Journal of the American Geriatrics Society最新文献

{"title":"Age Self Care, a program to improve aging in place through group learning and incremental behavior change: Preliminary data","authors":"Tracy Nguyen BA,&nbsp;Belinda Tang BS,&nbsp;Krista L. Harrison PhD,&nbsp;Susanne Stadler M.Arch, MBA,&nbsp;Louise C. Walter MD,&nbsp;Kate Hoepke MBA,&nbsp;Louise Aronson MD, MFA,&nbsp;Theresa A. Allison MD, PhD","doi":"10.1111/jgs.19289","DOIUrl":"10.1111/jgs.19289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Few programs exist to support aging in place for older adults. <i>Age Self Care</i> is a novel program providing older adults with evidence-based information using group sessions embedded within the structure of a community-based organization (CBO) to facilitate behavior change and support aging in place. We report on a preliminary study of <i>Age Self Care</i> conducted in collaboration between the University of California, San Francisco (UCSF) Division of Geriatrics, At Home With Growing Older (AHWGO), and San Francisco Village (SF Village).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited middle-income, community-dwelling adults aged 65+ from university outpatient clinics. Participants attended eight 90-min, video-based group sessions and enrolled in SF Village, a non-profit mutual support organization for older adults. Data collection included direct observations and a participant focus group. We used rapid analysis methods informed by the COM-B model (Capability, Opportunity, Motivation, Behavior Change) to assess behavior change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourteen participants completed the 8-week study (15 enrolled, 1 withdrew). Average attendance was 81% throughout the program. We found that 14 participants made concrete changes to optimize the ability to remain at home during the program. For example, participants engaged in evidence-based falls risk reduction activities such as decluttering and improving lighting. We identified three facilitators to behavior change. First, <i>Age Self Care</i> promoted self-management—the day-to-day management of health and chronic conditions by individuals—through education and community-based resources. Second, peer support empowered participants to take charge of their health, home environment, and social networks. Third, the online platform created a community and was a catalyst for social opportunity. We identified one non-modifiable barrier: pre-existing financial barriers hindered some behavior change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this preliminary study, <i>Age Self Care</i> facilitated behavior change, including minor home modifications, fall risk reduction, and engagement in social networks, all of which support aging in place.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"920-929"},"PeriodicalIF":4.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741020","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":"Caring for older adults' social needs in emergency departments: Where to draw the line?","authors":"Elizabeth M. Goldberg MD, ScM,&nbsp;Elizabeth Bloemen MD,&nbsp;Daniel M. Lindberg MD","doi":"10.1111/jgs.19296","DOIUrl":"10.1111/jgs.19296","url":null,"abstract":"&lt;p&gt;The popular conception of emergency departments (EDs) is that they primarily care for critically ill patients with sudden illness. It is all gunshot wounds, heart attacks, and sepsis. EDs are exceptionally adept at treating these illnesses, and many emergency clinicians chose their specialty due to an interest in addressing these acute life threats. In reality, ED clinicians and staff also work to address social determinants of health and help patients navigate increasingly complex medical and social care systems. On any given ED shift, one is much more likely to meet a person unable to access primary care due to homelessness, addiction, or social challenges, as to diagnose a heart attack or treat a gunshot wound.&lt;/p&gt;&lt;p&gt;In EDs, social needs are essentially bottomless—to address them all would devastate the ED's ability to complete its core mission. For older adults who are both medically and socially complex, EDs may be expensive and inefficient solutions for unmet care needs. Others have suggested several solutions: creating geriatric certified EDs, embedding pharmacists and physical therapists in the ED,&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; screening for social determinants of health, and using ED navigators&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; to help patients establish care with a clinic or primary care clinician. One currently popular approach, identifying social concerns and referring to external resources, has the advantage of minimal impact on the ED's core mission; however, it is often ineffective for older, vulnerable adults who face barriers to following up on referrals due to cognitive, hearing, visual, and other functional impairments.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this issue, Southerland et al. demonstrate the effectiveness of one approach to address the social needs of vulnerable elders.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; As a result of a unique partnership with the local Office on Aging (OA), they embedded OA case managers within their ED to connect vulnerable older adults to nutrition services, emergency response systems, transportation, and other services, as needed. In this model, OA case managers work with ED social workers to identify community-dwelling older patients and perform in-person intake assessments during daytime hours whereas older patients are in the ED. Case workers arrange needed community services, often starting them immediately.&lt;/p&gt;&lt;p&gt;The advantages of the program are twofold. First, by matching the right professional to the task, the program bypasses several known barriers to hospital-to-community transitions, such as: the ED clinicians forgetting to screen or refer, patients forgetting to reach out, and failure to engage family members.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; Second, the program eliminates inefficient communication between older adult patients and OA programs, as when successful service provision relies on the older adult to reach out for care, and to be available and willing to answer the phone when the OA worker calls.&lt;/p&gt;&lt;","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"3-5"},"PeriodicalIF":4.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741558","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 key deprescribing measures from electronic health data: A multisite data harmonization project","authors":"Sascha Dublin MD, PhD,&nbsp;Ladia Albertson-Junkans MPH,&nbsp;Thanh Phuong Pham Nguyen PharmD, MBA, MSCE,&nbsp;Juliessa M. Pavon MD, MHS,&nbsp;S. Nicole Hastings MD, MHS,&nbsp;Matthew L. Maciejewski PhD,&nbsp;Allison Willis MD, MS,&nbsp;Lindsay Zepel MS,&nbsp;Sean Hennessy PharmD, PhD,&nbsp;Kathleen B. Albers MPH,&nbsp;Danielle Mowery PhD, MS,&nbsp;Amy G. Clark PhD,&nbsp;Sunil Thomas MBA/TM,&nbsp;Michael A. Steinman MD,&nbsp;Cynthia M. Boyd MD, MPH,&nbsp;Elizabeth A. Bayliss MD, MSPH","doi":"10.1111/jgs.19280","DOIUrl":"10.1111/jgs.19280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stopping or reducing risky or unneeded medications (“deprescribing”) could improve older adults' health. Electronic health data can support observational and intervention studies of deprescribing, but there are no standardized measures for key variables, and healthcare systems have differing data types and availability. We developed definitions for chronic medication use and discontinuation based on electronic health data and applied them in a case study of benzodiazepines and Z-drugs in five diverse US healthcare systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of adults age 65+ from 2017 to 2019 with chronic benzodiazepine or Z-drug use. We determined whether sites had access to medication orders and/or dispensings. We developed definitions for chronic use and discontinuation using both data types. Discontinuation definitions were based on (1) gaps in medication availability during follow-up or (2) not having medication available at a fixed time point. We examined the impact of varying the gap length and requiring a 30-day period without orders/dispensings (“halo”) around the fixed time point. We compared results derived from orders versus dispensings at one site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Approximately 1.6%–2.6% of older adults had chronic benzodiazepine/Z-drug use (total <i>N</i> = 6775, ranging from 431 to 2122 across sites). Depending on the definition and site, the proportion discontinuing use during 12 months ranged from 6% to 49%. Requiring a longer gap or a 30-day “halo” resulted in lower estimates. At one site, only 56% of those with chronic use defined from orders also qualified based on dispensings, and the discontinuation rate at 180 days was 20% from orders versus 32% from dispensings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Requiring a gap of ≥90 days or a “halo” around a time point may more accurately capture discontinuation than using a shorter gap or no halo. Orders data underestimate discontinuation compared to dispensings. Work is needed to adapt these definitions for other drug classes and settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"399-410"},"PeriodicalIF":4.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741489","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":"Another Dundee story","authors":"Michael Gordon MD, MSc, FRCPC","doi":"10.1111/jgs.19279","DOIUrl":"10.1111/jgs.19279","url":null,"abstract":"&lt;p&gt;When people ask my why I chose geriatrics as a speciality, my first reply is “stories.” I love speaking to patients – which is the reason I so enjoy the practice of medicine.&lt;/p&gt;&lt;p&gt;Stories propelled me to change my original plan to study engineering. Two books; A.J. Cronin's &lt;i&gt;The Citadel&lt;/i&gt; and Paul de Kruif's &lt;i&gt;Microbe Hunters&lt;/i&gt; that fascinated me. The next part of my story resulted from a junior year traversing Europe during my Brooklyn College studies. I ended up in Copenhagen where I befriended several female medical students. Invited to attend a few of their sessions at medical school, I was impressed with how much they enjoyed their studies and the brightness of their attitudes towards medicine; a sharp contrast to the American medical students I knew, who always seemed so serious and complained about the weight of their studies.&lt;/p&gt;&lt;p&gt;An example of this special story experience occurred when I reviewed a file of a patient who came to the Toronto Memory Clinic at which I was working part-time after I retired from the 44 years at the Baycrest Geriatric Centre. I read, “Place of birth: Dundee.”&lt;/p&gt;&lt;p&gt;I knew that this was going to be a special visit. Ian, an older gent, came in, with his daughter, born in Canada but who had twice visited Dundee with her father. As soon as he opened his mouth, I recognized the distinctive regional accent. How I ended up in Dundee rather than in the United States, my home country, was a story.&lt;/p&gt;&lt;p&gt;My decision to study in Europe, preferably Copenhagen, was not rejected by my liberal-minded parents. It was long before the internet; thus, the investigations required hours in our public library. I applied to medical schools in Denmark, Sweden, Switzerland, Belgium, England, and Scotland. As the answers returned, I was disappointed that the Danish schools did not accept foreign students; many of their own citizens studied needed to study abroad. I received acceptances from Basel in Switzerland and Louvain in Belgium. All the Scottish schools accepted me for the following year, when I would graduate from Brooklyn College.&lt;/p&gt;&lt;p&gt;That late August a telegraph delivery man came to my door. I ripped open the envelope. (remember telegrams??) “You are offered a position in 2nd year of the University of St. Andrews Medical School, beginning on the 1st of October 1961. Please indicate by telegram if you would prefer to do your pre-clinical period at St. Andrews followed by your clinical years in Dundee, or would you prefer to do your pre-clinical and clinical period in Dundee?”&lt;/p&gt;&lt;p&gt;I could not believe it, my dream. That evening after telling my parents, I sent the return telegram and the next day arranged to meet with my local US Army selective service branch to get permission to study overseas rather be drafted which in 1961 meant Vietnam.&lt;/p&gt;&lt;p&gt;My years in Dundee were among the most wonderful of my life. The studies were engrossing, the teaching outstanding and my classmates amazing. Of the 70 students in our cl","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"626-628"},"PeriodicalIF":4.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735365","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":"Incremental healthcare costs of the simple SOF measure of phenotypic frailty in community-dwelling older adults","authors":"Kristine E. Ensrud MD, MPH,&nbsp;John T. Schousboe MD, PhD,&nbsp;Allyson M. Kats MS,&nbsp;Howard A. Fink MD, MPH,&nbsp;Brent C. Taylor PhD, MPH,&nbsp;Kerry M. Sheets MD,&nbsp;Cynthia M. Boyd MD, MPH,&nbsp;Lisa Langsetmo PhD","doi":"10.1111/jgs.19287","DOIUrl":"10.1111/jgs.19287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims-derived cost indicators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community-dwelling fee-for-service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector-specific healthcare costs ascertained for 36 months after frailty assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims-based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector-specific expenditures after accounting for claims-derived indicators. The parsimonious SOF phenotype can be readily assessed in space-constrained and time-limited practice settings to improve identification of older adults at high risk of costly care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"824-836"},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718076","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":"Longitudinal analysis of Annual Wellness Visit use among Medicare enrollees: Provider, enrollee, and clinic factors","authors":"Jennifer L. Gabbard MD,&nbsp;Ellis Beurle BA,&nbsp;Zhang Zhang PhD, MS,&nbsp;Erica L. Frechman PhD,&nbsp;Kristin Lenoir PhD,&nbsp;Emilie Duchesneau PhD,&nbsp;Michelle M. Mielke PhD,&nbsp;Amresh D. Hanchate PhD","doi":"10.1111/jgs.19263","DOIUrl":"10.1111/jgs.19263","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The utilization of Annual Wellness Visits (AWVs), preventive healthcare visits covered by Medicare Part B, has grown steadily since their inception in 2011. However, longitudinal patterns and variations in use across enrollees, providers, and clinics remain poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to analyze AWV usage trends from 2018 to 2022 among a sizable cohort of Medicare beneficiaries, employing electronic health record (EHR) data. The goal was to assess AWV frequency and explore variations across enrollees, providers, and clinics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This retrospective observational study utilized EHR data from Medicare beneficiaries aged 66 and above, receiving continuous primary care from 2018 to 2022 (<i>N</i> = 24,549). Enrollees were classified into three categories based on their AWV utilization over a 5-year period: low users (0–1 AWVs), moderate users (2–3 AWVs), and regular users (4–5 AWVs). AWV usage patterns were examined across individual demographics and provider/clinic characteristics using multilevel regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Results</h3>\u0000 \u0000 <p>Over the 2018–2022 period, 58.6% were regular AWV users, 27.7% were moderate users, and 13.7% were low users. Differences in primary care providers and clinics accounted for 56.4% (95% CI, 45.3%–66.9%) of the variation between low and regular users. Among enrollees who visited the same providers and clinics, individuals were less likely to be regular users of AWVs if they were 85 and older, Hispanic, from socioeconomically disadvantaged areas, or had multiple comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The majority of Medicare beneficiaries in the study engaged with AWVs, with 86% having two or more over the 5-year period. These findings underscore the broad acceptance of AWVs among beneficiaries but also show that clinic and provider factors influence usage, especially among older, minoritized, and socioeconomically disadvantaged populations. Interventions at the provider and clinic levels are necessary to further improve AWV uptake, particularly for vulnerable groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"759-770"},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718002","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":"Optimizing inpatient rehabilitation use in older adults with trauma: A collaborative geriatric trauma approach","authors":"Garrett Trang BS,&nbsp;Maeliss Gelas BS,&nbsp;Kristina Balangue MD,&nbsp;Natasha Keric MD,&nbsp;Nimit Agarwal MD, AGSF","doi":"10.1111/jgs.19285","DOIUrl":"10.1111/jgs.19285","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"973-975"},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718109","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":"Deprescribing considerations for central nervous system-active polypharmacy in patients with dementia","authors":"Anna Hung PharmD, PhD, MS,&nbsp;Matthew E. Growdon MD, MPH","doi":"10.1111/jgs.19294","DOIUrl":"10.1111/jgs.19294","url":null,"abstract":"&lt;p&gt;Older adults with dementia are much more likely than those without dementia to experience polypharmacy, defined as taking at least five medications. Approximately 72% of older adults with dementia, versus only 44% of those without dementia, experience polypharmacy.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although multiple medications may be prescribed to treat multiple chronic conditions, polypharmacy in older adults is associated with increased risks of adverse drug events,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; cognitive and physical impairment,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; frailty, falls, and mortality.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; For older adults with dementia, the most common contributors to polypharmacy include cardiovascular medications and medications acting on the central nervous system.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; An estimated 73% of adults aged 65 and over with dementia use at least one cardiovascular medication, and an estimated 85% use at least one medication acting on the central nervous system.&lt;span&gt;&lt;sup&gt;1, 5&lt;/sup&gt;&lt;/span&gt; Yet another risk beyond polypharmacy alone is the concomitant use of three or more medications all acting on the central nervous system, termed central nervous system-active polypharmacy. These medications typically include: antiepileptics, antidepressants, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics (i.e., z-drugs), opioids, and skeletal muscle relaxants.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; The concomitant use of these medications is associated with increased risks of falls,&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; cognitive decline,&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; emergency room visits, and hospitalizations.&lt;span&gt;&lt;sup&gt;9, 10&lt;/sup&gt;&lt;/span&gt; The 2023 Beers Criteria recommend against central nervous system-active polypharmacy.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Older adults with dementia are more likely to experience central nervous system-active polypharmacy because many of the medications can be used to manage neuropsychiatric symptoms, such as agitation, aggression, sleep disorders, mood disorders, and psychotic symptoms, related to the underlying dementia. This is concerning because antipsychotics, benzodiazepines, and z-drugs are specifically advised against in persons with dementia.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; In 2005, the Food and Drug Administration added a black box warning for atypical antipsychotics for persons with dementia due to increased mortality risks, and in 2008, the black box warning was expanded to all antipsychotics (including typical antipsychotics). Nonetheless, in community-dwelling older adults living with dementia in the United States, 14% in 2018 concomitantly used at least three medications acting on the central nervous system for at least 30 overlapping days.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this month's issue, Dr. Vordenberg and colleagues sought to understand how the 14% came to be, by analyzing 2019 prescription claims data from a cohort of community-dwelling Medicare beneficiaries aged 65 and above with Alzhei","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"343-346"},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735361","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":"Frailty integration in medical specialties: Current evidence and suggested strategies from the Clin-STAR frailty interest group","authors":"Namrata Singh MD MSCI,&nbsp;Adam S. Faye MD MS,&nbsp;Maheen Z. Abidi MD,&nbsp;Shakira J. Grant MBBS MSCR,&nbsp;Clark DuMontier MD MPH,&nbsp;Anand S. Iyer MD MSPH,&nbsp;Nelia Jain MD MA,&nbsp;Bharati Kochar MD MS,&nbsp;Sarah B. Lieber MD MS,&nbsp;Rachel Litke MD PhD,&nbsp;Julia V. Loewenthal MD,&nbsp;Mary Clare Masters MD, MSCI,&nbsp;Michael G. Nanna MD MHS,&nbsp;Raele Donetha Robison PhD CCC-SLP,&nbsp;Sebastian E. Sattui MD MS,&nbsp;Anoop Sheshadri MD MAS,&nbsp;Sandra M. Shi MD MPH,&nbsp;Andrea N. Sherman MS,&nbsp;Jeremy D. Walston MD,&nbsp;Katherine D. Wysham MD,&nbsp;Ariela R. Orkaby MD MPH","doi":"10.1111/jgs.19268","DOIUrl":"10.1111/jgs.19268","url":null,"abstract":"<p>Frailty is a syndrome that can inform clinical treatments and interventions for older adults. Although implementation of frailty across medical subspecialties has the potential to improve care for the aging population, its uptake has been heterogenous. While frailty assessment is highly integrated into certain medical subspecialties, other subspecialties have only recently begun to consider frailty in the context of patient care. In order to advance the field of frailty-informed care, we aim to detail what is known about frailty within the subspecialties of internal medicine. In doing so, we highlight cross-disciplinary approaches that can enhance our understanding of frailty, focusing on ways to improve the implementation of frailty measures, as well as develop potential interventional strategies to mitigate frailty within these subspecialties. This has important implications for the clinical care of the aging population and can help guide future research.</p><p>See related Editorial by Jacqueline M. McMillan and Julian Falutz in this issue.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1029-1040"},"PeriodicalIF":4.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712331","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":"Characterizing patient portal use of people with cognitive impairment and potentially inappropriate medications","authors":"Ariel R. Green MD, PhD, MPH,&nbsp;Daniel Martin MA,&nbsp;Andrew Jessen MS,&nbsp;Mingche M. J. Wu MPH,&nbsp;Andrea E. Daddato PhD, MS,&nbsp;Rosalphie Quiles Rosado PhD,&nbsp;Kelly T. Gleason PhD, RN,&nbsp;Aleksandra Wec BA,&nbsp;Jennifer L. Wolff PhD,&nbsp;Casey O. Taylor PhD,&nbsp;Elizabeth A. Bayliss MD, MSPH","doi":"10.1111/jgs.19284","DOIUrl":"10.1111/jgs.19284","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People with cognitive impairment commonly use central nervous system-active potentially inappropriate medications (CNS-PIM), increasing risk of adverse outcomes. Patient portals may be a promising tool for facilitating medication-related conversations. Little is known about portal use by this population related to medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To target portal interventions, we sought to identify individuals with cognitive impairment and CNS-PIM exposure who discussed medications through the portal and to determine how frequently their messages described possible adverse effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used electronic health record (EHR) data from an academic health system in Maryland (Site 1) from 2017 to 2022 and pharmacy and EHR data from an integrated health system in Colorado (Site 2) in 2022 to identify people with cognitive impairment and CNS-PIM exposure who communicated about medications through the portal. At Site 1, message threads were manually categorized based on content. At Site 2, messages were categorized using natural language processing (NLP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Site 1 cohort included 5543 patients aged ≥65 with cognitive impairment and ≥2 outpatient visits from 2017 to 2022. Over half (<i>n</i> = 3072; 55%) had CNS-PIM prescriptions. Most with CNS-PIM prescriptions had portal use (<i>n</i> = 1987; 65%); 1320 (66%) of those patients sent messages during possible CNS-PIM exposure. Coding of a 5% random sample of message threads revealed that 3% mentioned CNS-PIM and possible adverse effects, while 8% mentioned possible adverse effects without referencing CNS-PIM. At Site 2, 4270 people had cognitive impairment and CNS-PIM exposure in 2022; of these, 1984 (46%) had portal use and 1768 (41%) sent medication-related messages during CNS-PIM exposure. NLP identified 663 (8%) messages that mentioned CNS-PIM and possible adverse effects, while 726 (41%) mentioned possible adverse effects without referencing CNS-PIM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>People with cognitive impairment and care partners frequently send portal messages about medications and possible adverse effects. Identifying such messages can help target deprescribing interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"750-758"},"PeriodicalIF":4.3,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694032","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}