Journal of the American Geriatrics Society最新文献

{"title":"A Modified Delphi Process to Identify Clinical and Research Priorities for Aging Transgender Adults.","authors":"Megan Lau, Jill Blumenthal, Maile Young Karris","doi":"10.1111/jgs.70771","DOIUrl":"https://doi.org/10.1111/jgs.70771","url":null,"abstract":"<p><strong>Background: </strong>Aging transgender adults experience unique medical and social challenges, but limited data exist regarding healthcare needs and priorities. Identifying these can help guide transgender-informed, patient-centered care and aging research.</p><p><strong>Methods: </strong>We employed a modified, two-round Delphi method with a consensus committee to identify clinical and research priorities for aging transgender adults. Expert panelists with experience in transgender, geriatric, and/or HIV care and research rated 15 clinical and 7 research topics using a 5-point Likert scale. Consensus was defined as > 80% of expert panelists ranking a topic as \"Very important\" or \"Extremely important.\" Following Round 1, a consensus committee of older transgender adults reviewed topics and write-in suggestions and could elevate, reinstate, or add priorities by unanimous agreement. Topics selected by the committee advanced to Round 2 for expert panel ranking, followed by consensus committee review.</p><p><strong>Results: </strong>Forty-eight expert panelists completed Round 1, and 31 completed Round 2. After Round 1, 11 clinical and 3 research topics reached consensus. Following consensus committee review, 10 clinical and 6 research priorities advanced to Round 2. After final review, the highest-ranked clinical priorities were \"Provider knowledge on the unique needs of older transgender adults,\" \"Evaluation of social isolation, loneliness, and social support networks,\" and \"Provider/clinic knowledge of social, legal, financial, and mental health resources for transgender persons.\" The highest-ranked research priorities were \"Clinical implications of long-term gender-affirming hormone therapy and hormone cessation,\" \"Biologic mechanisms of hormone therapy on aging and aging outcomes,\" and \"Health, social, and structural needs of older transgender persons.\"</p><p><strong>Conclusions: </strong>Using a community-engaged modified Delphi approach, this study identified key clinical and research priorities for older transgender adults. Findings highlight the importance of provider knowledge, social support, and addressing knowledge gaps in gender-affirming care and aging. These results provide direction for future research and best practice guidelines for this population.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187176","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":"Coordinated Care Experience in Late-Life and Cognitive Aging of Older Adults in the United States: A Longitudinal Cohort Study.","authors":"Xiang Qi, Renhao Li, Nan Jiang, Jiaying Li, Derong Zeng, Jie Zhong, Lu Shao, Junwen Yu, Zheng Zhu, Jasmine Travers Altizer","doi":"10.1111/jgs.70797","DOIUrl":"https://doi.org/10.1111/jgs.70797","url":null,"abstract":"<p><strong>Background: </strong>The fragmentation of the US healthcare system imposes a high cognitive burden on older adults. Coordinated Care (CC) is hypothesized to improve patient outcomes, but the relationship between multidimensional CC experiences and cognitive aging remains unclear. We investigated whether experiences across three domains of CC (perceived CC, tangible support, and technical support) are associated with cognitive trajectories and incident cognitive impairment.</p><p><strong>Methods: </strong>Data were drawn from the Health and Retirement Study (2016-2022), including the 2016 CC module (N = 1321; aged ≥ 50). Baseline CC was assessed via three patient-reported scales: perceived CC (provider communication consistency, 0-20 scale), tangible support (family/professional assistance with medical tasks, 0-11 scale), and technical support (patient portal offered and used, 0-4 scale). Cognitive function was measured biennially (2016-2022) using the 27-point Telephone Interview for Cognitive Status (TICS). Incident cognitive impairment was defined as the first follow-up score of ≤ 11 among those cognitively normal at baseline. Linear mixed-effects models estimated 6-year cognitive trajectories, and Cox proportional hazards models assessed risk of incident impairment.</p><p><strong>Results: </strong>In fully adjusted models, higher perceived CC (β = 0.25, p < 0.05) and technical support (β = 0.22, p < 0.05) were associated with higher baseline cognitive scores. Greater tangible support was associated with lower baseline cognition (β = -0.48, p < 0.001) but also with slower cognitive decline over time (interaction β = 0.005, p < 0.05). Tangible support was associated with higher risk of impairment in unadjusted analyses (HR = 1.26), but this association was not statistically significant after adjustment.</p><p><strong>Conclusions and implications: </strong>Perceived CC and technology use characterized cognitively robust older adults, whereas tangible support identified vulnerable individuals yet was associated with slower cognitive decline. These findings underscore the need for nuanced CC strategies: digital tools engage those aging well, while intensive tangible support may be especially important for those with greater vulnerabilities. These associations are observational and do not establish causality.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187187","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":"Food Insecurity and Transportation Needs Associated With Lack of Active, Engaging Activities in Older Adults: A National Study.","authors":"Anna Oh, Siqi Gan, W John Boscardin, Alexander K Smith","doi":"10.1111/jgs.70784","DOIUrl":"https://doi.org/10.1111/jgs.70784","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187200","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":"Vision Impairment, Vision Correction, and Dementia Risk in Mild Cognitive Impairment.","authors":"Huilin Tang, David A Wolk, Gui-Shuang Ying, Tiansheng Wang, Steven T DeKosky, Yong Chen","doi":"10.1111/jgs.70772","DOIUrl":"https://doi.org/10.1111/jgs.70772","url":null,"abstract":"<p><p>Among individuals with mild cognitive impairment, no vision impairment (VI) and corrected VI were associated with a lower risk of dementia than uncorrected VI, particularly among those aged < 75 years.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187161","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":"Frailty Status and Medication Use Among U.S. Older Adults: Evidence From NHANES, 1999-2020.","authors":"Maryanne Kim, Matthew E Growdon, L Grisell Diaz-Ramirez, W John Boscardin, Jonathan H Watanabe, Michael A Steinman","doi":"10.1111/jgs.70759","DOIUrl":"https://doi.org/10.1111/jgs.70759","url":null,"abstract":"<p><strong>Background: </strong>Frailty and polypharmacy commonly coexist among older adults, yet population-level evidence on how the extent and therapeutic composition of medication use evolve across frailty stages remains limited.</p><p><strong>Methods: </strong>We analyzed nationally representative data from the U.S. National Health and Nutrition Examination Survey spanning 1999 through March 2020. Of 14,962 community-dwelling adults aged ≥ 65 years, 12,766 had sufficient data to construct a frailty index (FI). Frailty was categorized as robust (FI < 0.25), mildly frail (FI 0.25-0.34), or moderate to severely frail (FI ≥ 0.35). Outcomes included the mean number of prescription medications overall and by therapeutic class. Temporal trends were evaluated across frailty groups accounting for the complex survey design.</p><p><strong>Results: </strong>Medication use increased across all frailty groups from 1999-2000 to 2017-2020. The mean number of medications increased from 2.0 to 2.9 among robust individuals (p for trend < 0.001), from 3.9 to 5.5 among mildly frail individuals (p < 0.001), and from 6.0 to 7.8 among those with moderate to severe frailty (p = 0.001). Although cardiovascular agents consistently constituted the largest share of polypharmacy, their use remained stable. In contrast, metabolic and CNS/psychotherapeutic agents drove longitudinal increases in medication burden, with metabolic agents increasing across all frailty strata and CNS/psychotherapeutic agents increasing primarily among adults with moderate to severe frailty (p < 0.001). In 2017-2020, hyperpolypharmacy (≥ 10 medications) composition varied markedly by frailty status. Robust older adults predominantly used CNS/psychotherapeutic and topical agents, whereas frail adults primarily used cardiovascular and metabolic agents.</p><p><strong>Conclusion: </strong>Medication use among U.S. older adults increased substantially over two decades, with both the magnitude and composition of medication use pattern varying systematically by frailty status. These findings characterize the population-level landscape of frailty-stratified medication burden and provide clinical context for further research and efforts aimed at optimizing medication use across the frailty spectrum in older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187197","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":"Delineating a Spectrum of Physician Participation in Medical Aid in Dying: A Qualitative Exploration.","authors":"Karen Albright, Denae Gerasta, Todd D Becker, Vinay Kini, Daniel D Matlock, Stacy M Fischer, Eric G Campbell","doi":"10.1111/jgs.70775","DOIUrl":"10.1111/jgs.70775","url":null,"abstract":"<p><strong>Background: </strong>Physician participation in medical aid in dying (MAID) is commonly framed as a binary choice between participation and objection. Emerging evidence suggests physician involvement is nuanced, with levels of engagement shaped by ethical beliefs, professional responsibilities, and organizational structure. Improved understanding of how physicians make these decisions is needed to inform policy, clinical practice, and discussions about conscience-based practices.</p><p><strong>Methods: </strong>We conducted a qualitative descriptive study of 20 physicians practicing in US states where MAID is legal. We used purposive sampling to recruit typical cases, seeking maximum variation across geographic region, practice specialty, and MAID involvement. Participants completed virtual, semi-structured, in-depth interviews between April and August 2025. Interviews were analyzed using rapid qualitative analysis. Coding was adductive with deductive codes derived from extant literature, focusing on physicians' experiences with MAID, ethical orientations, and interpretations of bioethical principles.</p><p><strong>Results: </strong>Analysis identified a spectrum of physician participation classified across four broad categories: (1) discusses MAID only; (2) refers patients to MAID providers, because of ethical opposition or organizational constraints; (3) serves as a consulting provider only; and (4) serves as an attending provider. Although participants referenced the same core bioethical principles, variations in participation reflect differing interpretations of shared ethical principles and the influence of organizational and legal environments.</p><p><strong>Conclusions: </strong>Findings challenge the prevailing dichotomous view of MAID participation and demonstrate that physician engagement exists along a spectrum. Recognizing this spectrum may improve policy development, support clinician decision-making, and foster more nuanced discussions regarding conscience, ethics, and access to MAID.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Intensity Social Care for Dementia Caregivers: A Randomized Trial.","authors":"Jennifer A Makelarski, Kristen E Wroblewski, Victoria A Winslow, Emily M Abramsohn, Soo Borson, Delaney A Romanchick, Dena Schulman-Green, Katherine Thompson, Elbert S Huang, Stacy Tessler Lindau","doi":"10.1111/jgs.70684","DOIUrl":"https://doi.org/10.1111/jgs.70684","url":null,"abstract":"<p><strong>Background: </strong>Resource needs increase strain among dementia caregivers. We tested the impact of CommunityRx-Dementia, a low-intensity resource referral intervention that provides education about common resource needs, a personalized list of nearby resources, and navigation support via a navigator and online resource finder.</p><p><strong>Methods: </strong>We conducted a single-blind RCT comparing usual care (control) versus usual care plus CommunityRx-Dementia (intervention). We enrolled (12/2020-2/2024) English-speaking dementia caregivers agreeing to receive text messages who lived in a 62 ZIP code geography around an urban academic medical center. We assessed caregiver self-efficacy (primary, 12 months), loneliness, need for help and self-reported hospitalizations and emergency department (ED) visits (other pre-specified outcomes). Pre-planned, main analyses included participants with ≥ 1 baseline health-related social risk (HRSRs); post hoc analyses included caregivers without baseline HRSRs.</p><p><strong>Results: </strong>Caregivers with HRSRs (n = 133) were predominantly female (84%) and Black (79%); 52% had household income < $50 K/year; 94% texted a navigator and 31% requested additional resource information. Caregiver self-efficacy (range 1-5, intervention = 3.5; control = 3.5, odds ratio [OR]: 0.80, 95% CI: 0.30, 2.09) and rates of loneliness (intervention = 41%; control = 50%; OR: 0.62, 95% CI: 0.24, 1.59), needing help (23% = intervention, 34% = control; OR: 0.80, 95% CI: 0.30, 2.11) and hospitalization (intervention = 0.1, control = 0.2; IRR: 0.42, 95% CI: 0.14, 1.30) were similar at 12 months, but ED utilization was lower in the intervention group (0.3 vs. 0.7, IRR: 0.41, 95% CI: 0.19, 0.90). Caregivers without HRSRs (n = 210) were mainly female (75%) and Black (82%); 25% had household income < $50 K/year; 95% texted a navigator and 39% requested additional resource information. Self-efficacy, loneliness, hospitalizations, and ED utilization were similar between arms at 12 months, but odds of needing help were 0.31 (95% CI: 0.12, 0.83) for the intervention group.</p><p><strong>Conclusions: </strong>A low-intensity social care intervention aimed at dementia caregivers did not improve self-efficacy at 12 months but reduced emergency care utilization among those with HRSRs.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, Registered 10/29/19, Identifier: NCT04146545.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187136","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":"Caregivers in a Haystack? Informatics-Driven Clinical Trial Enrollment of Dementia Caregivers at Medical Visits.","authors":"Eva S Ren, Jennifer A Makelarski, Delaney A Romanchick, Veera Anand, Victoria A Winslow, Emily M Abramsohn, MariaDelSol De Ornelas, Elbert S Huang, Katherine Thompson, Soo Borson, Julie Johnson, Stacy T Lindau","doi":"10.1111/jgs.70783","DOIUrl":"https://doi.org/10.1111/jgs.70783","url":null,"abstract":"<p><strong>Background: </strong>Caregiving status is not routinely documented during clinical care, rendering caregivers difficult to identify for research and supportive interventions. We describe two informatics-based strategies for identifying dementia caregivers at their own or their care recipient's point of care (POC).</p><p><strong>Methods: </strong>The CommunityRx-Dementia trial was conducted at a U.S. urban academic medical center serving a predominantly Black population. Eligible participants were caregivers of a patient with dementia recruited mainly by: (1) fee-based queries of the clinical research data warehouse (CRDW) that identified patients with dementia and their listed contacts (potential caregivers) (August 2020-November 2022) or (2) no-cost self-service query using an electronic health record (EHR)-integrated cohort discovery tool that identified patients with dementia (June 2020). For CRDW lists, probabilistic matching was used to identify contacts who were also patients at the study site. An EHR dashboard displayed medical visits of patients with dementia (identified from both strategies) and their contacts (from CRDW only) to recruit at the POC.</p><p><strong>Results: </strong>A recruitment list of 8185 patients with dementia was created: 6282 from five CRDW queries and 1883 from one self-service EHR query, 20 from self- and clinician referrals. Target enrollment (N = 344) was reached in 27 months; 321 caregivers from CRDW contacts, 19 from self-service query contacts, 4 from clinician referrals. Enrollment rates were 66% (321/488) of eligible caregivers from CRDW and 48% (19/40) from self-service query. Seventeen percent of all enrolled caregivers were recruited from their own visit (28% internal medicine, 11% ophthalmology, 9% geriatrics, 5% hematology/oncology, 47% all other eligible clinics).</p><p><strong>Conclusions: </strong>A large dementia caregiver trial achieved recruitment goals using two replicable informatics-based strategies. The CRDW strategy involved no manual EHR abstraction and enabled direct recruitment of dementia caregivers at their own medical visits at relatively low cost.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165895","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 \"Implications of Missing Data Mechanisms in Randomized Controlled Trials\".","authors":"Guiping Huang, Yihua Yu","doi":"10.1111/jgs.70744","DOIUrl":"https://doi.org/10.1111/jgs.70744","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171887","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":"The Last Lesson: What Ms. E Taught Me About Living Fully.","authors":"Karen Bensinger","doi":"10.1111/jgs.70790","DOIUrl":"https://doi.org/10.1111/jgs.70790","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168760","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}