Journal of the American Geriatrics Society最新文献

{"title":"Racial and ethnic disparities in potentially inappropriate medication use in patients with dementia","authors":"Carolyn W. Zhu PhD,&nbsp;Justin Choi MEd,&nbsp;William Hung MD,&nbsp;Mary Sano PhD","doi":"10.1111/jgs.19152","DOIUrl":"10.1111/jgs.19152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Racial and ethnic disparities in potentially inappropriate medication (PIM) use among older adults with dementia are unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were drawn from the baseline visits of participants who were ≥60 years old and diagnosed with dementia in the National Alzheimer's Coordinating Center Uniform Data Set (NACCUDS) recruited from National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADCs) throughout the United States. PIM utilization was evaluated using the 2019 American Geriatrics Society Beers Criteria for PIM Use in Older Adults. We estimated the association between race and ethnicity and the following outcomes and estimation models: (1) any PIM use, any PIM in each drug class, and any PIM best avoided in dementia patients using logistic regression models, (2) total number of medications, total number of PIMs, and anticholinergic burden scale (ACBS) using Poisson or negative binomial regression models, and (3) proportion of total medications that were PIMs using generalized linear models (GLM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to White participants, Black, Hispanic, and Asian participants reported taking fewer total medications (incidence rate ratio [IRR] ± standard error[SE] = 0.903 ± 0.017, 0.875 ± 0.021, and 0.912 ± 0.041, respectively, all <i>p</i> &lt; 0.01). Asian participants were less likely to be exposed to any PIM (odds ratio [OR] ± SE = 0.619 ± 0.118, <i>p</i> &lt; 0.05). Compared to White participants, Black participants were less likely to be exposed to benzodiazepine (OR ± SE = 0.609 ± 0.094, <i>p</i> &lt; 0.01) and antidepressant (OR ± SE = 0.416 ± 0.103, <i>p &lt;</i> 0.001) PIMs, but greater antipsychotic (OR ± SE = 1.496 ± 0.204, <i>p</i> &lt; 0.01), cardiovascular (OR ± SE = 2.193 ± 0.255, <i>p</i> &lt; 0.001), and skeletal muscle relaxant (OR ± SE = 2.977 ± 0.860, <i>p &lt;</i> 0.001) PIMs. Hispanic participants were exposed to greater skeletal muscle relaxant PIMs and had lower anticholinergic burden. Asian participants were exposed to fewer benzodiazepine PIMs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Significant racial and ethnic disparities in exposure to PIMs and PIMs by medication category in dementia research participants who have access to dementia experts found in the study suggest that disparities may be wider in the larger community.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3360-3373"},"PeriodicalIF":4.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019933","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":"Geriatric medicine is advancing, not declining: A proposal for new metrics to assess the health of the profession","authors":"Timothy W. Farrell MD, AGSF,&nbsp;Amalia Korniyenko BA,&nbsp;Grace Hu BA,&nbsp;Terry Fulmer PhD","doi":"10.1111/jgs.19143","DOIUrl":"10.1111/jgs.19143","url":null,"abstract":"&lt;p&gt;Much has been written over the past 40 years about workforce challenges in aging-related disciplines. Geriatric medicine has more recently been at the forefront of the debate, and the field has been characterized as waning.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; But is it?&lt;/p&gt;&lt;p&gt;Such bleak perspectives regarding the geriatrics workforce typically cite the number of practicing geriatricians, which remains stubbornly around 7000 board-certified geriatricians, yielding roughly 0.96 geriatricians for every 10,000 older adults. Reasons commonly cited for the inadequate number of geriatricians include low prestige, low compensation compared with other specialties, and low match rates into geriatric medicine fellowship programs.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Many argue that the number of geriatricians must increase to meet the projected need of 28,000 geriatricians by 2025.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The fact that only three residency programs—family medicine, internal medicine, and medicine/pediatrics—require geriatrics-focused training may contribute to the inadequate supply of geriatricians.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Geriatric medicine fellowship fill rates remain among the lowest of all medicine subspecialties, although the overall fill rate is higher than the 43% reported by Gurwitz, with a geriatric medicine fellowship fill rate of 70% for the 2022–23 match.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; A metric that incorporates attention to both those who are exiting geriatric medicine and those who are embarking on careers as geriatricians is the American Board of Medical Specialties (ABMS) tracking of active geriatric medicine certificates. See Figure 1 below, which was developed by the American Geriatrics Society (AGS) based on a review of the last 18 years of data from ABMS.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This figure demonstrates that the number of board-certified geriatricians has remained stable at approximately 7000 each year. This number is probably a slight underestimate because ABMS does not include osteopathic physicians who receive geriatrics certification through the American Osteopathic Association. However, the ABMS does include osteopathic physicians who receive geriatrics board certification through the ABIM and ABFM.&lt;/p&gt;&lt;p&gt;What can be done to increase the supply of geriatricians? Simply placing health professions trainees where older adults are present and expecting them to develop adequate competency in geriatrics does not work.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; However, immersion when accompanied by structured geriatrics educational experiences improves competence in caring for older adults.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Negative attitudes related to aging can be improved with various exposures to older adults.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Geriatrics care is best delivered by interprofessional teams, but interprofessional team training presents logistical barriers and is infrequently provided by academic health centers.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; The Geriatrics Workforce Enhancement Prog","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"323-328"},"PeriodicalIF":4.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010164","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 lifetime quality of life effects of untreated and treated hearing loss among US adults","authors":"Ethan D. Borre MD, PhD,&nbsp;Julie N. Deleger BA,&nbsp;Lauren K. Dillard AuD, PhD,&nbsp;Judy R. Dubno PhD,&nbsp;Howard W. Francis MD, MBA,&nbsp;Gillian D. Sanders Schmidler PhD,&nbsp;Emily P. Hyle MD, MSc","doi":"10.1111/jgs.19117","DOIUrl":"10.1111/jgs.19117","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3905-3908"},"PeriodicalIF":4.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010165","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":"Factors associated with transfer from assisted living facilities to a nursing home: National Health Aging Trends Study 2011–2019","authors":"Jung Yoen Son MSN, RN, GNP-C,&nbsp;Deanna J. Marriott PhD,&nbsp;Laura M. Struble PhD, RN, GNP-BC,&nbsp;Weiyun Chen PhD,&nbsp;Janet L. Larson PhD, RN, FAAN","doi":"10.1111/jgs.19147","DOIUrl":"10.1111/jgs.19147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time-varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NHATS participants were included in this study if they: (1) resided in ALF from Round 1 (2011) through Round 8 (2018); (2) completed the sample person (SP) interview at baseline; (3) were admitted to ALF at age 65 years or older. We conducted Cox proportional hazards regression to examine candidate predictors (difficulty with basic activities of daily living (ADL), chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, self-reported health, participation in social and physical activity, and sociodemographic) associated with transfer to a nursing home. Employing backward elimination, we built parsimonious final models for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analytic sample included 970 participants of whom 143 transferred to nursing homes over 8 years. Those who had a better physical performance at baseline (HR = 0.83, 95% CI = 0.79–0.88) and were college educated (HR = 0.58, 95% CI = 0.36–0.92) demonstrated a significantly lower risk for transfer to a nursing home over 8 years. Residents who maintained physical activity (HR = 0.56, 95% CI = 0.37–0.86), better physical performance (HR = 0.87, 95% CI = 0.80–0.94), and difficulty with fewer basic ADLs (HR = 1.13, 95% CI = 1.02–1.26) were at lower risk for transfer to a nursing home over 8 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings can be used to identify older adults in ALFs at risk of transfer to a nursing home. Strategies to promote physical function and physical activity could avoid/delay the need to transfer. Helping older residents to age in place will have important health and economic benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3374-3384"},"PeriodicalIF":4.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006200","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":"Hospital at home worldwide: Program and clinician characteristics from the World Hospital at Home Congress survey","authors":"David M. Levine MD, MPH, MA,&nbsp;Sarah Findeisen BA,&nbsp;Meghna P. Desai MPH,&nbsp;Stephanie Blitzer BA,&nbsp;Linda V. DeCherrie MD,&nbsp;Daniel Lasserson MBBS, MD,&nbsp;Carme Hernandez PhD, MsC, RN,&nbsp;Michael Montalto MBBS, PhD,&nbsp;Bruce Leff MD","doi":"10.1111/jgs.19149","DOIUrl":"10.1111/jgs.19149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital at home (HaH) delivers hospital-level care to acutely ill patients at home as a substitute for brick-and-mortar hospital care. The clinician and program characteristics of HaH programs worldwide are relatively unknown. We sought to describe the world's HaH clinicians and their programs' characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed a survey administered to all attendees of the 2023 World Hospital at Home Congress. Clinician characteristics included age, years worked in HaH, profession, burnout, and experience. Program characteristics included location, daily census, types of care delivery, and clinical capabilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 670 attendees, about 305 were clinicians and 129 responded (42% response rate for clinicians). The majority of clinicians were 30–49 years old (65.1%), new to the field (70.5% worked less than 10 years), and part-time (18% dedicated &gt;74% effort to HaH). Clinicians reported overall satisfaction with their job and low burnout. About half of programs were in Europe (52.1%), newly operational (44.7% less than 5 years), mostly operated in urban environments (87.2%), and mostly had a daily census of less than 25 patients (62.8%). Most programs operated 7-days per week (88.3%), performed intermittent or continuous remote monitoring (81.4%), used video communication (63.8%), and had some advanced capabilities such as in-home imaging (47.9%) and advanced procedures (23.4%). Visit frequencies to the patient's home were variable: most programs had physicians visit the home, nearly all had nurses visit the home, and fewer performed virtual visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HaH clinicians and programs have significant similarities but also a fair number of divergent practices, much like brick-and-mortar hospital care. Further standardization of the care model will help to unify the field across the globe.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3824-3832"},"PeriodicalIF":4.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001621","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":"Technology use for health-related purposes among US older adults (65+ years)","authors":"Margaret C. Fahey PhD,&nbsp;Siyuan Huang MS,&nbsp;Jennifer Dahne PhD","doi":"10.1111/jgs.19122","DOIUrl":"10.1111/jgs.19122","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3913-3916"},"PeriodicalIF":4.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001622","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 retrospective cohort study of hospital discharge instructions following delirium episodes","authors":"Blair P. Golden MD, MS,&nbsp;David Sonnentag BS,&nbsp;Farah A. Kaiksow MD, MPP,&nbsp;Andrea Gilmore-Bykovskyi PhD, RN,&nbsp;Manish N. Shah MD, MPP,&nbsp;Sharon K. Inouye MD, MPH,&nbsp;Eduard E. Vasilevskis MD, MPH","doi":"10.1111/jgs.19146","DOIUrl":"10.1111/jgs.19146","url":null,"abstract":"&lt;p&gt;Delirium impacts a quarter of hospitalized adults and is associated with increased mortality and cognitive decline.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Symptoms may persist for months or recur, and timely recognition is critical.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Caregiver education may improve delirium recognition and ongoing management.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Prior work has demonstrated sub-optimal delirium documentation in discharge summaries, but the extent to which patients and/or caregivers receive written discharge instructions about delirium is unknown.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Our primary aim was to characterize how clinicians document about delirium in patient/caregiver-directed written discharge instructions. We also assessed patient factors associated with receipt of delirium-related discharge instructions.&lt;/p&gt;&lt;p&gt;We selected charts using a random number generator from a cohort of 1851 older adults (ages ≥65) discharged from medical services at an academic hospital. Patients had ≥1 Confusion Assessment Method (CAM) screen, which are routinely performed each shift by nurses. We included the first 50 charts for which patients had “delirium” documented in their discharge summary.&lt;/p&gt;&lt;p&gt;Among our final cohort, we abstracted verbatim text from the discharge summary problem list and hospital course related to acute changes in cognition. We reviewed the patient/caregiver-directed written discharge instructions (an institutional requirement) and recorded any mention of “delirium” or potential synonyms (e.g., “confusion”). We also identified new prescriptions intended for delirium (e.g., anti-psychotics) and any new or expedited specialty outpatient referrals for delirium, as these are listed in written instructions and may reflect intentions for ongoing delirium care. Unclear cases were adjudicated between two physicians (BPG, EEV). Finally, we used Fisher's exact and Mann–Whitney testing to compare receipt of delirium-related written discharge instructions by patient factors. This study was approved by the UW-Madison Institutional Review Board.&lt;/p&gt;&lt;p&gt;In our sample of 50 adults (Table S1), 76% were female, 88% were White, and the median age was 82 (IQR: 74–87). Most (86%) were discharged from hospital medicine. Approximately 34% had dementia and 64% received inpatient geriatrics consultations (psychiatry and neurology are rarely consulted for delirium at our institution).&lt;/p&gt;&lt;p&gt;All patients had personalized patient/caregiver-directed written discharge instructions regarding a hospital diagnosis, but only 2 cases (4%) specifically mentioned “delirium” (Figure 1). Thirteen charts (26%) had synonyms for delirium (e.g., “confusion” (5), “altered mental status” (5)). One patient received a new anti-psychotic for agitation. Five charts (10%) listed new or expedited outpatient specialty referrals (e.g., geriatrics (3), neurology (2)). Considered together, 18 (36%) contained delirium-related discharge instructions or intended follow-up.&lt;/p&gt;&lt;p&gt;Table 1 con","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"283-287"},"PeriodicalIF":4.3,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997139","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":"My first clinic patient taught me to be a geriatrician long before I became one","authors":"Mfon E. Umoh MD, PhD","doi":"10.1111/jgs.19144","DOIUrl":"10.1111/jgs.19144","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3903-3904"},"PeriodicalIF":4.3,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997140","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":"Wrist-worn voice recorders capture the circumstances and context of losses of balance among community-dwelling older adults","authors":"Youngjae Lee PhD,&nbsp;Neil B. Alexander MD, MS,&nbsp;Lisa Pompeii PhD,&nbsp;Linda V. Nyquist PhD,&nbsp;Michael L. Madigan PhD","doi":"10.1111/jgs.19148","DOIUrl":"10.1111/jgs.19148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Most falls among community-dwelling older adults are due to a loss of balance (LOB) after tripping or slipping. Unfortunately, limited insight is available on the detailed circumstances and context of these LOBs. Moreover, commonly used methods to collect this information is susceptible to limitations of memory recall. The goal of this pilot observational study was to explore the circumstances and context of self-reported LOBs captured by wrist-worn voice recorders among community-dwelling older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this pilot observational cohort study, 30 community-dwelling adults with a mean (SD) age of 71.8 (4.4) years were asked to wear a voice recorder on their wrist daily for 3 weeks. Following any naturally-occurring LOB, participants were asked to record their verbal responses to six questions regarding the circumstances and context of each LOB abbreviated with the mnemonic 4WHO: When, Where, What, Why, How, and Outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants wore the voice recorder 10.9 (0.6) hours per day for 20.7 (0.5) days. One hundred seventy-five voice recordings were collected, with 122 meeting our definition of a LOB. Each participant reported 0–23 LOBs over the 3 weeks or 1.4 (2.1) per participant per week. Across all participants, LOBs were most commonly reported 3 p.m. or later (42%), inside the home (39%), while walking (33%), resulting from a trip (54%), and having induced a stepping response to regain balance (48%). No LOBs resulted in a fall.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among community-dwelling older adults, wrist-worn voice recorders capture the circumstances and context of LOBs thereby facilitating the documentation of detail of LOBs and potentially falls, without reliance on later recall.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"193-198"},"PeriodicalIF":4.3,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992482","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 extended impact of the COVID-19 pandemic on long-term care residents in Medicare with frailty or dual Medicaid enrollment","authors":"Sunny C. Lin PhD, MS,&nbsp;Jie Zheng PhD,&nbsp;Arnold Epstein MD, MS,&nbsp;E. John Orav PhD,&nbsp;Michael Barnett MD, MS,&nbsp;David C. Grabowski PhD,&nbsp;Karen E. Joynt Maddox MD, MPH","doi":"10.1111/jgs.19131","DOIUrl":"10.1111/jgs.19131","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although many healthcare settings have since returned to pre-pandemic levels of operation, long-term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre-pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over-dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non-dually enrolled residents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre-pandemic years for all examined subgroups. For example, compared with 2018–2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In 2022, emergency department and hospital utilization rates among long-term residents were lower than pre-pandemic levels and mortality rates were higher than pre-pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3457-3466"},"PeriodicalIF":4.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984257","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}