Journal of the American Geriatrics Society最新文献

{"title":"A Death in the Hospital.","authors":"Emmet Hirsch","doi":"10.1111/jgs.19364","DOIUrl":"https://doi.org/10.1111/jgs.19364","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934209","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 Novel Integrated Geriatric Services Hub for Frailty Identification and Comprehensive Management of Community-Dwelling Older Adults in Singapore: Impact on Health Service Utilization.","authors":"Grace Sum, Robin Wai Munn Choo, Ze Ling Nai, Siew Fong Goh, Wee Shiong Lim, Yew Yoong Ding, Woan Shin Tan","doi":"10.1111/jgs.19339","DOIUrl":"https://doi.org/10.1111/jgs.19339","url":null,"abstract":"<p><strong>Background: </strong>Healthcare systems need to address the high healthcare use of frail older adults. The Geriatric Services Hub (GSH) is a novel program in Singapore that delivers frailty screening, comprehensive geriatric assessment and coordinated care for community-dwelling older persons with bio-psycho-social needs. We aimed to evaluate the effects of the GSH on healthcare use.</p><p><strong>Methods: </strong>We compared healthcare utilization of 634 GSH participants with 634 unique propensity score-matched non-GSH community-dwelling older adults at 12 months before and after GSH enrolment. Baseline matching covariates included demographics, socioeconomic status, disease burden, calendar quarter of enrolment, and past healthcare utilization. We did exact matching on frailty categories (Clinical Frailty Score (CFS) score 4, 5, and 6-7). Difference-in-differences technique was used to derive effect estimates.</p><p><strong>Results: </strong>After propensity score matching, baseline covariates were adequately balanced. Healthcare utilization declined in both groups after GSH enrolment. Relative to the comparators and after accounting for pre-enrolment differences, participation in the GSH was associated with greater primary care (mean difference: 0.06, 95% CI-0.64 to 0.77) and specialist outpatient clinic visits (mean difference: 0.42, 95% CI -0.29 to 1.13), and fewer emergency department visits (mean difference: -0.18, 95% CI -0.69 to 0.34). However, these effects did not reach statistical significance. While number of hospitalizations did not differ between the groups, cumulative length of stay differed by 1.15 bed-days and was not statistically significant. No statistically significant differences were observed within CFS groups.</p><p><strong>Conclusion: </strong>GSH was not associated with significant reductions in healthcare use in the first year of enrolment. Higher utilization of primary care and specialist outpatient clinic services could reflect the increased identification of care needs with the potential to reduce unnecessary healthcare use such as emergency department visits. Prospective studies with a longer follow-up would ascertain if the GSH translates to reduced healthcare utilization as hypothesized.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934213","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":"Taking CMS Back to HCFA: Harnessing Private Innovation to Secure and Enhance Medicare.","authors":"Richard G Stefanacci","doi":"10.1111/jgs.19345","DOIUrl":"https://doi.org/10.1111/jgs.19345","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934195","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":"Assessing the prevalence of anticholinergic and sedative medications to avoid in older adults from the French Health Data System.","authors":"Teddy Novais, Antoine Garnier-Crussard, Elsa Reallon, Christelle Mouchoux, Frederic Gervais","doi":"10.1111/jgs.19324","DOIUrl":"https://doi.org/10.1111/jgs.19324","url":null,"abstract":"<p><strong>Background: </strong>In older people, medications with anticholinergic or sedative properties are associated with falls, frailty, and functional and cognitive impairment. These medications are often described as a subset of potentially inappropriate medications (PIMs). We examined the prevalence of anticholinergic or sedative medications to avoid in older people in France in 2023.</p><p><strong>Methods: </strong>This cross-sectional study used anonymized data from a large electronic healthcare database, the French National Health Data System (Système National des Données de Santé, SNDS). All people aged 65 years or older from January 1, 2023, to December 31, 2023, were included in this study. Dispensations of anticholinergic and sedative medications were identified according to PIM criteria (2023 American Geriatrics Society Beers Criteria and REMEDI[e]S tool). The prevalence of anticholinergic or sedative medications was assessed for the study population and by age (65-84 and 85 or older) and living place (home and institutionalized patients) subgroups in terms of number and percentage of patients.</p><p><strong>Results: </strong>This study included 16,938,152 patients aged 65 years or older (55% women). Among all patients, 79.8% were aged between 65 and 84 years and 20.2% were aged 85 years or older. Most patients lived at home (97.0%), and 3.0% were institutionalized. The prevalence of anticholinergic or sedative medications was 32.8% among all patients, 32.3% among 65-84 patients, and 34.8% among 85 or older patients, 32.1% among home patients, and 54.5% among institutionalized patients. The most commonly dispensed anticholinergic or sedative medications were oxazepam (5.27%), alprazolam (5.27%), zopiclone (4.85%), bromazepam (4.23%), metopimazine (2.88%), paroxetine (2.70%), nefopam (2.57%), and hydroxyzine (2.17%).</p><p><strong>Conclusions: </strong>This study highlighted that anticholinergic and sedative medications to avoid in older people are still frequently prescribed despite the development and regular updating of PIM criteria. Future studies are needed to assess whether this has led to worsened outcomes among older adults who utilized these medications, and new initiatives should be developed to further promote deprescribing by prescribers and pharmacists.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924354","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":"Perceived Timeliness of Prior Authorization Approvals for Medicaid Home- and Community-Based Services.","authors":"Jennifer M Mellor, Peter J Cunningham, Erin Britton, Andrew Mitchell, Sandra Dagenhart","doi":"10.1111/jgs.19335","DOIUrl":"https://doi.org/10.1111/jgs.19335","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916756","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":"Clin-STAR Corner: Practice Changing Advances at the Interface of Oncology and Geriatrics.","authors":"Tanyanika Phillips, Jingran Ji, Vani Katheria, William Dale","doi":"10.1111/jgs.19361","DOIUrl":"https://doi.org/10.1111/jgs.19361","url":null,"abstract":"<p><p>Cancer and aging are inextricably linked, and older adults are a significant proportion of those diagnosed, treated, and living with and beyond a cancer diagnosis. Several large prospective studies have enhanced our understanding of how to improve the assessment, treatment, and outcomes of older adults with cancer starting therapy. This article summarizes three recent high-impact trials that produced practice-changing implications for the management of older adults with cancer that led to guideline updates. The key findings from these trials highlight that geriatric assessment-guided interventions in older adults with cancer: (1) facilitated higher rates of chemotherapy completion at planned doses with less modification among patients, (2) reduced grade 3 hematologic and non-hematologic toxicity during treatment delivery among patients of all stages of cancer receiving chemotherapy, and (3) influenced treatment decisions among advanced cancer patients receiving supportive care leading to reduced toxicity through reduced intensity of therapy without compromise of survival.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911387","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":"Do Medicare Beneficiaries Under Accountable Care or Medicare Advantage Use Lower Quality Nursing Homes?","authors":"Huiying Wang, Cyrus Kosar, Momotazur Rahman, Vince Mor","doi":"10.1111/jgs.19328","DOIUrl":"10.1111/jgs.19328","url":null,"abstract":"<p><strong>Background: </strong>With the growing number of Medicare beneficiaries attributed to Accountable Care Organizations (ACO) or enrolled in Medicare Advantage (MA) and their financial incentives to lower the cost of the cared patients, it is essential to understand how these alternative payment models affect post-acute outcomes among beneficiaries, with or without dementia diagnoses. In this study, we examined the quality of skilled nursing facilities (SNFs) that beneficiaries entered after hospital discharge under different payment models.</p><p><strong>Study participants: </strong>Medicare beneficiaries who were discharged from hospitals and admitted to SNFs between 2013 and 2018.</p><p><strong>Key measures: </strong>The exposure variable was a payment indicator, including ACO, MA, or non-ACO traditional Medicare (TM) fee-for-service. The dependent variable was high overall quality SNF, defined as with at least 4-star rating in the CMS Nursing Home Care Compare.</p><p><strong>Analytic plan: </strong>We examined the payer distribution by dementia diagnosis using ZIP Code Tabulation Areas (ZCTAs) fixed effects and adjusted for age, gender, and race. We also estimated the probabilities of entering high-quality SNF as a function of payer status and dementia diagnosis each year using hospital and ZCTA fixed effects and accounting for beneficiary-level covariates.</p><p><strong>Results: </strong>Among SNF admissions from 2013 to 2018, the share of ACO-attributed beneficiaries increased from 7.6% to 20.2%, MA enrollees increased from 25.2% to 32.8%, and non-ACO-attributed TM enrollees decreased from 67.2% to 47.3%. Consistently, ACO-attributed beneficiaries were the most likely, while MA enrollees were the least likely to enter high-quality SNFs, regardless of dementia diagnosis.</p><p><strong>Conclusions: </strong>Our findings highlight significant differences in access to high-quality SNFs across Medicare payment models, with ACO-attributed beneficiaries consistently experiencing better access than their MA or traditional Medicare counterparts, regardless of dementia diagnosis. These results underscore the need for further investigation into how payment models influence care quality and access, particularly for vulnerable populations.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911390","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":"Older Adults With Obesity: Need for 4Ms Age-Friendly Approach to Care.","authors":"Shenbagam Dewar, Mary R Janevic, John A Batsis, Neil B Alexander","doi":"10.1111/jgs.19353","DOIUrl":"https://doi.org/10.1111/jgs.19353","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901484","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":"Can We Improve Geriatrics Recruitment? An Analysis of U.S. Geriatrics Fellowship Programs on X.","authors":"Eloy F Ruiz, Oscar J Ponce, Helen M Fernandez","doi":"10.1111/jgs.19338","DOIUrl":"https://doi.org/10.1111/jgs.19338","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic accelerated the shift from in-person to virtual recruitment, prompting residency and fellowship programs to adopt innovative strategies, such as leveraging social media platforms to attract applicants and enhance visibility. Our aim was to identify and describe the presence of U.S. geriatric medicine fellowship programs on X.</p><p><strong>Methods: </strong>We identified all U.S. geriatric medicine fellowship programs using FREIDA, and then located their X accounts through a stepwise process. Data were collected on account creation, number of followers, posts, and activity level, with an analysis of the last 100 posts from the most active accounts. Descriptive statistics were used to analyze the data.</p><p><strong>Results: </strong>Among the 147 geriatric medicine fellowship programs identified, 38 (25.9%) had an X account. The majority of accounts were created after the start of the pandemic, reflecting likely the adaptation to virtual recruitment processes. Only a few accounts generated the majority of posts and followers. The accounts primarily posted or reposted educational content, research highlights, and promotional material.</p><p><strong>Conclusion: </strong>The use of X by geriatric medicine programs is still significantly underutilized, with only one-fourth of them having an account. Half of the accounts were created after the COVID-19 pandemic began. Programs should focus on building a robust social media presence to increase their visibility, especially as virtual interviews have become a permanent part of recruitment.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901482","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":"Implementation of Function Focused Care for Acute Care Using the Evidence Integration Triangle.","authors":"Barbara Resnick, Marie Boltz, Elizabeth Galik, Rachel McPherson, Ashley Kuzmik, Brittany Drazich, Nayeon Kim, Shijun Zhu, Chris Wells","doi":"10.1111/jgs.19334","DOIUrl":"https://doi.org/10.1111/jgs.19334","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to test the impact of Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT) on hospitalized patients living with dementia.</p><p><strong>Methods: </strong>This was a clustered randomized clinical trial including 12 hospitals from two states and 455 patients living with dementia. Hospitals were randomized to FFC-AC-EIT versus FFC Education Only. The mean age of the participants was 82.5 (SD = 8.5), the majority were women (62.6%), White (65.3%), married (64.4%), and had 3.0 (SD = 2.4) comorbidities. Outcome measures included the Barthel Index; the Physical Activity Survey, the Confusion Assessment Method Short Form (CAM-S), the Neuropsychiatric Inventory (NPI), and the Pain Assessment in Advanced Dementia.</p><p><strong>Results: </strong>At discharge, both groups improved in function and physical activity, patients in the intervention group had less increase in pain than those in the control group (β = -0.58, 95% confidence interval [95% CI] (-0.89, -0.26), p < 0.001). There were no group differences in behavioral symptoms or delirium. At 1 month post-discharge there was a significant improvement in function (β = 5.55, 95% CI [0.36, 10.75], p = 0.036) and physical activity (β = 3.07, 95% CI [1.87, 4.28], p < 0.001).</p><p><strong>Conclusions: </strong>Exposure to information about function focused care may help staff in acute care settings maintain and increase function and physical activity for older patients living with dementia during the hospital stay and help facilitate an increase in function and physical activity after discharge.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901483","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}