Esther S. Oh MD, Nicholas S. Reed AuD, PhD, Jennifer L. Wolff PhD","doi":"10.1111/jgs.19145","DOIUrl":"10.1111/jgs.19145","url":null,"abstract":"<p>The ability to adequately hear is instrumental to effective care.<span><sup>1</sup></span> For those with dementia, unidentified or unmanaged hearing loss may exacerbate neuropsychiatric symptoms, social isolation, cognitive decline, and dementia care challenges.<span><sup>2</sup></span></p><p>The electronic medical record (EMR) presents an opportunity to evaluate how clinicians' approach, discuss, or record health conditions or concerns within the context of a medical visit.<span><sup>3</sup></span> Few studies have characterized clinical documentation following expressed hearing concerns.<span><sup>4</sup></span> The Medicare Annual Wellness Visit (AWV), which includes collection of both hearing and cognition concerns through a required health risk assessment, may facilitate detection and management of new concerns.<span><sup>5</sup></span></p><p>We sought to characterize how clinicians approach and document hearing concerns identified at an AWV for patients with and without dementia or cognitive concerns.</p><p>This study uses EMR data for Medicare beneficiaries with an AWV at a large academic health system (2017–2022) as previously published.<span><sup>6</sup></span> Patients were included if they indicated hearing concerns for the first time at the AWV (<i>n</i> = 2596 patients). A 20% random sample of AWV encounters and associated clinical notes (<i>n</i> = 474 clinical notes) were coded for documentation of (1) elaboration on hearing concerns, (2) acknowledging a known hearing loss or hearing aid use, and (3) referral for hearing health care. Patient demographic characteristics, portal use, and chronic conditions were captured for the corresponding AWV.<span><sup>7</sup></span> We recorded presence of a concurrent dementia diagnosis via an algorithm incorporating EMR problem list or diagnosis code.<span><sup>7</sup></span> Indications of cognitive (memory or decision-making) concerns were captured from health risk assessment responses.</p><p>We included 2596 older adults with a Medicare AWV and reported hearing concerns (Table 1), 169 (6.5%) of whom had existing dementia diagnosis. The mean age was 78.8 years (SD 7.7), most were female (56.5%), White (74.5%), and active portal users (79.1%). Only 20% had a prior diagnosis of hearing loss in the EMR. Those with diagnosed dementia were older (mean 83.4 years vs 78.5 years, <i>p</i> < 0.001) and more likely to have concurrent cognitive concerns (92.3% vs 36.0%; <i>p</i> < 0.001). No differences by sex, race, marital status, prior hearing diagnosis or patient portal use were observed by dementia status.</p><p>Among the 474 patients randomly sampled for AWV clinical note review, 189 (39.8%) had a dementia diagnosis or cognitive concerns concurrent with hearing concerns (Table S1). Clinicians were less likely to elaborate on hearing concerns in the clinical note among those with diagnosed dementia or cognitive concerns compared to those without (30.2% vs 44.4%), especially when no heari","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3909-3912"},"PeriodicalIF":4.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083012","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":"Clinical performance of existing diagnostic criteria for pneumonia in older emergency patients: A prospective cohort study","authors":"Katherine M. Hunold MD, MPH,&nbsp;Lorraine C. Mion PhD, RN, FAAN,&nbsp;Tanya R. Gure MD,&nbsp;Andrew L. Schwaderer MD,&nbsp;Matthew Exline MD, MPH,&nbsp;Courtney Hebert MD, MS,&nbsp;Brent C. Lampert DO,&nbsp;Lauren T. Southerland MD,&nbsp;Julie A. Stephens MS,&nbsp;Edward W. Boyer MD, PhD,&nbsp;Michael Hill RN,&nbsp;Ching-Min B. Chu BS,&nbsp;Carson Reider PhD,&nbsp;Jeffrey M. Caterino MD, MPH","doi":"10.1111/jgs.19113","DOIUrl":"10.1111/jgs.19113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pneumonia accounts for over half a million older adult emergency department (ED) visits annually, but ED pneumonia diagnosis is inaccurate. Geriatric-specific pneumonia diagnostic criteria exist for other settings; no prospective data exist to determine if application in the older adult ED population is feasible. The objective was to prospectively evaluate the utility of four current diagnostic criteria (Loeb; Modified McGeer; Infectious Disease Society of America/American Thoracic Society; American College of Emergency Physicians) in older adult ED patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective, observational cohort study of older adult ED patients ≥65 years of age in two U.S. EDs with suspected pneumonia defined as having chest radiography ordered and treating physician suspicion. The standard we used for defining the presence, absence, or inability to determine a diagnosis of pneumonia diagnosis was expert physician chart adjudication. We report the summary statistics for demographic characteristics and symptoms/exam findings and sensitivity, specificity, and likelihood ratios with 95% confidence intervals of the existing diagnostic criteria. Pre-specified cutoff values of a positive LR &gt;10 and a negative LR &lt;0.3 were considered clinically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 135 patients enrolled, 27 had pneumonia by adjudicator review. Typical patient-reported pneumonia symptoms, such as fever (18.5%) and new/worse cough (51.9%), were not consistently present in pneumonia. The IDSA/ATS and ACEP criteria had positive LR &gt;10 and negative LR &lt;0.3; however, all confidence intervals included pre-specified cutoffs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older adults presented to the ED with low frequency of typical pneumonia symptoms. Although existing diagnostic definitions had promising test characteristics, they may not perform well enough for clinical application without refinement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3068-3077"},"PeriodicalIF":4.3,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047670","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":"Individual socioeconomic status, neighborhood disadvantage, and cognitive aging: A longitudinal analysis of the CLSA","authors":"John R. Best PhD","doi":"10.1111/jgs.19155","DOIUrl":"10.1111/jgs.19155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There are likely many contributors to variation in the rate of cognitive decline in middle and late adulthood, including individual and neighborhood socio-economic factors. This study examines whether individual socio-economic factors, namely income and wealth, correlate with cognitive decline, in part, through neighborhood-level social and material disadvantage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the three waves of data collection from the Canadian Longitudinal Study on Aging (CLSA), this study included 51,338 participants between the age of 45 and 85 years at baseline (51% female). Individual socio-economic status (SES) was assessed by annual household income and by the current value of savings and investments. Neighborhood disadvantage was measured by area-based material and social deprivation indices. Cognition was measured at each wave using verbal fluency, mental alternations, and delayed word recall. Latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of individual SES on cognitive change through area-level disadvantage. Multi-group models were constructed on the basis of age-group (45–64 years; 65–74 years; or 75+ years) to allow for varying estimates across age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 45–64-year-olds, income and wealth had indirect effects on initial cognitive level and on rate of cognitive decline through material disadvantage (standardized indirect effects = 0.01, <i>p</i> &lt; 0.001), but only wealth had an indirect effect through social disadvantage (<i>p</i> = 0.019). Among 65-74-year-olds, income and wealth had indirect effects on initial cognitive level (<i>p</i> &lt; 0.01) but not on rate of cognitive decline (<i>p</i> &gt; 0.05), and among 75+ year-olds, no indirect effects were observed (<i>p</i> &gt; 0.05). Wealth and income had direct effects, independent of neighborhood disadvantage, on cognition in all age groups (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among middle-aged adults, greater individual SES may mitigate cognitive decline, in part, by allowing individuals to live in more materially and socially advantaged neighborhoods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3335-3345"},"PeriodicalIF":4.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038126","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":"Veterans' use of inpatient and outpatient palliative care: The national landscape","authors":"Brystana G. Kaufman PhD, MSPH,&nbsp;Sandra Woolson MS,&nbsp;Catherine Stanwyck BA,&nbsp;Madison Burns BS,&nbsp;Paul Dennis PhD,&nbsp;Jessica Ma MD,&nbsp;Shelli Feder PhD, APRN,&nbsp;Joshua M. Thorpe PhD,&nbsp;S. Nicole Hastings MD,&nbsp;David B. Bekelman MD,&nbsp;Courtney H. Van Houtven PhD","doi":"10.1111/jgs.19141","DOIUrl":"10.1111/jgs.19141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010–2017) to describe veteran demographics, socioeconomic status, life-limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241–99245).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (<i>n</i> = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (<i>n</i> = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one-third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3385-3397"},"PeriodicalIF":4.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047671","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":"Impact of federal antipsychotic use policy in nursing homes on new diagnoses for approved indications in dementia residents","authors":"Theresa I. Shireman PhD,&nbsp;Neto Coulibaly MS,&nbsp;Tingting Zhang MD, PhD,&nbsp;Andrew R. Zullo PharmD, PhD,&nbsp;Lauren B. Gerlach DO, MS,&nbsp;Antoinette B. Coe PharmD, PhD,&nbsp;Lori A. Daiello PharmD, ScM,&nbsp;Derrick Lo ScM,&nbsp;Julie P. W. Bynum MD, MPH","doi":"10.1111/jgs.19129","DOIUrl":"10.1111/jgs.19129","url":null,"abstract":"<p>See related editorial by Joseph G. Ouslander in this issue.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3742-3752"},"PeriodicalIF":4.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of loneliness and social isolation after spousal loss: A systematic review of longitudinal studies on widowhood","authors":"Kerri Niino BS,&nbsp;Molly A. Patapoff BA,&nbsp;Brent T. Mausbach PhD,&nbsp;Hui Liu PhD,&nbsp;Alison A. Moore MD, MPH,&nbsp;Benjamin H. Han MD, MPH,&nbsp;Barton W. Palmer PhD,&nbsp;Dylan J. Jester PhD, MPH","doi":"10.1111/jgs.19156","DOIUrl":"10.1111/jgs.19156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Spousal loss is a stressful life event that is associated with loneliness and social isolation, both of which affect mental and physical health. The primary objective of this paper was to synthesize longitudinal studies that investigated loneliness and social isolation in widowhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of the literature was conducted using three electronic databases. 26 longitudinal studies published through June 2024 were included for further analysis. Participant characteristics, study design, and key findings were extracted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most studies were from the United States or Europe, included more widows than widowers, and assessed loneliness in older adults aged &gt;60 years. Loneliness peaked directly following spousal death, but findings were inconsistent regarding the lasting effects of widowhood. Heterogeneity in the longitudinal trajectories of loneliness was noted, with studies showing linear increases, decreases, or curvilinear relationships over time. Several factors modified the relationship between widowhood and loneliness, including volunteerism, military experience, income, and age. Widowers consistently reported greater loneliness and worse social isolation when compared with widows. Few studies investigated social isolation specifically, but those that did found that social isolation may decrease in widowhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As the world grapples with a social pandemic of loneliness and social isolation, widowed adults may be uniquely affected. Few studies investigated the longitudinal trajectory of loneliness and especially social isolation in widowhood, and those that did found heterogenous results. Future work is needed to understand why some widowed adults are uniquely affected by feelings of loneliness and social isolation while others are not, and whether potentially modifiable factors that moderate or mediate this relationship could be leveraged by psychosocial interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"253-265"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Peptic ulcers with ChEIs, NSAIDs","authors":"Máté Szilcz PhD,&nbsp;Jonas W. Wastesson PhD,&nbsp;Amaia Calderón-Larrañaga PhD,&nbsp;Daniel Prieto-Alhambra MD, PhD,&nbsp;Pierre-Olivier Blotière PhD,&nbsp;Géric Maura PharmD, PhD,&nbsp;Kristina Johnell PhD","doi":"10.1111/jgs.19133","DOIUrl":"10.1111/jgs.19133","url":null,"abstract":"&lt;p&gt;We sincerely thank Professor Montastruc for their letter.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; We appreciate that our call for further research on the interaction between non-steroidal anti-inflammatory drugs (NSAIDs) and cholinesterase inhibitors (ChEIs) and their effects on peptic ulcer was noticed.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; We value the use of established pharmacovigilance methods for detecting a signal for the drug–drug interaction we identified. Signal detection is an important first step in the process of establishing evidence, which we omitted in our research, where we directly moved to hypothesis testing with pharmacoepidemiologic methods.&lt;/p&gt;&lt;p&gt;Professor Montastruc investigated the drug–drug interaction using disproportionality analyses, which focuses on the differences in the proportion of adverse event reports in a global pharmacovigilance database. They found that the reporting odds ratios of peptic ulcer for the combination of ChEIs and NSAIDs were three times as high as for NSAIDs alone, an effect estimate that is in line with our findings. Furthermore, they highlighted that their study extends our research, as we compared treatment episodes with no treatment, whereas they compared the combination treatment with NSAIDs alone.&lt;/p&gt;&lt;p&gt;To quantify the comparison between combination of ChEIs and NSAIDs and NSAIDs alone, similarly to Montastruc, we performed a post hoc analysis on the results obtained from our self-controlled case series study. We found that the incidence rate ratio of peptic ulcer with concomitant use of ChEIs and NSAIDs is 1.74 (95% confidence interval: 1.27–2.38) compared to NSAIDs alone. This is a slightly smaller effect size than reported by Montastruc. This discrepancy could be due to the fact that Montastruc calculated &lt;i&gt;reporting&lt;/i&gt; odds ratios, which might overestimate the true risk of adverse effects in pharmacovigilance databases, especially in the case of drug–drug interactions.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We appreciate that our work has inspired further research on the topic, but there are necessary next steps. Following the detected signal from Montastruc and our pharmacoepidemiologic research, future studies should use big data, for example via federated networks of health data.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Analyzing a large cohort would potentially allow for the examination of subgroups, such as different combinations of chemical substances in ChEIs (e.g., donepezil, rivastigmine, galantamine) and NSAIDs (e.g., diclofenac, naproxen, ibuprofen), and their effects on bleeding or non-bleeding peptic ulcers—analyses we could not perform. Increasing the size of the study population via federated networks would further enhance precision and enable wider generalizability of the results. Ultimately, when enough evidence is gathered, concomitant ChEIs and NSAIDs use should be carefully evaluated and potentially included in guidelines to prevent inappropriate medication use, ensuring better safety and outcomes for patients.&lt;","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3612-3613"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019934","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":"Cognitive and functional change in skilled nursing facilities: Differences by delirium and Alzheimer's disease and related dementias","authors":"Jane S. Saczynski PhD,&nbsp;Benjamin Koethe MPH,&nbsp;Donna Marie Fick PhD,&nbsp;Quynh T. Vo MPH,&nbsp;John W. Devlin PharmD,&nbsp;Edward R. Marcantonio MD,&nbsp;Becky A. Briesacher PhD","doi":"10.1111/jgs.19112","DOIUrl":"10.1111/jgs.19112","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer's disease related dementias (ADRD) has not been examined.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To compare change in cognition and function among short-stay SNF patients with delirium, ADRD, or both.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Retrospective cohort study using claims data from 2011 to 2013.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Centers for Medicare and Medicaid certified SNFs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 740,838 older adults newly admitted to a short-stay SNF without prevalent ADRD who had at least two assessments of cognition and function.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Measurements&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD-9 codes, and incident ADRD by ICD-9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD-only and delirium-only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among older adults without dementia admitted to SNF for post-acute care following hospitalization, a positive screen for delirium and a new diagnosis ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3501-3509"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019931","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":"Peptic ulcers with ChEIs, NSAIDs","authors":"Jean-Louis Montastruc MD, PhD","doi":"10.1111/jgs.19128","DOIUrl":"10.1111/jgs.19128","url":null,"abstract":"&lt;p&gt;We read with great interest the Szilcz's study showing that the risk of peptic ulcer increased for the combination of cholinesterase inhibitors (ChEIs) and non-steroidal anti-inflammatory drugs (NSAIDs) more than for NSAIDs alone&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; in patients ≥65 years. Their work was a self-controlled study. Since approaches in pharmacovigilance and pharmacoepidemiology should be multisource,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; we investigated this possible drug interaction (DI) using disproportionality analyses&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; in the global pharmacovigilance database Vigibase®.&lt;/p&gt;&lt;p&gt;All reports with ChEIs (N06DA following Anatomical Therapeutic Chemical (ATC) classification) and NSAIDs (M01AA butylpyrazolidines, M01AB acetic acid derivatives and related substances, M01AC oxicams, M01AE propionic and derivatives, M01AG fenamates, M01AH coxibs) registered as “suspected/interacting” in Vigibase® between 01/01/1994 and 31/12/2023 in adults (≥65 years) with known age and sex were included. Disproportionality analyses&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; were performed with cases being reports of “&lt;i&gt;gastrointestinal ulcerations&lt;/i&gt; and perforations” (GUP) (HLGT according to Standardized MedDRA Queries classification, excluding anal, rectal, and esophagus ulcers) with the drug(s) of interest and non-cases all other reports with the same drug(s) of interest. Following this case non-case analysis,&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; results with ChEIs + NSAIDs were compared with NSAIDs alone. To minimize the potential reporting bias and increase the medical meaning, a sensitivity analyses was performed only including reports by physicians. Results are presented as reporting odds ratios (ROR),&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; a ratio similar in concept to the odds ratio in case–control studies with their 95% confidence interval. The research was performed and paper written according to the READUS-PV consensus statement for drug safety signal detection using Individual case safety reports in pharmacovigilance.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Among the 7,054,411 reports registered in VigiBase® according to the criteria defined above, 31,494 were GUP with 283 including ChEIs alone (mainly donepezil 49.5%), 9060 NSAIDs alone (mainly propionic drugs like ibuprofen 33.0%) and 29 the combination ChEIs + NSAIDs. Patients were mainly women (57.9% for NSAIDs, 54.1% for ChEIs, 82.8% for combination). Most of them were ≥75 years old (60.0% for NSAIDs, 78.4% for ChEIs, 79.3% for combination).&lt;/p&gt;&lt;p&gt;Table 1 shows the number of GUP reports. Significant ROR values were found for ChEIs alone, NSAIDs alone and their combination for all reports (whatever the reporter) as well as for reports only coming from physicians. ROR values for the comparison ChEIs + NSAIDs vs NSAIDs alone was 3.24 (2.18–4.81) for all reports and 2.64 (1.56–4.46) for physicians.&lt;/p&gt;&lt;p&gt;Using a validated method for detecting risk signals,&lt;span&gt;&lt;sup&gt;3-6&lt;/sup&gt;&lt;/span&gt; our results are in line with the self-contro","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3609-3611"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019932","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":"Unleashing frailty from laboratory into real world: A critical step toward frailty-guided clinical care of older adults","authors":"Dae Hyun Kim MD, MPH, ScD","doi":"10.1111/jgs.19151","DOIUrl":"10.1111/jgs.19151","url":null,"abstract":"<p>Understanding patients' degree of frailty is crucial for tailoring clinical care for older adults based on their physiologic reserve and health needs (“frailty-guided clinical care”). Two prerequisites for frailty-guided clinical care are: (1) access to frailty information at the point of care and (2) evidence to inform decisions based on frailty information. Recent advancements include web-based frailty assessment tools and their electronic health records integration for time-efficient, standardized assessments in clinical practice. Additionally, database frailty scores from administrative claims and electronic health records data enable scalable assessments and evaluation of the effectiveness and safety of medical interventions across different frailty levels using real-world data. Given limited evidence from clinical trials, real-world database studies can complement trial results and help treatment decisions for individuals with frailty. This article, based on the Thomas and Catherine Yoshikawa Award lecture I gave at the American Geriatrics Society Annual Meeting in Long Beach, California, on May 5, 2023, outlines our group's contributions: (1) developing and integrating a frailty index calculator (Senior Health Calculator) into the electronic health records at an academic medical center; (2) developing a claims-based frailty index for Medicare claims; (3) applying this index to evaluate the effect of medical interventions for patients with and without frailty; and (4) efforts to disseminate frailty assessment tools through the launch of the eFrailty website and the forthcoming addition of the claims-based frailty index to the Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse. This article concludes with future directions for frailty-guided clinical care.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3299-3314"},"PeriodicalIF":4.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019935","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}