Journal of the American Geriatrics Society最新文献

{"title":"Engaging Community Reviewers: The Geriatric Emergency Care Applied Research (2.0)—Advancing Dementia Care Network Approach","authors":"Angela Gifford,&nbsp;Chelsea McClellan,&nbsp;Morgan Daven,&nbsp;Michael Ellenbogen,&nbsp;Beverly Foster,&nbsp;Heidi Gil,&nbsp;Jerry Johnson,&nbsp;Deborah Jobe,&nbsp;Christopher R. Carpenter,&nbsp;Scott M. Dresden,&nbsp;Andrea Gilmore-Bykovskyi,&nbsp;Ula Hwang,&nbsp;Manish N. Shah","doi":"10.1111/jgs.19515","DOIUrl":"10.1111/jgs.19515","url":null,"abstract":"<p>A core tenant of the Geriatric Emergency care Applied Research Network 2.0—Advancing Dementia Care (GEAR 2.0-ADC) is the inclusion of community members during all stages of clinical research. As such, we deliberately integrated and supported patient and public involvement in the evaluation and selection of GEAR 2.0-ADC Pilot Research Grants by developing and adapting traditional grant application review structures, with input from community members, to create the GEAR 2.0-ADC Community Review Committee approach. Community members, including persons living with dementia, effectively participated in all three rounds of research grant application review and selection, complementing the traditional scientific review process. The structure and flexibility of the GEAR 2.0-ADC Community Review Committee approach serve as a model for patient and public grant application review involvement with strong potential for applications across grant reviews in other medical specialties.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2678-2684"},"PeriodicalIF":4.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082897","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":"Comment on: The Halo Effect: Perceptions of Information Privacy Among Healthcare Chatbot Users","authors":"Hinpetch Daungsupawong,&nbsp;Viroj Wiwanitkit","doi":"10.1111/jgs.19542","DOIUrl":"10.1111/jgs.19542","url":null,"abstract":"<p>The publication on “The Halo Effect: Perceptions of Information Privacy Among Healthcare Chatbot Users [<span>1</span>]” is interesting. This study is intriguing in terms of privacy attitudes concerning healthcare chatbots. However, there are certain drawbacks to the study methods that should be noted. One point that could be raised is whether the poll of chatbot users' attitudes toward privacy is comprehensive and reflective of the general public. For example, the sample size was drawn from chatbot users in a large healthcare system, which may not accurately represent the overall public, particularly older adults. As such, the findings may not be applicable to people with different healthcare experiences.</p><p>Additionally, the study may fail to fully account for the socioeconomic issues that influence consumers' attitudes toward privacy. The study may also be limited in its ability to analyze the impact of education and race on privacy attitudes. The findings, which suggest that highly educated and non-Hispanic Black users are less concerned about privacy, may indicate different experiences with access to information or data security.</p><p>This study presents a novel approach that uses both survey and interview data to gain a deeper understanding of chatbot users' attitudes toward privacy. Notably, the study observes a “halo effect” among older adults who believe chatbots are linked to reliable healthcare systems. This warrants further investigation. A combination of interviews and survey data has the potential to yield more thorough results. However, research may need to use different data sources to substantiate the findings.</p><p>In the future, studies could broaden the survey of chatbot users' sentiments to include users from underserved communities or individuals with additional health risks, who may have different viewpoints than users in larger health systems. This will provide a more comprehensive understanding of privacy concerns. Furthermore, research into the long-term consequences of technology use and the implications of delivering medical information via digital platforms could offer insights into the development of safe and dependable solutions.</p><p>H.P. 50% ideas, writing, analyzing, approval. V.W. 50% ideas, supervision, approval.</p><p>The authors declare no conflicts of interest.</p><p>This publication is linked to a related reply by DeCamp and Ellis. To view this article, visit https://doi.org/10.1111/jgs.19544.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2939-2940"},"PeriodicalIF":4.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082893","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":"A Large Language Model Approach to Identifying Preoperative Frailty Among Older Adults From Clinical Notes","authors":"Ying Qiu Zhou,&nbsp;Onkar Litake,&nbsp;Minhthy N. Meineke,&nbsp;Jeffrey L. Tully,&nbsp;Nicole Xu,&nbsp;Waseem Abdou,&nbsp;Rodney A. Gabriel","doi":"10.1111/jgs.19545","DOIUrl":"10.1111/jgs.19545","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with frailty have a higher risk of major postoperative mortality and morbidity. Identifying frailty from the medical record, however, is not straightforward since it is a multifactorial state based on multiple organ systems and a sum of factors accumulated over time. The objective of this study was to develop a large language model-based binary classifier using accurately phenotyped datasets to identify preoperative frailty from clinical notes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We trained various large language models to identify frailty from anesthesia preoperative clinic notes. There were two development datasets used: (1) patients undergoing spine surgery whose frailty was characterized by patient responses to the Vulnerable Elders-13 Survey (VES-13); and (2) patients undergoing surgery whose frailty was characterized by their calculated electronic frailty index (eFI) score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>When trained on our VES-13 development set and tested on our VES-13 validation set, the area under the receiver operating characteristics curve (AUC) for the RoBERTa, BERT, BioBERT, and PubMedBERT models was 0.99, 0.64, 0.67, and 0.73, respectively. When tested on the eFI validation set, the AUCs were 0.63, 0.83, 0.87, and 0.87, respectively. Models trained on the eFI development dataset did not discriminate frailty adequately when tested on the VES-13 validation set.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We report the development and validation of a classifier that detects older adults at risk for preoperative frailty from preoperative anesthesia clinical notes. Large language models can be used to accurately identify a difficult-to-quantify and multifactorial characteristic such as frailty in patients by using readily available unstructured information from clinical notes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2422-2430"},"PeriodicalIF":4.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082891","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":"Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials","authors":"Lajjaben Patel,&nbsp;Matthew W. Segar,&nbsp;Muhammad S. Usman,&nbsp;Ritika Dhruve,&nbsp;Neil Keshvani,&nbsp;Alexander Postalian,&nbsp;Amgad Mentias,&nbsp;Craig D. Rubin,&nbsp;Kershaw V. Patel,&nbsp;Dharam J. Kumbhani,&nbsp;Subhash Banerjee,&nbsp;Ambarish Pandey","doi":"10.1111/jgs.19508","DOIUrl":"10.1111/jgs.19508","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (<i>P</i>\u0000 _interactionfrailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (<i>P</i>\u0000 _interactionfrailty × intervention arm &lt; 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2376-2385"},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015466","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":"Hallways Feel Like Homelessness: The Geriatric Boarder Experience","authors":"Sarah E. Perelman,&nbsp;Danielle M. Muriel,&nbsp;Anita N. Chary,&nbsp;Emily M. Hayden,&nbsp;Grace Wang,&nbsp;Shan W. Liu","doi":"10.1111/jgs.19518","DOIUrl":"10.1111/jgs.19518","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Boarding in the Emergency Department (ED) is associated with increased delirium, morbidity, and mortality. Geriatric patients are especially vulnerable to these harms and are more likely to board for a prolonged time. Although multiple studies have investigated clinical outcomes for older adults, we present the first study examining the subjective experience of geriatric boarders through qualitative methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews between June 2024 and July 2024 at a large urban academic hospital. We recruited patients over the age of 65 boarding in the ED for over four hours after an inpatient bed request. Patients were located in hallway care spaces, ED rooms, or in a dedicated unit for ED boarding patients. Interviews were transcribed, coded, and discussed for themes using grounded theory. We halted interviews when we reached thematic saturation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 26 participants (mean age 77). Four themes emerged: (1) Care space location matters, and border units are far preferable to hallways, (2) patients were able to compartmentalize the kindness of the hospital staff and quality of medical care from their environment, (3) boarding elicits feelings of powerlessness, and (4) older adults felt acuity of condition and dementia or frailty, rather than age, should determine who should be prioritized for an inpatient room.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our sample of older adults felt stressed and powerless while boarding. They especially struggled in hallway care spaces and preferred dedicated units for boarding. They felt comorbidities and acuity of condition should determine prioritization for inpatient beds rather than age. These insights can help guide health systems how to improve the boarding experience for geriatric patients. More research is needed to understand the older adult's experience boarding in the ED and how to improve it.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2387-2396"},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045434","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":"Humility and Medicine, Lessons Learned: Perhaps the Fifth Ethics Principle","authors":"Michael Gordon","doi":"10.1111/jgs.19538","DOIUrl":"10.1111/jgs.19538","url":null,"abstract":"&lt;p&gt;There are many qualities necessary to be an effective and compassionate physician. In the modern era, much of medical education focuses on the complex pathophysiology of disease and clinical presentation. This is the current challenge of the necessary investigations and therapeutic interventions. What I have learned after almost 50 years of practice is that a hefty dose of humility is necessary to complete the prescription for humane and empathetic medicine. As well, for physicians, the principles of medical ethics are very important, and perhaps humility should be added as the fifth principle to the traditional four principles of autonomy, beneficence, non-maleficence, and justice.&lt;/p&gt;&lt;p&gt;I recall vividly how Dr. William Walker, the physician who was one of my teachers in Dundee who moved to Aberdeen, where I followed him for a house job (internship) communicated to the head nurse (sister) who joined us on ward rounds. When a suggestion as to a treatment or investigation was expressed, he invariably would turn to her and say, “what do you think sister (term for head nurse)?” If she had any reservation, he would consider it carefully before planning. My other great model was Dr., Barnard Berris, whose chief resident I became in 1974 at Toronto's Mt. Sinai Hospital. When a politician patient was being seen by him with his team which included me and an intern the patient remarked that he only wanted Dr. Berris and none of the “students”. Berris replied, “In this teaching hospital, the only way you can see me is with them. That is how I learned to be a doctor and now it is my duty to help train them to be good doctors as well.” That was the end of that conversation.&lt;/p&gt;&lt;p&gt;While working at a memory clinic, I saw an 83-year-old gentleman with a chief complaint of decreased recall and a tendency to repeat himself. He was still working as the director of a large and successful construction company. He was independent in his activities of daily living. He scored 22/30 on his MOCA (Montreal Cognitive Assessment), with demonstrated problems in recall and in the Trails B part of the examination, but otherwise he performed well. [&lt;span&gt;1&lt;/span&gt;] His MRI revealed atrophy and microangiopathy. I was concerned about whether he might be a candidate for Donepezil therapy and was concerned about his driving. I explained to him the MOT (Ministry of Transport) reporting requirements and the risk of insurance problems should he have an accident and the insurer questioning why he was still driving. With a modicum of resistance, he agreed to take the on-road driving assessment but turned down the cholinesterase inhibitor. Several months later he passed the driving test and was pleased but still had memory problems.&lt;/p&gt;&lt;p&gt;He sold his company but remained on the board of directors and on the board of his condominium. His family wished for another opinion, and he saw a behavioral neurologist (I am a geriatrician) who sent him for another driving test and told him and his","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2956-2957"},"PeriodicalIF":4.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045435","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":"The Piano Lesson","authors":"Biren B. Kamdar","doi":"10.1111/jgs.19546","DOIUrl":"10.1111/jgs.19546","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 8","pages":"2598-2599"},"PeriodicalIF":4.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060003","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":"Emergency Department Utilization Among Co-Residing Family Caregivers of Persons Living With Dementia","authors":"Pei-Chun Cha,&nbsp;Craig Rothenberg,&nbsp;Anita N. Chary,&nbsp;Justine Seidenfeld,&nbsp;Ula Hwang,&nbsp;Terri Fried,&nbsp;Joan K. Monin,&nbsp;Arjun K. Venkatesh,&nbsp;Cameron J. Gettel","doi":"10.1111/jgs.19522","DOIUrl":"10.1111/jgs.19522","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2920-2922"},"PeriodicalIF":4.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an Annual Mobility Screen for Preclinical Mobility Limitation: Test Selection and Interpretation Guidelines","authors":"Michelle M. Lusardi,&nbsp;Victoria Hamby,&nbsp;Sterling Eckert,&nbsp;Jason Dring","doi":"10.1111/jgs.19521","DOIUrl":"10.1111/jgs.19521","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preclinical mobility limitation (PCML) is an emerging public health issue in the United States. A standardized assessment to identify those with PCML has not been established. A Task Force of the American Physical Therapy Association's Academy of Geriatric Physical Therapy (APTA Geriatrics) developed an evidence-based protocol for an Annual Mobility Screen (AMS) with the potential to meet this gap in practice. Early identification of PCML increases the potential for remediation, improved function, and a slower rate of decline. Because mobility is key for independence and quality of life, aging adults would value access to mobility screening. Physical therapists, experts in movement, are uniquely qualified to provide this service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This report reviews decision-making for the selection of test/measures and the development of an interpretation rationale for an AMS. Test selection criteria included ratio level measures (time, distance, repetition), time or equipment requirements, ability to predict adverse health events, and availability of reference values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four performance-based measures met inclusion criteria: self-selected and fast walking speed (overall mobility and functional reserve), 30 s Chair Stand (lower extremity muscle performance), Four Square Step test (dynamic balance stepping over low obstacles and changing direction), and Timed Up Go cognitive (ability to dual task while moving). Classification of mobility was based on normal distribution of performance across the population of aging adults as follows: PCML unlikely (at or above—0.5 SD or more from mean for age/gender), PCML likely (between −0.5 SD and − 1.0 SD from mean), and impending mobility limitation (−1 SD below the mean).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The AMS was developed to identify older adults with PCML. The reliability and validity of the AMS and its interpretation strategies will be evaluated as the screening protocol is piloted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2839-2845"},"PeriodicalIF":4.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061372","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":"Support and Internet Use in Navigating Medicare Plans Among Older Americans","authors":"Lianlian Lei,&nbsp;Kierstdea Petzold,&nbsp;Julie Strominger,&nbsp;Donovan T. Maust","doi":"10.1111/jgs.19516","DOIUrl":"10.1111/jgs.19516","url":null,"abstract":"&lt;p&gt;U.S. counties offer an average of 42 Medicare Advantage plans [&lt;span&gt;1&lt;/span&gt;] and 14 stand-alone prescription drug plans [&lt;span&gt;2&lt;/span&gt;], which vary in benefits, provider networks, operations (e.g., prior authorizations), and quality. Insurance decision-making may be particularly challenging for older adults given their complex health needs [&lt;span&gt;3&lt;/span&gt;]. Insurance decision-making tools and resources are available online, but older adults may have limited access or comfort [&lt;span&gt;4, 5&lt;/span&gt;]. To support older adults' enrollment choices—critical decisions with enormous financial and health implications—it is important to understand the resources they use to make insurance-related decisions.&lt;/p&gt;&lt;p&gt;We used the 2015–2023 National Health and Aging Trends Study (NHATS), a nationally representative, longitudinal survey of Medicare beneficiaries aged 65 or older. Surveys were fielded between May and December each year except in 2023 (March 2023–April 2024), with response rates of 50.8%–96.0%. Respondents were asked whether they changed Medicare plans (i.e., supplemental, prescription drug, Medicare Advantage) in the past year and, if so, whether anyone helped. Respondents were also asked whether they used the internet to handle Medicare insurance matters (e.g., comparing plans, looking up coverage, filing claims).&lt;/p&gt;&lt;p&gt;From 2015 to 2023, we examined prevalences of two outcomes: receiving help changing Medicare plans and using the internet for insurance matters. For cohort comparability across years, we limited the analysis each year to respondents aged 71 or older. We tested the trend using a linear probability model with year included as a continuous variable and additional binary indicators for years 2021, 2022, and 2023 to allow for deviations from the 2015 to 2020 linear trend during the COVID-19 pandemic; we did not include an additional binary indicator for the year 2020 since the survey asked about respondents' receipt of help and internet use in the past year. Then we used logistic regression to examine factors associated with each outcome, adjusting for respondent characteristics (Table 1). For this analysis, we used the 2022 survey and included respondents aged 65 or older to generate nationally representative estimates for older adults of all ages, calculating predicted probabilities and marginal effects. We used NHATS analytic weights, adjusted for complex survey design. Statistical significance was set at two-tailed &lt;i&gt;p&lt;/i&gt; &lt; 0.05; analyses were performed using Stata, version 18.0 (StataCorp LLC).&lt;/p&gt;&lt;p&gt;The proportion of respondents (&lt;i&gt;N&lt;/i&gt; = 44,467 respondent-years) who changed Medicare plans was stable at 10%–12% each year from 2015 to 2022 and increased slightly to 13.5% in 2023 (&lt;i&gt;p&lt;/i&gt; = 0.01; Figure 1). Among those who changed, approximately 50% received help until 2020, but this dropped to 40% by 2022 (&lt;i&gt;p&lt;/i&gt; = 0.02). The proportion of respondents who used the internet for insurance matters slowly increased to 15% b","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2923-2927"},"PeriodicalIF":4.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015467","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}