Journal of the American Geriatrics Society最新文献

{"title":"Clin-STAR Corner: Practice-Changing Advances at the Interface of Gastroenterology & Geriatrics.","authors":"Adam S Faye, Bharati Kochar, Aasma Shaukat","doi":"10.1111/jgs.19467","DOIUrl":"https://doi.org/10.1111/jgs.19467","url":null,"abstract":"<p><p>With nearly 60 million Americans aged 65 and older, gastrointestinal (GI) conditions are a leading cause of healthcare utilization in this population. Despite this, older adults remain underrepresented in GI clinical trials and research, limiting evidence-based care. This review highlights three pivotal studies addressing this gap: (1) proton pump inhibitors, which are commonly used to treat gastroesophageal reflux disease, are not associated with the later development of dementia; (2) undertreatment of chronic inflammation among older adults with inflammatory bowel disease is associated with a higher rate of adverse events compared to treatment with anti-TNF therapy, a biologic agent; (3) the majority (85%) of surveillance colonoscopies among older adults with a life expectancy of ≥ 10 years did not yield colorectal cancer, advanced dysplasia, or ≥ 3 polyps.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Frailty, Dementia, and Disability Among Community-Living Older Americans According to County-Level Disadvantage.","authors":"Yi Wang, Emma X Zang, Kendra Davis-Plourde, Brent Vander Wyk, Thomas M Gill, Robert D Becher","doi":"10.1111/jgs.19465","DOIUrl":"https://doi.org/10.1111/jgs.19465","url":null,"abstract":"<p><strong>Background: </strong>County-level contextual disadvantage is a novel social determinant of health (SDOH) for older persons. No prior study has evaluated the national incidence of geriatric conditions according to county-level contextual disadvantage among older persons. Our objective was to estimate the incidence of frailty, probable dementia, and disability over a 5-year period on the basis of county-level contextual disadvantage among community-living older Americans.</p><p><strong>Methods: </strong>This prospective, nationally representative longitudinal study used data from the 2015 cohort of the National Health and Aging Trends Study (NHATS), linked to various publicly available, geographically based contextual datasets. County-level disadvantage was assessed using the Geriatric Index of County-Level Multi-Dimensional Contextual Disadvantage (GERi-County), which included nine contextual indicators from these linked datasets. Data on frailty, probable dementia, and activities of daily living (ADL) disability were obtained from the NHATS annual assessments (2015-2020).</p><p><strong>Results: </strong>Totally 7499 participants were included in the analysis, representing 40,728,543 community-living older Americans. The 5-year incidence rates per 1000 person-years were significantly higher in the disadvantaged compared to the non-disadvantaged counties: 52.8 (95% confidence interval (CI), 41.6-64.0) versus 40.3 (95% CI, 37.2-43.3) for frailty; 29.9 (95% CI, 25.4-34.3) versus 21.2 (95% CI, 19.0-23.4) for probable dementia; and 78.1 (95% CI, 70.2-86.0) versus 62.5 (95% CI, 58.2-66.8) for ADL disability. For participants who lived versus did not live in disadvantaged counties, the age- and sex-adjusted HRs were 1.38 (95% CI, 1.08-1.75) for frailty, 1.53 (95% CI, 1.25-1.86) for probable dementia, and 1.30 (95% CI, 1.13-1.49) for ADL disability.</p><p><strong>Conclusions: </strong>Community-living older Americans who reside in disadvantaged counties have a higher incidence of frailty, probable dementia, and ADL disability over a 5-year follow-up period compared to their non-disadvantaged counterparts. Findings underscore the vital, underappreciated role that county-level social contextual disadvantage plays on clinically meaningful outcomes in older persons in the U.S.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaling Alzheimer's Care: The Case for Specialized Treatment Clinics.","authors":"Eric D Vidoni, Adam C Parks, Amanda Brunette, Katelynn Kreszyn, Ryan A Townley, Anne K Arthur, Lindsey Gillen, Jaime Perales Puchalt, Tina Lewandowski, Dinesh P Mudaranthakam, Jill K Morris, T Ryan Smith, Jennifer Woodward, Jeffrey M Burns","doi":"10.1111/jgs.19461","DOIUrl":"https://doi.org/10.1111/jgs.19461","url":null,"abstract":"<p><strong>Background: </strong>The approval of amyloid-targeting monoclonal antibodies has transformed Alzheimer's disease (AD) treatment, shifting the field from symptomatic management to targeting the underlying pathology. These therapies require specialized care models to manage the selection, treatment, and monitoring of eligible patients.</p><p><strong>Methods: </strong>Here, we describe the implementation of the Anti-Amyloid Treatment Clinic (KU-AATC) at the University of Kansas Health System, a dedicated clinic model designed to streamline access to amyloid-clearing therapies and to provide safe, efficient patient care. We detail the KU-AATC's structured approach, including a multidisciplinary team with advanced practice providers (APPs), leading patient evaluation and shared decision-making, and tailored workflows to ensure timely access to treatment. We review data from the clinic's first 18 months.</p><p><strong>Results: </strong>The KU-AATC model demonstrates a feasible approach to managing the complex needs of amyloid-targeting therapy for AD.</p><p><strong>Conclusions: </strong>Our findings suggest that a specialized clinic structure can support safe, accessible, and efficient care for AD patients, potentially serving as a scalable model for healthcare systems adapting to the demands of emerging AD treatments. Expanding similar clinics may address neurologist shortages and improve equitable access to advanced therapies.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifespan Fluidity and Its Biological Limitations in Socio-Economic Health Differences.","authors":"Caleb E Finch, Marja K Jylhä","doi":"10.1111/jgs.19458","DOIUrl":"https://doi.org/10.1111/jgs.19458","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Comment on: Changes in Leisure Activity, All-Cause Mortality, and Functional Disability in Older Japanese Adults.","authors":"Sayo Masuko, Yusuke Matsuyama, Shiho Kino, Katsunori Kondo, Jun Aida","doi":"10.1111/jgs.19453","DOIUrl":"https://doi.org/10.1111/jgs.19453","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Changes in Leisure Activity, All-Cause Mortality, and Functional Disability in Older Japanese Adults: The JAGES Cohort Study.","authors":"Merve Yilmaz Kars, Veyis Vanlilar, Orhan Cicek, Ilyas Akkar, Zeynep Iclal Turgut, Mustafa Hakan Dogan, Muhammet Cemal Kızılarslanoglu","doi":"10.1111/jgs.19451","DOIUrl":"https://doi.org/10.1111/jgs.19451","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home-Based Rehabilitation After Transcatheter Aortic Valve Replacement (REHAB-TAVR): A Pilot Randomized Controlled Trial.","authors":"Sandra M Shi, Faith-Anne Rapley, Heather Margulis, Roger J Laham, Kimberly Guibone, Edward Percy, Tsuyoshi Kaneko, Kuan-Yuan Wang, Dae Hyun Kim","doi":"10.1111/jgs.19456","DOIUrl":"10.1111/jgs.19456","url":null,"abstract":"<p><strong>Background: </strong>The benefit of early cardiac rehabilitation after transcatheter aortic valve replacement (TAVR) is not well established. This pilot study evaluated the feasibility and short-term effects of a home-based exercise program, with or without cognitive-behavioral intervention (CBI).</p><p><strong>Methods: </strong>We randomized 51 patients (mean age, 83.9 years; 19 women) to a home-based exercise program with CBI (Group A; n = 18) or without CBI (Group B; n = 15), or telephone-based education control (Group C; n = 18). The exercise program focusing on balance, flexibility, strength, and endurance began within 7 days post-discharge and was delivered once weekly by a physical therapist for 8 weeks. CBI included discussions on exercise benefits and barriers, goal setting, detailed exercise planning, and a weekly cash adherence incentive. The primary outcome was a disability score (range: 0-22; higher scores indicate greater disability) at 8 weeks. Secondary outcomes included the Short Physical Performance Battery (SPPB) (range: 0-12; higher scores indicate better function), self-efficacy, and outcome expectation scores. Feasibility outcomes included adherence and drop-out rates.</p><p><strong>Results: </strong>Fifteen participants (83.3%) in Group A, 10 (58.8%) in Group B, and 10 (52.6%) in Group C completed ≥ 5 of the eight assigned weekly sessions (p = 0.196). Two participants in each group were lost to follow-up. At 8 weeks, the home-based exercise groups (Group A and B combined) demonstrated lower disability scores (mean [SE]: 2.6 [0.3] vs. 4.5 [0.5]; p = 0.042) and higher SPPB scores (9.5 [0.6] vs. 6.5 [0.8]; p = 0.003) compared with the education group (Group C). Group A had lower disability scores than Group B (2.1 [0.4] vs. 3.4 [0.5]; p = 0.047), with no differences in self-efficacy and outcome expectation scores.</p><p><strong>Conclusions: </strong>An early, home-based, multi-domain exercise program appears feasible and may prevent disability and improve physical function in older adults after TAVR. Adding CBI, including a modest cash incentive, showed trends toward improved adherence and reduced disability.</p><p><strong>Trial registration: </strong>NCT02805309.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patient Speaks.","authors":"Donna Singer","doi":"10.1111/jgs.19449","DOIUrl":"https://doi.org/10.1111/jgs.19449","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Discontinuation of Fall-Risk-Increasing Drugs on Falls in Multimorbid Older Patients With Polypharmacy.","authors":"Namiko A Goto, Dayna A M van Heel, Lauren Dautzenberg, François-Xavier Sibille, Emma Jennings, Douglas C Bauer, Carole E Aubert, Anne Spinewine, Nicolas Rodondi, Huiberdina L Koek, Mariëlle H Emmelot-Vonk, Wilma Knol","doi":"10.1111/jgs.19460","DOIUrl":"https://doi.org/10.1111/jgs.19460","url":null,"abstract":"<p><strong>Background: </strong>Falls are a major concern in the older population. An important cause of falls is fall-risk-increasing drugs (FRID). However, it is not known if the discontinuation of FRID leads to a reduction of falls. Therefore, the aim of this study was to assess the association between discontinuation of FRID and the occurrence of falls and recurrent falls.</p><p><strong>Methods: </strong>This study included adults aged ≥ 70 years with multimorbidity and polypharmacy who were enrolled in a cluster randomized controlled trial assessing hospital pharmacotherapy optimization (OPERAM). Participants who were using FRID at baseline, were alive after 2 months of follow-up, and provided data on fall occurrence were included. FRID discontinuation was defined as discontinuation of ≥ 1 FRID within 2 months after inclusion, including the following groups: antidepressants, antiepileptics, antihistamines, antipsychotics, benzodiazepines and z-drugs, diuretics, opioids, and alpha-blockers. Multivariable cox regression analysis, using inverse probability weighting, was performed to assess the association between FRID discontinuation and the occurrence of falls.</p><p><strong>Results: </strong>Our analysis included 1546 participants, with a median age of 79 years (IQR 74-84) and 45% female. After 2 months of follow-up, FRID were discontinued in 878 (57%) participants. Among all participants, 378 (24%) experienced a fall within 1 year of follow-up, with 137 (9%) of the participants experiencing two or more falls, and 199 (13%) participants experiencing a serious fall. No association was found between FRID discontinuation and the occurrence of falls. In a subgroup of participants with a previous fall, discontinuation of antipsychotics was associated with a lower occurrence of falls (HR 0.32 [CI 0.12-0.84], p = 0.02).</p><p><strong>Conclusions: </strong>In multimorbid older patients using FRID, falls are highly prevalent. No association was found between discontinuation of FRID and the risk of falls, except for the discontinuation of antipsychotics in patients who experienced a previous fall.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Call for Improving Clinical and Cognitive Assessments to Reduce the Gap Between Amyloid/Tau Pathology Onset and Detection of Cognitive Dysfunction.","authors":"Jordi A Matias-Guiu, Rosie E Curiel-Cid, Bruce P Hermann, David A Loewenstein","doi":"10.1111/jgs.19455","DOIUrl":"https://doi.org/10.1111/jgs.19455","url":null,"abstract":"<p><p>In this commentary, we discuss the new perspectives on the definition and criteria for Alzheimer's disease, particularly in relation to the biological and clinical-biological approaches. We argue that research must continue to focus on improving clinical and cognitive tools to contextualize biomarker findings and understand the clinical implications of different pathophysiological processes at the individual level. We propose several solutions, including the development of \"cognitive stress tests,\" digital clinical biomarkers, innovative analytical procedures, more refined studies for collecting rigorous and longitudinal normative data, and, ultimately, enhanced clinical skills. Overall, these strategies could help \"shorten\" the preclinical period and bridge the gap between the biological and clinical-biological approaches by aligning biomarker abnormalities with the onset of cognitive dysfunction more effectively.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}