Journal of the American Geriatrics Society最新文献

{"title":"Trends in Initiation of Buprenorphine for Opioid Use Disorder Among Older Adults.","authors":"Bridget M Mayrer, Roisin M Sabol, Bryant Shuey, Payel J Roy, Katie J Suda, Tae Woo Park, Timothy S Anderson","doi":"10.1111/jgs.70182","DOIUrl":"https://doi.org/10.1111/jgs.70182","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369353","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":"Psychotropic Drug Use Among Danish Care Home Residents During and After the COVID-19 Pandemic.","authors":"Hanin Harbi, Lotte Rasmussen, Emma Bjørk, Mikkel Højlund, Carina Lundby, Jens Søndergaard, Jesper Ryg, Helene Kildegaard","doi":"10.1111/jgs.70172","DOIUrl":"https://doi.org/10.1111/jgs.70172","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic and related measures led to social isolation and disrupted daily routines for care home residents, potentially harming their mental health. This study explored changes in incident psychotropic drug use among Danish care home residents during and after the pandemic.</p><p><strong>Methods: </strong>We conducted an interrupted time series analysis on all individuals admitted to Danish care homes between 2015 and 2023 (n = 128,915). We compared monthly rates of incident psychotropic drug use during and after the COVID-19 pandemic with predictions from the pre-pandemic trends, estimating the excess number of cases for each period.</p><p><strong>Results: </strong>At care home admission, residents had a median age of 85 years (interquartile range: 78-90), and 51% used psychotropic drugs. During the pandemic, incident psychotropic drug use exceeded levels expected from the pre-pandemic trend (179 excess users/10,000 residents; 95% confidence interval (CI): 72-286), with small increases for antidepressants (68/10,000; 95% CI: 7.9-128) and antipsychotics (81/10,000; 95% CI: 36-126). In the post-pandemic period, overall incident psychotropic use remained higher than expected from the pre-pandemic trend (343/10,000; 95% CI: 29-656). Although on a declining trend, incidence rates for antidepressants and Z-drugs were slightly elevated in the post-pandemic period (antidepressants: 237/10,000; 95% CI: 83-390; Z-drugs: 60/10,000; 95% CI: 23-98), while incident antipsychotic use returned to the pre-pandemic trend. Benzodiazepines and melatonin showed no substantial changes. Among incident psychotropic drug users during and after the pandemic, 58% had recent exposure to another psychotropic drug class, and 71% continued treatment beyond 6 months.</p><p><strong>Conclusions: </strong>Incident psychotropic drug use among Danish care home residents increased during the COVID-19 pandemic and remained slightly elevated afterward. This warrants closer scrutiny of prescribing practices and highlights the need for targeted interventions to optimize psychotropic drug use in the post-pandemic era.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357376","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":"GLP-1 Receptor Agonist Therapy and Cardiorenal Outcomes in Patients ≥ 80 Years Old With Type 2 Diabetes.","authors":"Jui-Cheng Chen, Yu-Wei Fang, Ya-Fang Liu, Mon-Ting Chen, Ming-Hsien Tsai","doi":"10.1111/jgs.70187","DOIUrl":"https://doi.org/10.1111/jgs.70187","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential in improving glycemic control and reducing adverse outcomes in patients with Type 2 diabetes mellitus (T2DM); however, their efficacy in individuals aged 80 years and older remains understudied. To evaluate the efficacy of GLP-1 RAs compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in patients aged ≥ 80 years with T2DM.</p><p><strong>Participant and setting: </strong>De-identified records from the TriNetX United States database identified 284,417 patients aged ≥ 80 years with T2DM, including 12,032 new GLP-1 RA users and 28,230 new DPP4i users, analyzed from January 2018 to December 2022.</p><p><strong>Methods: </strong>This retrospective cohort study utilized a new-user and active comparator design to evaluate clinical outcomes between GLP-1 RA and DPP4i users during a follow-up period of up to 5 years. Propensity score matching, incorporating all the baseline covariates, was used to minimize baseline differences. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs) for clinical outcomes. Sensitivity analyses were performed to validate the findings.</p><p><strong>Results: </strong>After 1:1 propensity score matching, 11,464 patients were included in each group. Both cohorts had a mean age of 81.6 years; 47.7% were female, and 67% were White. GLP-1 RA users had significantly lower risks of major adverse cardiovascular events (HR: 0.86, 95% CI: 0.81-0.91), major adverse kidney events (HR: 0.86, 95% CI: 0.82-0.91), all-cause hospitalization (HR: 0.91, 95% CI: 0.84-0.97), and all-cause mortality (HR: 0.82, 95% CI: 0.77-0.88) compared with DPP4i users. No significant differences were observed between the groups in the rate of heart failure or bone fractures.</p><p><strong>Conclusions: </strong>GLP-1 RAs may offer substantial cardiorenal and survival benefits in patients aged 80 years and older with T2DM. These findings support the use of GLP-1 RAs as a therapeutic option in this high-risk, older population.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357374","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: Domain-Specific LLMS in Clinical Medicine: Identifying Preoperative Frailty From Clinical Notes.","authors":"Ying Qiu Zhou, Rodney A Gabriel","doi":"10.1111/jgs.70177","DOIUrl":"https://doi.org/10.1111/jgs.70177","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357402","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":"Domain-Specific LLMs in Clinical Medicine: Identifying Preoperative Frailty From Clinical Notes.","authors":"Mete Ucdal, Mihriban Gungor, Elif Gecegelen, Mustafa Cankurtaran","doi":"10.1111/jgs.70171","DOIUrl":"https://doi.org/10.1111/jgs.70171","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357382","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":"Nursing Home Segregation and Quality of Care.","authors":"Sunny C Lin, Shekinah Fashaw-Walters, Gmerice Hammond, Ganesh M Babulal, Ellesse-Roselee Akré, Bailey A Martin Giacalone, R J Waken, Karen Joynt Maddox","doi":"10.1111/jgs.70165","DOIUrl":"https://doi.org/10.1111/jgs.70165","url":null,"abstract":"<p><strong>Background: </strong>Racial segregation is believed to play a critical role in enforcing racial disparities in nursing home quality. In this study, we test whether segregation exacerbates racial disparities in nursing home quality.</p><p><strong>Methods: </strong>We used data from the 2023 Minimum Data Set (MDS) and 2025 public use files on nursing home quality from the Center for Medicare and Medicaid Services to compare the quality of nursing homes with a high versus low proportion of Black residents and assess whether that relationship varied depending on the level of racial segregation among nursing homes in the county. Racial segregation was measured based on how Black and non-Hispanic White nursing home residents were distributed across nursing homes in a county. Nursing home quality measures included: star ratings, nursing turnover rates, adjusted staffing hours, and inspection deficiency scores.</p><p><strong>Results: </strong>Racial disparities existed at all levels of segregation. Nursing home segregation was associated with widening disparities in inspection deficiency scores; no statistically significant association was found between segregation and racial disparities in star rating, nursing turnover rates, or adjusted staffing hours.</p><p><strong>Conclusions: </strong>Racial disparities in nursing home quality are stark, with disparities in inspection deficiency scores exacerbated in counties with more segregated nursing home markets. These findings highlight the need for targeted policies to mitigate the impact of systemic disinvestment on nursing homes that serve a high proportion of Black residents.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357334","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":"Comparative Effectiveness of Inpatient Rehabilitation Versus Skilled Nursing Facilities for Stroke and Hip Fracture Patients.","authors":"Derek Lake, Soryan Kumar, Fangli Geng, Pedro Gozalo","doi":"10.1111/jgs.70164","DOIUrl":"https://doi.org/10.1111/jgs.70164","url":null,"abstract":"<p><strong>Background: </strong>Prior research suggests discharge to inpatient rehabilitation facilities (IRF) leads to improved outcomes for stroke and hip fracture patients relative to skilled nursing facilities (SNF), while incurring greater costs. However, these estimates are likely biased by non-random patient selection.</p><p><strong>Methods: </strong>We used a quasi-experimental design to compare post-acute care outcomes among Medicare beneficiaries hospitalized for stroke or hip fracture in 55 US hospitals that closed their IRF units between 2009 and 2017. Primary and secondary outcomes were 30-, 90-, and 180-day readmission and mortality, and successful community discharge.</p><p><strong>Results: </strong>Among 10,761 stroke and 13,963 hip fracture hospitalizations, IRF discharge declined sharply, offset by increases to SNF and home health. Relative to IRF, SNF discharge was associated with no significant differences in readmissions but an increase in 90-day mortality for stroke (+6.5%, 95% CI 1.5%-11.4%) and hip fracture (+5.8%, 95% CI 2.5%-9.0%). Successful community discharge did not differ for patients redirected to SNF, but stroke patients redirected to home health had significantly higher rates of successful discharge (DID estimate: +6.8%; 95% CI 0.1%-13.5%). The protective effect of IRF was concentrated within 20 days post-discharge.</p><p><strong>Conclusions: </strong>Following hospitalization for stroke and hip fracture, discharge to an IRF was associated with lower mortality relative to SNF. However, given the potential for unmeasured confounding, this association should be interpreted with caution. Careful post-acute care referral protocols are critical to ensure good patient outcomes.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357336","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":"Six-Month Prognostic Tool for Community-Dwelling People With Dementia.","authors":"Krista L Harrison, Sun Y Jeon, W James Deardorff, Alexandra K Lee, Lauren J Hunt, Claire Ankuda, Melissa D Aldridge, Kenneth E Covinsky, Irena Cenzer, W John Boscardin, Sei J Lee, Alexander K Smith","doi":"10.1111/jgs.70183","DOIUrl":"https://doi.org/10.1111/jgs.70183","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357358","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":"Predictors of Advance Directive Changes in Ontario Nursing Home Residents: A Case-Control Study.","authors":"Hannah J Wong, Hsien Seow, Anastasia Gayowsky, Robert C Wu, Hilda Lim, Rinku Sutradhar","doi":"10.1111/jgs.70184","DOIUrl":"https://doi.org/10.1111/jgs.70184","url":null,"abstract":"<p><strong>Background: </strong>Goals of care (GOC) discussions between the clinical team and nursing home (NH) residents provide the basis for decision-making on advance directives (AD) that include do-not-resuscitate (DNR) and do-not-hospitalize (DNH). Optimal timing and prompts for initiating GOC discussions are unclear. This study investigates recent emergency department (ED) use and clinical and demographic factors associated with subsequent AD changes.</p><p><strong>Methods: </strong>Nested case-control study within a population-based retrospective cohort using linked administrative health care data of individuals admitted to NHs in Ontario, Canada between 2013 and 2017 and then followed up until 2019. Eligible cases and controls were residents with and without an AD change between 2013 and 2019, respectively. Cases and controls were matched 1:1 by sex, composite AD at NH admission, NH admission date (±90 days), and birthdate (±365 days). The primary outcome was incident AD change, and exposures included recent ED use (either ED visits discharged back to NH or ED visits that resulted in hospitalization) and clinical and demographic variables measured at the time of documented AD change. Conditional logistic regression provided adjusted odds ratios for associations between exposures and incident AD change.</p><p><strong>Results: </strong>The cases and controls (27,942 residents) had a mean age of 84 years at NH admission and 67.1% were female. 48.3% had a baseline AD of \"DNR Only\" while the remaining were evenly divided between \"Full Code\" and \"DNR+DNH.\" The estimated adjusted odds ratio of AD change was 2.01 (95% CI, 1.83-2.21) in residents with recent hospitalization, 1.89 (95% CI, 1.67-2.13) in those having end-stage disease, and 1.82 (95% CI, 1.56-2.12) in residents who were mostly bedfast.</p><p><strong>Conclusions: </strong>A recent hospitalization, end-stage disease, or being bedfast are significant predictors of AD change. These important predictors exhibited by NH residents present opportunities to reassess GOC.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357384","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":"Combating Ageism and Improving Attitudes Towards Aging Among Medicine Residents.","authors":"Brent R Schell, Jesse R Katz, Megan Carr, Maryam Hasan","doi":"10.1111/jgs.70179","DOIUrl":"https://doi.org/10.1111/jgs.70179","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357418","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}