Journal of the American Geriatrics Society最新文献

{"title":"Risk factors for urinary tract infections among nursing home residents initiating sodium-glucose cotransporter-2 inhibitors","authors":"Iju Shakya MPH, Andrew R. Zullo PharmD, PhD, Kaleen N. Hayes PharmD, PhD, Richa Joshi MBA, MS, Sarah D. Berry MD, MPH","doi":"10.1111/jgs.19029","DOIUrl":"10.1111/jgs.19029","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-cultural study of the Montreal Cognitive Assessment for people with hearing impairment","authors":"Stacey Theocharous MClinNeuro,&nbsp;Greg Savage PhD,&nbsp;Anna Pavlina Charalambous PhD,&nbsp;Mathieu Côté MD,&nbsp;Renaud David MD,&nbsp;Kathleen Gallant PhD,&nbsp;Catherine Helmer MD,&nbsp;Robert Laforce MD, PhD,&nbsp;Iracema Leroi MD, PhD,&nbsp;Ralph N. Martins PhD,&nbsp;Ziad Nasreddine MD,&nbsp;Antonis Politis MD, PhD,&nbsp;David Reeves Bsc, PhD,&nbsp;Gregor Russell MD,&nbsp;Marie-Josée Sirois PhD,&nbsp;Hamid R. Sohrabi PhD,&nbsp;Chyrssoula Thodi PhD,&nbsp;Christiane Völter MD, PhD,&nbsp;Wai Kent Yeung PhD,&nbsp;Piers Dawes PhD","doi":"10.1111/jgs.19020","DOIUrl":"10.1111/jgs.19020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cognitive screening tools enable the detection of cognitive impairment, facilitate timely intervention, inform clinical care, and allow long-term planning. The Montreal Cognitive Assessment for people with hearing impairment (MoCA-H) was developed as a reliable cognitive screening tool for people with hearing loss. Using the same methodology across four languages, this study examined whether cultural or linguistic factors affect the performance of the MoCA-H.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The current study investigated the performance of the MoCA-H across English, German, French, and Greek language groups (<i>n</i> = 385) controlling for demographic factors known to affect the performance of the MoCA-H.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a multiple regression model accounting for age, sex, and education, cultural–linguistic group accounted for 6.89% of variance in the total MoCA-H score. Differences between languages in mean score of up to 2.6 points were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cultural or linguistic factors have a clinically significant impact on the performance of the MoCA-H such that optimal performance cut points for identification of cognitive impairment derived in English-speaking populations are likely inappropriate for use in non-English speaking populations. To ensure reliable identification of cognitive impairment, it is essential that locally appropriate performance cut points are established for each translation of the MoCA-H.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285744","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":"Geriatric conditions and healthcare utilization among older adults living in subsidized housing","authors":"Sarah E. Kler MD, SCM,&nbsp;L. Grisell Diaz-Ramirez MS,&nbsp;Kira L. Ryskina MD, MSHP,&nbsp;Sun Young Jeon PhD,&nbsp;Kanan Patel MBBS, MPH,&nbsp;Thomas K. M. Cudjoe MD, MPH,&nbsp;Christine S. Ritchie MD, MSPH, FACP, FAAHPM,&nbsp;Krista L. Harrison PhD,&nbsp;W. John Boscardin PhD,&nbsp;Rebecca T. Brown MD, MPH","doi":"10.1111/jgs.18979","DOIUrl":"10.1111/jgs.18979","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nearly 2.9 million older Americans with lower incomes live in subsidized housing. While regional and single-site studies show that this group has higher rates of healthcare utilization compared to older adults in the general community, little is known about healthcare utilization nationally nor associated risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of Medicare beneficiaries aged ≥65 enrolled in the National Health and Aging Trends Study in 2011, linked to Medicare claims data, including individuals living in subsidized housing and the general community. Participants were followed annually through 2020. Outcomes were hospitalization, short-term skilled nursing facility (SNF) utilization, long-term care utilization, and death. Fine–Gray competing risks regression analysis was used to assess the association of subsidized housing residence with hospitalization and nursing facility utilization, and Cox proportional hazards regression analysis was used to assess the association with death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 6294 participants (3600 women, 2694 men; mean age, 75.5 years [SD, 7.0]), 295 lived in subsidized housing at baseline and 5999 in the general community. Compared to older adults in the general community, those in subsidized housing had a higher adjusted subdistribution hazard ratio [sHR] of hospitalization (sHR 1.21; 95% CI, 1.03–1.43), short-term SNF utilization (sHR 1.49; 95% CI, 1.15–1.92), and long-term care utilization (sHR 2.72; 95% CI, 1.67–4.43), but similar hazard of death (HR, 0.86; 95% CI, 0.69–1.08). Individuals with functional impairment had a higher adjusted subdistribution hazard of hospitalization and short-term SNF utilization and individuals with dementia and functional impairment had a higher hazard of long-term care utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older adults living in subsidized housing have higher hazards of hospitalization and nursing facility utilization compared to those in the general community. Housing-based interventions to optimize aging in place and mitigate risk of nursing facility utilization should consider risk factors including functional impairment and dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18979","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285755","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 and ethics at the end of life: The importance of a comprehensive assessment","authors":"Paolo Mazzola MD,&nbsp;Chukwuma Okoye MD, PhD,&nbsp;Alice Riccò MD,&nbsp;Simona Umidi MD,&nbsp;Matteo Crippa PhD,&nbsp;Gianlorenzo Scaccabarozzi MD,&nbsp;Giuseppe Bellelli MD","doi":"10.1111/jgs.19023","DOIUrl":"10.1111/jgs.19023","url":null,"abstract":"&lt;p&gt;In their recent paper, Thomas and colleagues discuss the emerging issue of managing delirium in older patients approaching the end of life (EoL).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The authors significantly depart from the traditional ethical principles of benevolence, nonmaleficence, respect for autonomy, and justice in favor of a new paradigm centered on restoration, means-end proportionality, discretion, and parsimony. Thomas et al. propose that adopting these four canons would help clinicians better navigate the numerous complexities and uncertainties associated with managing delirium in older patients near EoL.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The authors presented four cases in their article, which all involved relatively young patients with a single terminal illness to indirectly support their claim that these principles could be universally applicable to all delirium patients near EoL, without requiring additional information.&lt;/p&gt;&lt;p&gt;While we largely agree with the authors and appreciate the paradigm shift, we believe there is an additional layer of complexity not fully addressed in their article. To illustrate our viewpoint, we present two clinical cases, both involving female individuals of the same age, but with different clinical contexts that were already present before delirium development (Table 1). In the case of Mrs P, clinicians may reasonably hypothesize a potential to recover after delirium, supported by her mild vulnerability (Clinical Frailty Scale = 4/9) and frailty (PC-FI = 0.12, CGA FI = 0.23), good nutritional status (albuminemia = 3.8 g/dL and MNA = 12/14), intact cognition (MMSE = 28/30), and absence of sarcopenia (normal handgrip strength). These elements are crucial as frailty, malnutrition, cognitive impairment, and sarcopenia independently predict negative outcomes and unsuccessful recovery after delirium.&lt;span&gt;&lt;sup&gt;2-5&lt;/sup&gt;&lt;/span&gt; Investigating the causes of delirium makes logical sense in this scenario because recovery is plausible. However, we know that below a certain threshold of reserve reduction, often influenced by factors such as multimorbidity, malnutrition, and frailty, the likelihood of recovery diminishes significantly.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; This becomes striking in the case of Mrs R, where delirium might represent the harbinger of an imminent end,&lt;span&gt;&lt;sup&gt;8, 9&lt;/sup&gt;&lt;/span&gt; rendering the search of its causes less relevant. Here, especially if the patient is agitated, the primary goal of care shifts from identifying delirium causes to managing agitation symptoms. In other words, what is relevant for Mrs R is determining the most likely prognosis “&lt;i&gt;quoad vitam&lt;/i&gt;” before any other action.&lt;/p&gt;&lt;p&gt;Therefore, we speculate that the greatest ability to guide treatment objectives in older patients with delirium does not lie in the identification of reversible or non-reversible factors, but rather in determining the individual's expected lifespan. Given the challenges of doing that among older complex, multimorbid, ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263075","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":"Racial and ethnic differences in telemedicine use among community-dwelling older adults with dementia","authors":"Qiuyuan Qin MS,&nbsp;Helena Temkin-Greener PhD,&nbsp;Peter Veazie PhD,&nbsp;Shubing Cai PhD","doi":"10.1111/jgs.19039","DOIUrl":"10.1111/jgs.19039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Routine ambulatory care is essential for older adults with Alzheimer's disease and related dementias (ADRD) to manage their health conditions. The federal government expanded telemedicine coverage to mitigate the impact of the COVID-19 pandemic on ambulatory services, which may provide an opportunity to improve access to care. This study aims to examine differences in telemedicine use for ambulatory services by race, ethnicity, and community-level socioeconomic status among community-dwelling older adults with ADRD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used Medicare claims data between April 01, 2020 and December 31, 2021. We included community-dwelling Medicare fee-for-service beneficiaries aged 65 years and older with ADRD. The outcome variable is individual's use (yes/no) of telemedicine evaluation and management (tele-EM) visits in each quarter. The key independent variables are race, ethnicity, and community-level socioeconomic status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analytical sample size of the study was 2,068,937, including 9.9% Black, 82.7% White, and 7.4% Hispanic individuals. In general, we observed a decreasing trend of tele-EM use, and the average rate of quarterly tele-EM use was 23.0%. Tele-EM utilization varied by individual race, ethnicity, and community-level socioeconomic status. On average, White and Black individuals in deprived communities were 3.5 and 2.4 percentage-points less likely to use tele-EM compared with their counterparts in less-deprived communities (<i>p</i> &lt; 0.001). However, Hispanic individuals in deprived communities were 2.4 percentage-points more likely to utilize tele-EM compared with those in less-deprived communities (<i>p</i> &lt; 0.001). Additionally, we observed various racial and ethnic differences in telemedicine use in deprived communities versus less-deprived communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We observed various racial and ethnic differences in telemedicine use, both within and between communities by socioeconomic status. Telemedicine is a viable healthcare delivery option that may influence healthcare access for racial and ethnic minorities and for individuals in socioeconomically deprived communities. Further policies or interventions may be needed to ensure all individuals have equal access to newly available care delivery models.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263118","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: Frailty and ethics at the end of life: The importance of a comprehensive assessment","authors":"Columba Thomas MD,&nbsp;Eduardo Bruera MD,&nbsp;William Breitbart MD,&nbsp;Yesne Alici MD,&nbsp;Liz Blackler MBE, LCSW-R,&nbsp;Julia D. Kulikowski MD,&nbsp;Daniel P. Sulmasy MD, PhD","doi":"10.1111/jgs.19024","DOIUrl":"10.1111/jgs.19024","url":null,"abstract":"&lt;p&gt;The care of older persons at the end of life often involves competing concerns and highly value-sensitive decisions. In a recent article, we proposed a set of ethical rules—the canons of therapy—to help clinicians navigate complex cases involving older adults with delirium at the end of life.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The canons of therapy most pertinent to such cases are restoration, means-end proportionality, discretion, and parsimony (see Table 1 for a description). These canons provide a structured toolset aligned with practical wisdom, which can serve as an ethical heuristic for guiding therapeutic judgments.&lt;/p&gt;&lt;p&gt;Building on our proposal, Mazzola et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; have argued for the need to consider additional layers of clinical complexity when applying the canons of therapy in the care of older adults. Specifically, the authors contend that prognostic factors associated with short-term mortality may shift the balance with respect to patients' overall goals of care, the utility of a workup to identify reversible causes of delirium, and the analysis of how the canons of therapy apply. For instance, frailty independently predicts short-term mortality.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Mazzola et al. suggest that the presence of severe frailty in an older patient with delirium may prompt a decision to focus interventions on comfort—with means-end proportionality as the most salient canon.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In a contrasting scenario involving a patient with mild frailty, the authors emphasize the canon of restoration because the management goal is to address reversible causes of her acute respiratory distress. The authors conclude that integrating well-established approaches that capture frailty—such as the comprehensive geriatric assessment (CGA)—into palliative care practices may enhance the care of older adults at the end of life.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We appreciate the authors' thoughtful application of the canons of therapy to cases involving patients of more advanced age and with varying degrees of frailty and agree regarding the need to perform careful clinical assessments and consider patients' short-term prognosis to inform decision-making.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; For example, the CGA is recommended by the National Comprehensive Cancer Network (NCCN) for all older adults with cancer, if there are any concerns about their ability to tolerate treatment.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; However, the reasons for performing the CGA are not limited to its prognostic value but also include the detection of reversible problems and the use of targeted interventions to improve outcomes.&lt;/p&gt;&lt;p&gt;More specifically for older adults with delirium at the end of life, we suggest that the utility of the CGA and other clinical assessments&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; may extend beyond estimates of short-term mortality risk to a consideration of reversible and irreversible causes of their delirium and overall health trajectory. For i","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263119","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":"Modified enhanced recovery after surgery protocol in octogenarians undergoing minimally invasive colorectal cancer surgery","authors":"Po-Li Wei MD, PhD,&nbsp;Yan-Jiun Huang MD, PhD,&nbsp;Weu Wang MD,&nbsp;Yu-Min Huang MD, PhD","doi":"10.1111/jgs.19026","DOIUrl":"10.1111/jgs.19026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Colorectal cancer (CRC) is a major health issue worldwide. As the population ages, more older patients including octogenarians will require CRC treatment. However, this vulnerable group has decreased functional reserves and increased surgical risks. Enhanced recovery after surgery (ERAS) pathways aim to reduce surgical stress and complications, but concerns remain about applying ERAS protocols to older patients. We assessed whether a modified ERAS (mERAS) protocol combined would improve outcomes in octogenarian CRC patients undergoing minimally invasive surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, we compared 360 non-octogenarians aged 50–64 years and 114 octogenarians aged 80–89 years before and after mERAS protocol implementation. Outcomes including postoperative functionary recovery, length of stay, complications, emergency department visits, and readmissions were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Despite comparable tumor characteristics, octogenarians had poorer nutrition, American Society of Anesthesiologists status, and more comorbidities. After mERAS, octogenarians had reduced complications, faster return of bowel function, and shorter postoperative length of stay, similar to non-octogenarians. mERAS implementation improved recovery in both groups without increasing emergency department visits or readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although less remarkable than in non-octogenarians, mERAS protocols mitigated higher complication rates and improved recovery in octogenarians after minimally invasive surgery for CRC, confirming protocol feasibility and safety in this vulnerable population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263110","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":"Patterns of national emergency department utilization by fee-for-service Medicare beneficiaries with dementia","authors":"Jason K. Bowman MD,&nbsp;Christine S. Ritchie MD, MSPH,&nbsp;Kei Ouchi MD, MPH,&nbsp;James A. Tulsky MD,&nbsp;Joan M. Teno MD, MS","doi":"10.1111/jgs.19025","DOIUrl":"10.1111/jgs.19025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individuals with Alzheimer's disease and related dementias (ADRD) often face high acute care clinical utilization and costs with unclear benefits in survival or quality of life. The emergency department (ED) is frequently the site of pivotal decisions in these acute care episodes. This study uses national Medicare data to explore this population's ED utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study of persons aged ≥66 years enrolled in traditional Medicare with a Chronic Condition Warehouse diagnosis of dementia. Primary 1-year outcome measures included ED visits with and without hospitalization, ED visits per 100 days alive, and health-care costs. A multivariate random effects regression model (clustered by county of residence), adjusted for sociodemographics and comorbidities, examined how place of care on January 1, 2018, was associated with subsequent ED utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2018, 2,680,006 ADRD traditional Medicare patients (mean age 82.9, 64.2% female, 9.4% Black, 6.2% Hispanic) experienced a total of 3,234,767 ED visits. Over half (52.2%) of the cohort experienced one ED visit, 15.5% experienced three or more, and 37.1% of ED visits resulted in hospitalization. Compared with ADRD patients residing at home without services, the marginal difference in ED visits per 100 days alive varied by location of care. Highest differences were observed for those with hospitalizations (0.48 visits per 100 days alive, 95% confidence interval [CI] 0.47–0.49), skilled nursing facility (rehab/skilled nursing facility [SNF]) stays (0.27, 95% CI 0.27–0.28), home health stays (0.25, 95% CI 0.25–0.26), or observation stays (0.82, 95% CI 0.77–0.87). Similar patterns were observed with ED use without hospitalization and health-care costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Persons with ADRD frequently use the ED—particularly those with recent hospitalizations, rehab/SNF stays, or home health use—and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal-concordant care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263116","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":"Primary care and community partnerships to promote age-friendly care for Hispanic older adults","authors":"Sarah E. Ross DO, MS,&nbsp;Jennifer J. Severance PhD, MS,&nbsp;Sara C. Murphy PhD,&nbsp;Robert A. Yockey PhD,&nbsp;Johny Morkos DO,&nbsp;Shakita Johnson Esq, LBSW,&nbsp;Janice A. Knebl DO, MBA","doi":"10.1111/jgs.19034","DOIUrl":"10.1111/jgs.19034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Healthcare and community collaborations have the potential to address health-related social needs. We examined the implementation of an educational initiative and collaborative intervention between a geriatric clinic and Area Agency on Aging (AAA) to enhance age-friendly care for a Hispanic patient population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>As part of a Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Program, a geriatric clinic partnered with AAA to embed an English- and Spanish-speaking Social Service Coordinator (SSC). The SSC met with patients during new and annual visits or by referral to address What Matters and Mentation in the patient's primary language, provide education, and make social service referrals. Patients aged 60 and older, who received SSC services during a 12-month period, were defined as the intervention group (<i>n</i> = 112). Using a retrospective chart review, we compared them to a non-intervention group (<i>n</i> = 228) that received primary care. We examined available demographic and clinical data within the age-friendly areas of What Matters and Mentation. Measures included cognitive health screenings, advance care planning, patient education, and community referrals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most of the intervention groups were eligible for AAA services and had the opportunity for service referrals to address identified needs. A higher proportion of patients within the intervention group completed screenings for cognitive health and advance care planning discussions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Interagency partnerships between ambulatory care settings and community-based organizations have the potential to expand access to linguistically and culturally competent age-friendly primary care for older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200790","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":"Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries","authors":"Anna Hung PharmD, PhD, MS,&nbsp;Lauren E. Wilson PhD, MS,&nbsp;Valerie A. Smith DrPH,&nbsp;Juliessa M. Pavon MD, MHS,&nbsp;Caroline E. Sloan MD, MPH,&nbsp;Susan N. Hastings MD, MHS,&nbsp;Matthew L. Maciejewski PhD","doi":"10.1111/jgs.19013","DOIUrl":"10.1111/jgs.19013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive medication review (CMR) to all beneficiaries who qualify, and provides a platform to reduce PIM use. The objective of this study was to assess the impact of CMR on PIM discontinuation in Medicare beneficiaries and whether this differed by race or ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study of community-dwelling Medicare Part D beneficiaries ≥66 years of age who were eligible for MTM from 2013 to 2019 based on 5% Medicare fee-for-service claims data linked to the 100% MTM data file. Among those using a PIM, MTM-eligible CMR recipients were matched to non-recipients via sequential stratification. The probability of PIM discontinuation was estimated using regression models that pooled yearly subcohorts accounting for within-beneficiary correlations. The most common PIMs that were discontinued after CMR were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We matched 24,368 CMR recipients to 24,368 CMR non-recipients during the observation period. Median age was 74–75, 35% were males, most were White beneficiaries (86%–87%), and the median number of PIMs was 1. In adjusted analyses, CMR receipt was positively associated with PIM discontinuation (adjusted relative risk [aRR]: 1.26, 95% CI: 1.20–1.32). There was no evidence of differential impact of CMR by race or ethnicity. The PIMs most commonly discontinued after CMR were glimepiride, zolpidem, digoxin, amitriptyline, and nitrofurantoin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among Medicare beneficiaries who are using a PIM, CMR receipt was associated with PIM discontinuation, suggesting that greater CMR use could facilitate PIM reduction for all racial and ethnic groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200785","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}