Katherine M. Hunold, Andrew Schwaderer, Julie A. Stephens, Randell Wexler, Carlos A. Camargo Jr., Ozan Y. Suer, Lai Wei, David Hains, Lauren T. Southerland, Jason J. Bischof, Jeffrey M. Caterino
{"title":"Antimicrobial Peptides (AMPs) Are Not Increased in Asymptomatic Bacteriuria in Healthy Older Adult Patients","authors":"Katherine M. Hunold, Andrew Schwaderer, Julie A. Stephens, Randell Wexler, Carlos A. Camargo Jr., Ozan Y. Suer, Lai Wei, David Hains, Lauren T. Southerland, Jason J. Bischof, Jeffrey M. Caterino","doi":"10.1111/jgs.19431","DOIUrl":"10.1111/jgs.19431","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Objective</h3>\u0000 \u0000 <p>Antimicrobial peptides have demonstrated promise as biomarkers for urinary tract infection (UTI) in older adults (age ≥ 65 years). However, it is unknown if urinary AMP levels also increase in asymptomatic bacteriuria. Our objective was to determine if AMP levels vary between older adult patients with and without asymptomatic bacteriuria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a preplanned secondary analysis of older adults enrolled in a cross-sectional study of patients presenting to a family medicine clinic for a non-acute visit and without urinary symptoms. Asymptomatic bacteriuria was considered present if a patient had a positive culture defined as (> 10,000) colony-forming units (CFUs) of a single organism. All other culture results were considered negative. Urinalysis results are presented based on the presence/absence of asymptomatic bacteriuria. Urinary levels of 4 AMPs (human neutrophil peptides 1–3 (HNP 1–3), human alpha-defensin-5 (HD-5), human beta-defensin-2 (hBD-2), and cathelicidin (LL-37)) are reported as median and interquartile range. The Wilcoxon Rank Sum test was used to compare the log-transformed AMP values between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analytic cohort included 162 older adult patients; 18 (11%) had asymptomatic bacteriuria. Urinalysis results varied between asymptomatic older adult patients with positive asymptomatic bacteriuria and negative cultures, but AMP values did not differ (<i>p</i> > 0.2 for all four AMPs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AMPs did not differ between asymptomatic older adult patients with positive and negative cultures in this secondary analysis. AMPs should be further studied as if they increase in older adults with symptomatic UTI, they may then be able to distinguish negative culture/asymptomatic bacteriuria from true infection where urinalysis cannot.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2176-2180"},"PeriodicalIF":4.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588807","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}
Sofia Wills, Bryanna De Lima, Jonathan Soffer, Elizabeth Eckstrom
{"title":"Increasing Medicare Part D Vaccine Administrations via a Novel Primary Care Clinic-Pharmacy Collaboration","authors":"Sofia Wills, Bryanna De Lima, Jonathan Soffer, Elizabeth Eckstrom","doi":"10.1111/jgs.19432","DOIUrl":"10.1111/jgs.19432","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2287-2289"},"PeriodicalIF":4.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588881","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}
Maria C. Duggan, Anna Goroncy, Ryan Z. Chippendale
{"title":"Laughter and Life in the Geri-a-FLOAT Community: A Rising Tide Lifts all Boats, Brains, and Hearts","authors":"Maria C. Duggan, Anna Goroncy, Ryan Z. Chippendale","doi":"10.1111/jgs.19426","DOIUrl":"10.1111/jgs.19426","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2308-2311"},"PeriodicalIF":4.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588884","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: Comment on: Neuropsychiatric Presentations of Common Dementia Syndromes: A Concise Review for Primary Care Team Members","authors":"Zoe Bell, Maureen K. O'Connor, Lauren R. Moo","doi":"10.1111/jgs.19413","DOIUrl":"10.1111/jgs.19413","url":null,"abstract":"<p>In Strijkert et al. [<span>1</span>]'s response to our article “Neuropsychiatric presentations of common dementia syndromes: A concise review for primary care team members” [<span>2</span>] describing the neuropsychiatric symptoms (NPS) of common dementia syndromes, they point out that impairment in social cognition may explain many of the symptoms associated with mild behavioral impairment (MBI). Therefore, they advocate for assessing for changes in social cognition during dementia screenings in primary care. We agree that social cognition is an important facet of NPS in emerging dementia syndromes and therefore should be evaluated. However, as the authors point out, social cognition cannot be fully assessed during a routine primary care visit.</p><p>In our article, we suggest the use of questionnaires such as the Mild Behavioral Impairment Checklist (MBI-C) and the Neuropsychiatric Symptom Inventory (NSI) to assess for behavioral impairment. In Strijkert et al. [<span>1</span>]'s reply, they point out that these measures rely on subjective sources of information and omit certain aspects of social cognition. Other questionnaires have similar shortcomings [<span>3, 4</span>]. We acknowledge the limitations of these questionnaires and time burden of administering such questionnaires in a primary care setting. In their reply, the authors suggest that well-validated objective neuropsychological measures be used to assess different aspects of social cognition, and we agree. However, as we have noted previously, referral to specialty care, including neuropsychology, though ideal, is not always possible [<span>2, 5</span>]. We are not aware of a standardized way to assess for changes in social cognition in a generalist setting. In the service of providing guidance to individuals in a primary care setting, as was the focus of our original article, we suggest that when there is concern for changes in cognitive, behavioral, or psychiatric functioning in adults age 50+, primary care team members ask broad, open-ended questions that may be sensitive to changes in social cognition. A simple inquiry into the patient's social relationships (e.g., “Have you noticed any changes in your relationships?”) may help to elucidate emerging impairments in social cognition by revealing recent relational tension or discord, as impaired social cognition is expected to negatively affect interpersonal dynamics [<span>6</span>]. A query regarding changes in sexual behavior/sexual health may also be telling, as changes in sexual behavior are often associated with changes in social cognition [<span>7, 8</span>]. If the response to these screening questions conveys a possible decline in social cognition, this becomes another data point that the primary care team member can use to determine whether further evaluation by specialty care is warranted.</p><p>In short, we agree that changes in social cognition should be added to the list of NPS that can accompany or predate dementi","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1966-1967"},"PeriodicalIF":4.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575015","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":"Nonpharmacological Pain Management for People With Dementia: A Scoping Review Mapping Research Gaps From a Pragmatic Lens","authors":"Annalisa Na, Justine S. Sefcik, Laura N. Gitlin","doi":"10.1111/jgs.19418","DOIUrl":"10.1111/jgs.19418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nonpharmacological pain interventions are effective but underutilized in people living with dementia (PLWD). Leveraging an implementation lens (i.e., the Readiness Assessment for Pragmatic Trials [RAPT] model) to scope the literature may reveal research gaps contributing to this underutilization. The purpose of this scoping review is to summarize the literature, map the studies to the RAPT model, and identify research gaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA- ScR) guidelines, two reviewers screened, collated, extracted, and mapped data from eligible studies to the 9 RAPT domains (implementation, evidence, risk, feasibility, measurement, cost, acceptability, alignment, and impact). We used descriptive statistics to summarize the studies and the extent to which interventions were mapped to RAPT domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 81 studies covering 24 interventions, 64% were in long-term care facilities (LTCFs), 66% reported unspecified pain, and 32% reported unspecified dementia. Of the interventions, the Tailored Activities Program had literature informing the most domains (6 domains), followed by exercise, pain education, and stepwise approaches (5 domains each). Most studies were mapped to the evidence domain (33 studies), few studies to feasibility (7 studies), acceptability (5 studies), and implementation (10 studies) domains, one study to cost, and no studies to risk or impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the variety of nonpharmacological pain interventions studied, there is a notable lack of literature that aligns with the RAPT model. Furthermore, there is limited consideration of the specific pain and dementia conditions, as well as the diverse environments where PLWD reside and receive care. These gaps underscore the need for robust and holistic research to ensure pain interventions are effectively tailored and implemented for PLWD. Starting with acceptability and feasibility studies can establish a foundation for building robust evidence, ensuring practical and well-received interventions before larger-scale clinical trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 7","pages":"2247-2261"},"PeriodicalIF":4.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575014","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}
Fijanne Strijkert, Myrthe E. Scheenen, Rients B. Huitema, Esther van den Berg, Barbara C. van Munster, Jacoba M. Spikman
{"title":"Comment on: “Neuropsychiatric Presentations of Common Dementia Syndromes: A Concise Review for Primary Care Team Members”","authors":"Fijanne Strijkert, Myrthe E. Scheenen, Rients B. Huitema, Esther van den Berg, Barbara C. van Munster, Jacoba M. Spikman","doi":"10.1111/jgs.19412","DOIUrl":"10.1111/jgs.19412","url":null,"abstract":"<p>Bell et al. [<span>1</span>] provide a highly insightful and clinically useful overview of the behavioral presentation of four types of dementia (i.e., Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), dementia with Lewy bodies (DLB) and vascular dementia (VaD), that are often encountered in both memory clinics and by primary care providers. In their article, they stress the importance of timely recognition of neuropsychiatric symptoms (NPS) as potential early markers of neurodegeneration and explain symptoms such as social inappropriateness, lack of motivation, and impulsivity to be part of the construct of mild behavioral impairment (MBI), analogous to mild cognitive impairment (MCI), which can precede cognitive symptoms [<span>2</span>]. However, in our opinion, an important concept related to NPS and MBI is missing, namely social cognition. Social cognition, first added as a core neurocognitive domain in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) [<span>3</span>], refers to the processing and understanding of socially relevant information, necessary for adequately regulating behavior in a social interpersonal context [<span>4</span>]. Socio-cognitive processes include empathy, emotion recognition, and mentalizing about others' thoughts, beliefs, and feelings, which is also being referred to as Theory of Mind (ToM)) [<span>4</span>]. Consequently, impairments in social cognition are often at the root of behaviors such as social inappropriateness, aggression, lack of motivation, and impulsivity, that are referred to as NPS and are described as being part of MBI.</p><p>Ample evidence already exists of impaired social cognition in patients with neurodegenerative diseases [<span>5</span>], and particularly in patients with bvFTD, impaired social cognition is a core feature [<span>6</span>]. In addition to the clear descriptions by Bell et al. [<span>1</span>] of typical behavioral symptoms in four often encountered types of dementia (i.e., bvFTD, AD, VaD and LBD), we would like to describe the most common changes in social cognition in these dementia types, to enhance their early recognition in primary care settings. Furthermore, we give suggestions for follow up analysis in a memory clinic.</p><p>As previously mentioned, in patients with bvFTD, impaired social cognition is a core feature [<span>6</span>], with early symptoms of loss of empathy and impairments in both emotion recognition and in mentalizing/ToM. In patients with AD, social cognitive functions are also known to be impaired, including emotion recognition and ToM, albeit to a lesser extent than in patients with bvFTD [<span>7</span>]. Particularly in young onset AD, social behavioral symptoms can be prevalent from an early phase on, which led to the definition of a behavioral subtype of AD [<span>8</span>]. Up until now, in patients with VaD and LBD, less is known about social cognitive functioning in an early","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1964-1965"},"PeriodicalIF":4.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574998","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}
Benignus Logan, Kristiana Ludlow, Elaine M. Pascoe, Andrea K. Viecelli, David W. Johnson, Carmel M. Hawley, Laura E. Hickey, Charani Kiriwandeniya, Misa Matsuyama, Allison Jaure, Ruth E. Hubbard
{"title":"Goals of Frail Older People Living With Chronic Kidney Disease: A Mixed Methods Study","authors":"Benignus Logan, Kristiana Ludlow, Elaine M. Pascoe, Andrea K. Viecelli, David W. Johnson, Carmel M. Hawley, Laura E. Hickey, Charani Kiriwandeniya, Misa Matsuyama, Allison Jaure, Ruth E. Hubbard","doi":"10.1111/jgs.19421","DOIUrl":"10.1111/jgs.19421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frail older adults with chronic kidney disease (CKD) have complex care needs, and their priorities may differ from those assumed by healthcare providers. Understanding their goals is crucial to delivering person-centred care. This study aimed to identify and categorize the goals of this population and determine any association with participants' frailty status, quality of life, and CKD stage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We report the goals of frail older people living with moderate to severe CKD enrolled as participants in the GOAL trial, a cluster-randomized controlled trial assessing the effectiveness of comprehensive geriatric assessment. This study employs a mixed-methods approach, utilizing a triangulation design and a data transformation model. Participants set goals by Goal Attainment Scaling. Deductive content analysis was undertaken, aided by a pre-specified matrix (physical health; psychological health; function; planning; social engagement). Descriptive statistics assessed the relationships between goals and participant characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 224 participants (mean age 77 [±6.7]; 56% male; 84% white/European; median FI 0.39 [IQR: 0.33–0.47]) set 408 goals in the categories of function, physical health, social engagement and leisure, psychological health, and future readiness. Most participants set one or two goals (<i>n</i> = 183, 82%). They were most frequently set in the function (<i>n</i> = 172, 42%), physical health (<i>n</i> = 86, 21%), and social engagement and leisure (<i>n</i> = 79, 19%) domains. The number and nature of the set goals were similar across participant frailty status, quality of life (EQ-5D-5L) scores, and CKD stage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Frail older adults with CKD most frequently focus their goals on function, physical health, social engagement, and leisure. These goals did not vary by participants' frailty status or CKD stage. This study's findings can guide healthcare professionals in ensuring management plans consider these identified priorities. Geriatricians may have a role in managing this population, given the commonality of these goals with those of older people more generally.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1742-1752"},"PeriodicalIF":4.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560310","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}
Sasha M. Vergez, Yolanda Barrón, Margaret V. McDonald
{"title":"Disparities in Timely Receipt of Home Healthcare: Neighborhood Disadvantage and Delayed Start-of-Care Visits in New York City","authors":"Sasha M. Vergez, Yolanda Barrón, Margaret V. McDonald","doi":"10.1111/jgs.19406","DOIUrl":"10.1111/jgs.19406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research has shown that delayed receipt of home healthcare (HHC) is linked to negative patients' outcomes such as hospitalizations, emergency department visits, and death. Studies have looked at factors contributing to delays including high-unemployment areas and racial/ethnic backgrounds of patients. However, no previous study had examined how the deliverance of timely care differs among levels of neighborhood disadvantage within an urban city. The objective of this study was to assess if there were associations between neighborhood disadvantage and delayed start-of-care (SOC) HHC visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational study on newly admitted HHC patients after a hospital discharge during the years 2021 and 2022. The total sample included 73,536 HHC episodes of care. We used log-binomial regressions to examine the association between a delayed SOC HHC visit, defined as a first HHC visit occurring after 48 h of hospital discharge, and neighborhood disadvantage, adjusting for patients' age, race, sex, and clinical status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Close to one-third (23,712; 32.3%) of HHC episodes experienced a delayed SOC HHC visit. As the level of neighborhood disadvantage increased, so did the risk of experiencing delayed care. After adjusting for covariates, patients living in the most disadvantaged neighborhoods (level 5) had a 13% (RR 1.13; 95% CI 1.10–1.17) higher risk of experiencing delayed care when compared to those in the least disadvantaged neighborhoods (level 1). As the level of neighborhood disadvantage increased, so did the proportion of minority patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings underscore the disparities in receipt of timely HHC among differing levels of neighborhood disadvantage. As HHC is presented as a safer and more comfortable alternative to institutional post-acute care, ensuring the availability and equitable care is essential for maintaining high-quality care especially for already marginalized populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1462-1471"},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545132","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}
Ilse vom Hofe, Bruno H. Stricker, M. Kamran Ikram, Frank J. Wolters, M. Arfan Ikram
{"title":"Long-Term Exposure to Non-Steroidal Anti-Inflammatory Medication in Relation to Dementia Risk","authors":"Ilse vom Hofe, Bruno H. Stricker, M. Kamran Ikram, Frank J. Wolters, M. Arfan Ikram","doi":"10.1111/jgs.19411","DOIUrl":"10.1111/jgs.19411","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-steroidal anti-inflammatory (NSAID) medication could reduce dementia risk due to anti-inflammatory and possibly amyloid-lowering properties. However, the results of observational studies and short-term randomized-controlled trials have been inconsistent, and duration and dose–response relationships are still unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 11,745 dementia-free participants from the prospective population-based Rotterdam Study (59.5% female, mean age 66.2 years). NSAID use from 1991 was derived from pharmacy dispensing records, from which we determined cumulative duration and dose. We defined four mutually exclusive categories of cumulative use: non-use, short-term use (< 1 month), intermediate-term use (between 1 and 24 months), and long-term use (> 24 months). We determined the association with dementia risk until 2020 using Cox regression models, including NSAID use as a time-varying exposure. Models were adjusted for lifestyle factors, comorbidity, and comedication use. We repeated the analyses stratified by previously established amyloid-β lowering properties of different NSAIDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During an average follow-up period of 14.5 years, a total of 9520 (81.1%) participants had used NSAIDs at any given time, and 2091 participants developed dementia. Use of NSAIDs was associated with lower dementia risk for long-term users (HR [95% CI]: 0.88 [0.84–0.91]), and a small increased risk with short-term use (HR [95% CI]: 1.04 [1.02–1.07]) or intermediate-term use (HR: 1.04 [1.02–1.06]). The cumulative dose of NSAIDs was not associated with decreased dementia risk (HR for ≤ 25th percentile: 1.06 [1.03–1.09], 26–50th percentile: 1.02 [0.99–1.05], 51–75th percentile: 1.03 [0.99–1.06], > 75th percentile: 0.99 [0.96–1.02]). Associations were somewhat stronger for long-term use of NSAIDs without known effects on amyloid-β than for amyloid-lowering NSAIDs (HR [95% CI]: 0.79 [0.74–0.85] versus 0.89 [0.85;0.93]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Long-term NSAID use, but not cumulative dose, was associated with decreased dementia risk. This suggests that prolonged rather than intensive exposure to anti-inflammatory medication may hold potential for dementia prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1484-1490"},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Use of Nursing Homes Among Medicaid Beneficiaries Newly Diagnosed With Cancer","authors":"Amanda C. Chen, David C. Grabowski","doi":"10.1111/jgs.19391","DOIUrl":"10.1111/jgs.19391","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 6","pages":"1957-1959"},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560328","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}