Journal of the American Geriatrics Society最新文献

{"title":"Pain management inequities by demographic and geriatric-related variables in older adult inpatients","authors":"Aksharananda Rambachan MD, MPH,&nbsp;Torsten B. Neilands PhD,&nbsp;Leah Karliner MD, MAS,&nbsp;Kenneth Covinsky MD, MPH,&nbsp;Margaret Fang MD, MPH,&nbsp;Tung Nguyen MD","doi":"10.1111/jgs.19076","DOIUrl":"10.1111/jgs.19076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pain is ubiquitous, yet understudied. The objective of this study was to analyze inequities in pain assessment and management for hospitalized older adults focusing on demographic and geriatric-related variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study from January 2013 through September 2021 of all adults 65 years or older on the general medicine service at UCSF Medical Center. Primary exposures included (1) demographic variables including race/ethnicity and limited English proficiency (LEP) status and (2) geriatric-related variables including age, dementia or mild cognitive impairment diagnosis, hearing or visual impairment, end-of-life care, and geriatrics consult involvement. Primary outcomes included (1) adjusted odds of numeric pain assessment versus other assessments and (2) adjusted opioids administered, measured by morphine milligram equivalents (MME).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15,809 patients were included across 27,857 hospitalizations with 1,378,215 pain assessments, with a mean age of 77.8 years old. Patients were 47.4% White, 26.3% with LEP, 49.6% male, and 50.4% female. Asian (OR 0.75, 95% CI 0.70–0.80), Latinx (OR 0.90, 95% CI 0.83–0.99), and Native Hawaiian or Pacific Islander (OR 0.77, 95% CI 0.64–0.93) patients had lower odds of a numeric assessment, compared with White patients. Patients with LEP (OR 0.70, 95% CI 0.66–0.74) had lower odds of a numeric assessment, compared with English-speaking patients. Patients with dementia, hearing impairment, patients 75+, and at end-of-life were all less likely to receive a numeric assessment. Compared with White patients (86 MME, 95% CI 77–96), Asian patients (55 MME, 95% CI 46–65) received fewer opioids. Patients with LEP, dementia, hearing impairment and those 75+ years old also received significantly fewer opioids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Older, hospitalized, general medicine patients from minoritized groups and with geriatric-related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3000-3010"},"PeriodicalIF":4.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602390","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":"Commentary on the Health Resources and Services Administration Geriatrics Workforce Enhancement Program special supplement","authors":"Nina Tumosa PhD,&nbsp;Joan Weiss PhD, RN, CRNP, FAAN","doi":"10.1111/jgs.19073","DOIUrl":"10.1111/jgs.19073","url":null,"abstract":"&lt;p&gt;The Health Resources and Services Administration (HRSA) is committed to providing healthcare providers with the knowledge and skills to care for older adults and supports the training of the healthcare workforce through its Geriatrics Workforce Enhancement Program (GWEP) cooperative agreement program. The purpose of GWEP is to improve health outcomes for older adults by developing a healthcare workforce that maximizes patient and family engagement, and by integrating geriatrics and primary care. An infographic (Figure 1) shows the major components of GWEP, including education and training on patient-centered care and evaluation. Evaluation includes trainee satisfaction and increase in their knowledge and skills. Evaluation also measures the adoption of new knowledge, skills, and patient satisfaction with their healthcare. GWEP began in 2015 (44 awards). A second cohort of 48 awardees began in 2019. A third cohort (42 awards) begins in July of 2024.&lt;/p&gt;&lt;p&gt;GWEP recipients use multiple tools to manage and evaluate their IPET. These tools include (1) working within reciprocal partnerships; (2) using the age-friendly health system (AFHS) framework to promote age-friendly and dementia-capable care in primary care; (3) embracing innovations that lead to practice transformations; and (4) using process and patient outcome evaluation techniques. Examples of how these tools have been used by the second cohort of GWEP recipients are provided in this Special Supplement.&lt;/p&gt;&lt;p&gt;Geriatrics educators must focus on developing trainings and education that can be used nationally, as well as locally, to improve health and healthcare of older adults. Given the variability of sites that provide primary care to older adults, from self-care to nursing home care, and from in-home care services to hospice care, this is not an easy task. However, identifying and delivering this training and education content, and determining which educational modalities work best in any given site, are well worth that effort.&lt;/p&gt;&lt;p&gt;The examples of work described in this supplement show that the future of aging includes reasons to hope for ongoing increases in longevity with less disability, with the inclusion of the patient, family, and caregivers in this journey. GWEP will continue to work at reducing disability and maintaining autonomy to allow longer, fuller lives. This effort will have an impact on the long-term health of everyone as they age, if not now, then in the future.&lt;/p&gt;&lt;p&gt;The authors made equal contributions to this work, including concept and design, drafting, and revision of the manuscript for important intellectual content, and final review.&lt;/p&gt;&lt;p&gt;The authors report no conflicts of interest.&lt;/p&gt;&lt;p&gt;The activities described in this article were funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) grant number U1QHP28732.&lt;/p&gt;&lt;p&gt;The views expressed by Nina Tumosa and Joan Weiss in this article are solely the opinions ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 S3","pages":"S1-S5"},"PeriodicalIF":4.3,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565439","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":"Disparities in end-of-life care for minoritized racial and ethnic patients during terminal hospitalizations in New York State","authors":"Miguel Cid MPH,&nbsp;Main Lin Quan Vega MD,&nbsp;Zhixin Yang MS,&nbsp;Jean Guglielminotti MD, PhD,&nbsp;Guohua Li MD, DrPH,&nbsp;May Hua MD, MS","doi":"10.1111/jgs.19046","DOIUrl":"10.1111/jgs.19046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Racial and ethnic minorities often receive care at different hospitals than non-Hispanic white patients, but how hospital characteristics influence the occurrence of disparities at the end of life is unknown. The aim of this study was to determine if disparities in end-of-life care were present among minoritized patients during terminal hospitalizations, and if these disparities varied with hospital characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified hospitalizations where a patient died in New York State, 2016–2018. Using multilevel logistic regression, we examined whether documented end-of-life care (do-not-resuscitate status (DNR), palliative care (PC) encounter) differed by race and ethnicity, and whether these disparities differed based on receiving care in hospitals with varying characteristics (Black or Hispanic-serving hospital; teaching status; bed size; and availability of specialty palliative care).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 143,713 terminal hospitalizations in 188 hospitals. Across all hospitals, only Black patients were less likely to have a PC encounter (adjusted odds ratio (aOR) 0.83 [0.80–0.87]) or DNR status (aOR 0.91 [0.87–0.95]) when compared with non-Hispanic White patients, while Hispanic patients were more likely to have DNR status (aOR 1.07 [1.01–1.13]). In non-teaching hospitals, all minoritized groups had decreased odds of PC (aOR 0.80 [0.76–0.85] for Black, aOR 0.91 [0.85–0.98] for Hispanic, aOR 0.93 [0.88–0.98] for Others), while in teaching hospitals, only Black patients had a decreased likelihood of a PC encounter (aOR 0.88 [0.82–0.93]). Also, Black patients in a Black-serving hospitals were less likely to have DNR status (aOR 0.80 [0.73–0.87]). Disparities did not differ based on whether specialty PC was available (<i>p</i> = 0.27 for PC encounter, <i>p</i> = 0.59 for DNR status).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>During terminal hospitalizations, Black patients were less likely than non-Hispanic White patients to have documented end-of-life care. This disparity appears to be more pronounced in non-teaching hospitals than in teaching hospitals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2690-2699"},"PeriodicalIF":4.3,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565440","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":"Sex differences in patterns of potentially inappropriate prescribing and adverse drug reactions in hospitalized older people: Findings from the SENATOR trial","authors":"Denis O'Mahony MD,&nbsp;Alfonso J. Cruz-Jentoft MD,&nbsp;Adalsteinn Gudmundsson MD,&nbsp;Roy L. Soiza MD,&nbsp;Mirko Petrovic PhD,&nbsp;Antonio Cherubini MD,&nbsp;Stephen Byrne PhD,&nbsp;Paula Rochon MD","doi":"10.1111/jgs.19071","DOIUrl":"10.1111/jgs.19071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older women experience more adverse drug reactions (ADRs) than older men. However, the underlying basis for this sex difference is unclear. Sex (biological status) and/or gender (sociocultural constructs) influences on patterns of inappropriate prescribing in multimorbid older adults may be one reason for this ADR sex difference. In this secondary analysis, we examined whether incident ADR sex differences could be related to concurrent sex differences in potentially inappropriate prescribing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Setting</h3>\u0000 \u0000 <p>A retrospective secondary analysis of sex differences in the prevalence of potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs), and ADRs among the 1537 participants (47.2% female, median [IQR] age 78 [72–84] years) was undertaken in the SENATOR clinical trial database, conducted in six large European medical centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants and Methods</h3>\u0000 \u0000 <p>We looked specifically for male/female differences relating to PIMs and PPOs (defined by STOPP/START version 2 criteria) identified within 48 h of acute hospitalization. We also assessed sex differences for ADRs identified at 14 days from admission or discharge, whichever came first. ADRs were assessed by blinded endpoint adjudication panel consensus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During hospitalization, significantly more females experienced ≥1 ADR compared to males (28% and 21%, respectively; odds ratio 1.40, 95% CI 1.10–1.78, <i>p</i> &lt; 0.005). Nine of the 11 STOPP-criteria PIMs showing a significant sex difference occurred more often in females. Of the four START-criteria PPOs showing a significant sex difference, all occurred more often in females. Some sex-associated PIMs reflect higher prevalence of related conditions in older women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We conclude that specific STOPP-criteria PIMs and START-criteria PPOs were identified more frequently in older women than older men during acute hospitalization, possibly contributing to higher ADR incidence in older women. Prescribers should appreciate sex differences in exposure to potentially inappropriate prescribing and ADR risk, given the preponderance of older women over older men in most clinical settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3476-3483"},"PeriodicalIF":4.3,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560620","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":"Postoperative use of sleep aids and delirium in older adults after major surgery: A retrospective cohort study","authors":"Su Been Lee BA,&nbsp;Chan Mi Park MD, MPH,&nbsp;Raisa Levin MS,&nbsp;Dae Hyun Kim MD, ScD","doi":"10.1111/jgs.19067","DOIUrl":"10.1111/jgs.19067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sleep aids are commonly prescribed to treat sleep disturbance, a modifiable risk factor for postoperative delirium in older patients. The use of melatonin receptor agonists in the postoperative period has been increasing. The comparative safety of melatonin receptor agonists, zolpidem, and temazepam remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 22,083 patients ≥65 years old who initiated melatonin receptor agonists, zolpidem, or temazepam after major surgery in the Premier Healthcare Database 2009–2018. We performed propensity score-based overlap weighting and estimated the risk ratio (RR) and risk difference (RD) of postoperative delirium as the primary outcome and a composite of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality as secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of the study population was 78 (SD, 7) years and 50% were female. There was no significant difference in the risk of postoperative delirium among patients treated with melatonin receptor agonists (3.4%, reference group), zolpidem (2.9%; RR [95% CI], 0.9 [0.7–1.2]; RD [95% CI] per 100 persons, −0.3 [−1.1 to 0.6]), and temazepam (3.1%; 0.9 [0.7–1.1]; RD [95% CI] per 100 persons, −0.5 [−1.2 to 0.3]). The risks of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality were also similar among all groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Melatonin receptor agonists were not associated with a lower risk of postoperative delirium and other adverse outcomes compared with zolpidem and temazepam in older adults after major surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3484-3491"},"PeriodicalIF":4.3,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560619","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":"Use of chronic care management service among Medicare beneficiaries in 2015–2019","authors":"Jieun Jang PhD,&nbsp;Ellen P. McCarthy PhD, MPH,&nbsp;Brianne Olivieri-Mui PhD, MPH,&nbsp;Sandra M. Shi MD, MPH,&nbsp;Chan Mi Park MD, MPH,&nbsp;Gahee Oh MD, MPH,&nbsp;Stephanie Denise M. Sison MD, MBA,&nbsp;Dae Hyun Kim MD, MPH, ScD","doi":"10.1111/jgs.19066","DOIUrl":"10.1111/jgs.19066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Centers for Medicare and Medicaid Services (CMS) introduced chronic care management (CCM) services in 2015 for patients with multiple chronic diseases. Few studies examine the utilization of CCM services by geographic region, sociodemographic, and clinical characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used 2014–2019 Medicare claims data from a 5% random sample of fee-for-service beneficiaries aged 65 years or over. We included beneficiaries potentially eligible for CCM services because they had multiple chronic conditions (1,073,729 in 2015 and 1,130,523 in 2019). We calculated the proportion of potentially eligible beneficiaries receiving CCM service each year for the total population and by geographic region, sociodemographic, and clinical characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of beneficiaries with two or more chronic conditions receiving CCM services increased from 1.1% in 2015 to 3.4% in 2019. The increase in CCM use was higher in the southern region, among dually eligible beneficiaries and beneficiaries with a greater burden of chronic conditions (2–5 conditions vs ≥10 conditions: 0.7% vs 2.0% in 2015; 2.1% vs 7.0% in 2019) and frailty (robust vs severely frail: 0.6% vs 3.3% in 2015; 1.9% vs 9.4% in 2019). Nearly one out of five recipients did not continue CCM service after the initial service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found that CCM service is being used by a very small fraction of eligible patients. Barriers and facilitators to more effective CCM adoption should be identified and incorporated into strategies that encourage more widespread use of this Medicare benefit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2730-2737"},"PeriodicalIF":4.3,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560621","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":"Decline in use of high-risk agents for tight glucose control among older adults with diabetes in New York City: 2017–2022","authors":"Jeff Zhang MS,&nbsp;Rania Kanchi MPH,&nbsp;Sarah Conderino DrPH, MPH,&nbsp;Natalie K. Levy MD,&nbsp;Samrachana Adhikari PHD,&nbsp;Saul Blecker MD,&nbsp;Nichola Davis MD,&nbsp;Jasmin Divers PHD,&nbsp;Catherine Rabin BS,&nbsp;Mark Weiner MD,&nbsp;Lorna Thorpe PhD, MPH,&nbsp;John A. Dodson MD, MPH","doi":"10.1111/jgs.19060","DOIUrl":"10.1111/jgs.19060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to examine the prevalence of inappropriate tight glycemic control in older adults with type 2 diabetes and other chronic conditions in New York City, and to identify factors associated with this practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using the INSIGHT Clinical Research Network. The study population included 11,728 and 15,196 older adults in New York City (age ≥ 75 years) with a diagnosis of type 2 diabetes, and at least one other chronic medical condition, in 2017 and 2022, respectively. The main outcome of interest was inappropriate tight glycemic control, defined as HbA1c &lt;7.0% (&lt;53 mmol/mol) with prescription of at least one high-risk agent (insulin or insulin secretagogue).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of older adults with inappropriate tight glycemic control decreased by nearly 19% over a five-year period (19.4% in 2017 to 15.8% in 2022). There was a significant decrease in insulin (27.8% in 2017; 24.3% in 2022) and sulfonylurea (29.4% in 2017; 21.7% in 2022) medication prescription, and increase in use of GLP-1 agonists (1.8% in 2017; 11.4% in 2022) and SGLT-2 inhibitors (5.8% in 2017; 25.1% in 2022), among the total population. Factors associated with inappropriate tight glycemic control in 2022 included history of heart failure (adjusted odds ratio [aOR] 1.38), chronic kidney disease ([aOR] 1.93), colorectal cancer ([aOR] 1.38), acute myocardial infarction ([aOR] 1.28), “other” ([aOR] 0.72) or “unknown” ([aOR] 0.72) race, and a point increase in BMI ([aOR] 0.98).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found an encouraging trend toward less use of high-risk medication strategies for older adults with type 2 diabetes and multiple chronic conditions. However, one in six patients in 2022 still had inappropriate tight glycemic control, indicating a need for continued efforts to optimize diabetes management in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2721-2729"},"PeriodicalIF":4.3,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560618","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":"Comment on Saving the profession of geriatric medicine: No shortage of good ideas","authors":"Nancy E. Lundebjerg MPA,&nbsp;Mark A. Supiano MD, AGSF,&nbsp;Donna M. Fick PhD, RN, GCNS-BC, AGSF, FGSA, FAAN","doi":"10.1111/jgs.19070","DOIUrl":"10.1111/jgs.19070","url":null,"abstract":"<p>The recommendations enumerated in the commentary from Dr. Gurwitz and Dr. Seligman, “Saving the Profession of Geriatric Medicine: No Shortage of Good Ideas,”<span>¹</span> are in alignment with long-standing American Geriatrics Society (AGS) priorities<span>²</span> for achieving our mission and vision. We appreciate the citations to selected papers<span>^3-7</span> that have been published on this topic. We were surprised, however, to find that decades of work by AGS,<span>^8-19</span> individual geriatrics health professional leaders,<span>^20-23</span> and other organizations<span>^24-29</span> were not cited in the commentary. We are submitting this letter to ensure that readers of the <i>Journal of the American Geriatrics Society</i> (<i>JAGS</i>) have the historical context and knowledge of the work that AGS and others have done in service of advancing our collective vision for a future where all are able to maintain our health, safety, and independence as we age.</p><p>On a more personal note, we are inspired by the young people who are choosing a career in geriatrics.<span>³⁰</span> We appreciate your enthusiasm, energy, and talent and we believe the future of our field is bright. As always, we invite our AGS members to share ideas for new approaches that would help us to advance our priorities and achieve our vision via <span>[email protected]</span>.</p><p>All authors contributed to the manuscript.</p><p>The authors have no conflicts of interest to disclose.</p><p>There was no sponsor for this manuscript.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3271-3272"},"PeriodicalIF":4.3,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565438","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":"Esophageal motor disorders across ages: A retrospective multicentric analysis","authors":"Andrea Pasta MD,&nbsp;Chiara Facchini MD,&nbsp;Francesco Calabrese MD,&nbsp;Giorgia Bodini MD, PhD,&nbsp;Nicola De Bortoli MD, PhD,&nbsp;Manuele Furnari MD,&nbsp;Amir Mari MD, PhD,&nbsp;Edoardo V. Savarino MD, PhD,&nbsp;Vincenzo Savarino MD, PhD,&nbsp;Pierfrancesco Visaggi MD,&nbsp;Patrizia Zentilin MD, PhD,&nbsp;Edoardo G. Giannini MD, PhD,&nbsp;Elisa Marabotto MD, PhD","doi":"10.1111/jgs.19068","DOIUrl":"10.1111/jgs.19068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Age-related changes in the gastrointestinal system are common and may be influenced by physiological aging processes. To date, a comprehensive analysis of esophageal motor disorders in patients belonging to various age groups has not been adequately reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective assessment of high-resolution manometry (HRM) studies in a multicenter setting. HRM parameters were evaluated according to the Chicago Classification version 4.0. Epidemiological, demographic, clinical data, and main manometric parameters, were collected at the time of the examination. Age groups were categorized as early adulthood (&lt;35 years), early middle-age (35–49 years), late middle-age (50–64 years), and late adulthood (≥65 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 1341 patients (632, 47.0% male) were included with a median age of 55 years. Late adulthood patients reported more frequently dysphagia (35.2%) than early adulthood patients (24.0%, <i>p</i> = 0.035), early middle-age patients (21.0%, <i>p</i> &lt; 0.0001), and late middle-aged patients (22.7%, <i>p</i> &lt; 0.0001). Esophagogastric junction outflow obstruction was more prevalent in late adulthood (16.7%) than in early adulthood (6.1%, <i>p</i> = 0.003), and in early middle-age (8.1%, <i>p</i> = 0.001). Patients with normal esophageal motility were significantly younger (52.0 years) than patients with hypercontractile esophagus (61.5 years), type III achalasia (59.6 years), esophagogastric junction outflow obstruction (59.4 years), absent contractility (57.2 years), and distal esophageal spasm (57.0 years), in multivariate model (<i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The rate of esophageal motor disorders is higher in older patients, in particular esophagogastric junction outflow obstruction and hypercontractile esophagus. Future prospective studies are necessary to confirm our results and to find tailored strategies to improve clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2782-2791"},"PeriodicalIF":4.3,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556286","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":"Medicare expenditures among spouses of persons with dementia","authors":"Bailey C. Ingraham PhD,&nbsp;Douglas Barthold PhD,&nbsp;Norma B. Coe PhD,&nbsp;Paul Fishman PhD","doi":"10.1111/jgs.19074","DOIUrl":"10.1111/jgs.19074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Spouses of persons living with dementia face intense strains on their well-being compared with similarly aged adults and spouses of partners with no dementia. This strain can impact spouses' health and healthcare needs, and therefore affect their healthcare utilization and expenditures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the Health and Retirement Study linked with Medicare claims, we matched dyads of spouses and their partners with dementia (SPWD) to a comparison group of similar spouses and their partners with no dementia (SPWND). We then examined Medicare expenditures for spouses in the 5 years following their partner's dementia onset month using a two-part regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SPWD cumulative total Medicare expenditures were, on average, $60,043 in the 5 years post dementia onset, compared to $56,068 for SPWND. This difference ($3974, 95% CI = [−$3,199; $11,477]) was not significant. However, there were significant differences in the 5th year's total expenditures (+$2,748 [$321; $5,447]), driven by inpatient expenditures ($1,562 [$22; $3,277]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite the differences in partner's dementia status, we found no significant difference in the 5-year cumulative Medicare expenditures between SPWD and SPWND. Compared to previous studies, we likely captured an earlier stage of dementia more consistently for a broader population which may be less straining on spouses. Further research should examine patterns of expenditures in later years and around critical timepoints in caregiving, such as partner transitions to formal long-term care settings and death, to better understand healthcare expenditures for spouses of persons living with dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3200-3209"},"PeriodicalIF":4.3,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556287","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}