Journal of the American Geriatrics Society最新文献

{"title":"Comment on: Willingness to take less medication for type 2 diabetes among older patients.","authors":"Petra Denig, Peter J C Stuijt","doi":"10.1111/jgs.19175","DOIUrl":"10.1111/jgs.19175","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094349","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":"Editorial on: Protection against influenza hospitalizations from enhanced influenza vaccines among older adults: A systematic review and network meta-analysis.","authors":"Melissa K Andrew, Allison McGeer","doi":"10.1111/jgs.19248","DOIUrl":"https://doi.org/10.1111/jgs.19248","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559887","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":"Sex differences in patterns of potentially inappropriate prescribing and adverse drug reactions in hospitalized older people: Findings from the SENATOR trial.","authors":"Denis O'Mahony, Alfonso J Cruz-Jentoft, Adalsteinn Gudmundsson, Roy L Soiza, Mirko Petrovic, Antonio Cherubini, Stephen Byrne, Paula Rochon","doi":"10.1111/jgs.19071","DOIUrl":"10.1111/jgs.19071","url":null,"abstract":"<p><strong>Background: </strong>Older women experience more adverse drug reactions (ADRs) than older men. However, the underlying basis for this sex difference is unclear. Sex (biological status) and/or gender (sociocultural constructs) influences on patterns of inappropriate prescribing in multimorbid older adults may be one reason for this ADR sex difference. In this secondary analysis, we examined whether incident ADR sex differences could be related to concurrent sex differences in potentially inappropriate prescribing.</p><p><strong>Design and setting: </strong>A retrospective secondary analysis of sex differences in the prevalence of potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs), and ADRs among the 1537 participants (47.2% female, median [IQR] age 78 [72-84] years) was undertaken in the SENATOR clinical trial database, conducted in six large European medical centers.</p><p><strong>Participants and methods: </strong>We looked specifically for male/female differences relating to PIMs and PPOs (defined by STOPP/START version 2 criteria) identified within 48 h of acute hospitalization. We also assessed sex differences for ADRs identified at 14 days from admission or discharge, whichever came first. ADRs were assessed by blinded endpoint adjudication panel consensus.</p><p><strong>Results: </strong>During hospitalization, significantly more females experienced ≥1 ADR compared to males (28% and 21%, respectively; odds ratio 1.40, 95% CI 1.10-1.78, p < 0.005). Nine of the 11 STOPP-criteria PIMs showing a significant sex difference occurred more often in females. Of the four START-criteria PPOs showing a significant sex difference, all occurred more often in females. Some sex-associated PIMs reflect higher prevalence of related conditions in older women.</p><p><strong>Conclusion: </strong>We conclude that specific STOPP-criteria PIMs and START-criteria PPOs were identified more frequently in older women than older men during acute hospitalization, possibly contributing to higher ADR incidence in older women. Prescribers should appreciate sex differences in exposure to potentially inappropriate prescribing and ADR risk, given the preponderance of older women over older men in most clinical settings.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560620","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":"Identifying priority challenges of older adults with COPD: A multiphase intervention refinement study.","authors":"Anand S Iyer, Rachel D Wells, Avery C Bechthold, Margaret Armstrong, Ronan O'Beirne, Jun Y Byun, Jazmine Coffee-Dunning, J Nicholas Odom, Russell G Buhr, Angela O Suen, Ashwin A Kotwal, Leah J Witt, Cynthia J Brown, Mark T Dransfield, Marie A Bakitas","doi":"10.1111/jgs.19158","DOIUrl":"10.1111/jgs.19158","url":null,"abstract":"<p><strong>Background: </strong>Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well-being and independence.</p><p><strong>Objective: </strong>To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: Empowering People to Independence in COPD).</p><p><strong>Design: </strong>Multiphase study guided by Baltes Theory of Successful Aging and the 5Ms Framework: Phase 1: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. Phase 2: Rapid qualitative analysis. Phase 3: Intervention mapping and refinement.</p><p><strong>Setting: </strong>Ambulatory, virtual.</p><p><strong>Participants: </strong>Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders.</p><p><strong>Results: </strong>NGT sessions were conducted by constituency group with 37 participants (n = 7 patients, n = 6 family caregivers, n = 8 clinic staff, n = 9 clinicians, n = 7 health system leaders) (Phase 1). Participants generated 92 statements across five themes (Phase 2): (1) \"Barriers to care\", (2) \"Family caregiver needs\", (3) \"Functional status and mobility issues\", (4) \"Illness understanding\", and (5) \"COPD care complexities\". Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized \"Functional status and mobility issues\", family caregivers prioritized \"Family caregiver needs\", and clinicians and health system leaders prioritized \"COPD care complexities\". Intervention mapping (Phase 3) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities.</p><p><strong>Conclusions: </strong>Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, emerged as patient prioritized challenges.</p><p><strong>Implications: </strong>Patient-centered interventions for older adults with COPD must account for their prioritized functional and supplemental oxygen needs and explore diverse constituent perspectives to facilitate intervention enrichment.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116613","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":"Limitations in Geriatric Medicine Training on Hearing Loss.","authors":"Katherine Runkel, Prajakta Shanbhag, Steven Huart, Janna Hardland, Hillary D Lum","doi":"10.1111/jgs.19095","DOIUrl":"10.1111/jgs.19095","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731705","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":"Postoperative use of sleep aids and delirium in older adults after major surgery: A retrospective cohort study.","authors":"Su Been Lee, Chan Mi Park, Raisa Levin, Dae Hyun Kim","doi":"10.1111/jgs.19067","DOIUrl":"10.1111/jgs.19067","url":null,"abstract":"<p><strong>Background: </strong>Sleep aids are commonly prescribed to treat sleep disturbance, a modifiable risk factor for postoperative delirium in older patients. The use of melatonin receptor agonists in the postoperative period has been increasing. The comparative safety of melatonin receptor agonists, zolpidem, and temazepam remains uncertain.</p><p><strong>Methods: </strong>This retrospective study included 22,083 patients ≥65 years old who initiated melatonin receptor agonists, zolpidem, or temazepam after major surgery in the Premier Healthcare Database 2009-2018. We performed propensity score-based overlap weighting and estimated the risk ratio (RR) and risk difference (RD) of postoperative delirium as the primary outcome and a composite of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality as secondary outcomes.</p><p><strong>Results: </strong>The mean age of the study population was 78 (SD, 7) years and 50% were female. There was no significant difference in the risk of postoperative delirium among patients treated with melatonin receptor agonists (3.4%, reference group), zolpidem (2.9%; RR [95% CI], 0.9 [0.7-1.2]; RD [95% CI] per 100 persons, -0.3 [-1.1 to 0.6]), and temazepam (3.1%; 0.9 [0.7-1.1]; RD [95% CI] per 100 persons, -0.5 [-1.2 to 0.3]). The risks of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality were also similar among all groups.</p><p><strong>Conclusions: </strong>Melatonin receptor agonists were not associated with a lower risk of postoperative delirium and other adverse outcomes compared with zolpidem and temazepam in older adults after major surgery.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560619","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 effect of anxiety on all-cause dementia: A longitudinal analysis from the Hunter Community Study.","authors":"Kay Khaing, Xenia Dolja-Gore, Balakrishnan R Nair, Julie Byles, John Attia","doi":"10.1111/jgs.19078","DOIUrl":"10.1111/jgs.19078","url":null,"abstract":"<p><strong>Background: </strong>Anxiety is common, however, the effect of chronicity of anxiety on dementia has not been explored. This study aims to assess the longitudinal relationship between chronic versus resolved versus new onset anxiety, and all-cause dementia risk.</p><p><strong>Methods: </strong>A total of 2132 participants with mean age 76 years from the Hunter Community Study were recruited. Anxiety was measured using Kessler Psychological Distress Scale (K10). Dementia was defined as per International Classification of Disease-10 codes. The Fine-Gray subdistribution hazard model was computed to assess dementia risk, while adjusting for the competing risk of death.</p><p><strong>Results: </strong>Chronic anxiety and new onset anxiety at follow-up were associated with all-cause dementia risk (HR 2.80, 95% CI 1.35-5.72 and HR 3.20, 95% CI 1.40-7.45 respectively) with an average time to dementia diagnosis of 10 years (SD = 1.7) whereas resolved anxiety was not. In subgroup analyses, these results were driven particularly by chronic and new anxiety among participants below the age of 70 years (HR 4.58, 95% CI 01.12-18.81 and HR 7.21, 95%CI 1.86-28.02 respectively). Sensitivity analyses imputing missing data and addressing reverse causation gave very similar results.</p><p><strong>Conclusion: </strong>Chronic and new anxiety were associated with increased risk of all-cause dementia, and this association was significant in those 70 years and younger. However, the resolved anxiety at follow-up reduced the risk, similar to that of the non-exposed group. These results suggest that timely management of anxiety may be a viable strategy in reducing the risk of dementia.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753710","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":"Associations between hearing loss, peripheral neuropathy, balance, and survival in older primary care patients.","authors":"James W Mold, Frank H Lawler, Xiaolan Liao, David E Bard","doi":"10.1111/jgs.19142","DOIUrl":"10.1111/jgs.19142","url":null,"abstract":"<p><strong>Background: </strong>Both age-associated hearing loss (AAHL) and peripheral neuropathy (PN) are common in older patients, and both are associated with impaired balance, falls, and premature mortality. The objectives of this study were to document the prevalence and severity of AAHL in older primary care patients, and to explore associations between AAHL, PN, balance, falls, and mortality.</p><p><strong>Methods: </strong>We analyzed information obtained in 1999 from 793 primary care patients recruited from practices participating in the Oklahoma Longitudinal Assessment of the Health Outcomes of Mature Adults (OKLAHOMA) Studies. Available data included demographic and health information, history of falls and hospitalizations, audiometry, balance testing, examination of the peripheral nerves, 50 foot timed gait, and dates of death up to 22 calendar years and 8106 person-years of follow-up. Proportionate hazards (PH) and structural equation modeling (SEM) were used to examine associations between AAHL, PN, balance, gait time, and mortality.</p><p><strong>Results: </strong>501 of the 793 participants (63%) had AAHL. Another 156 (20%) had low frequency and 32 (4%) had unilateral deficits. Those with moderate or severe AAHL and the 255 (32%) with PN had impaired balance (p < 0.0001), increased gait time (p = 0.0001), and reduced survival time (p < 0.0001). In the PH model, both AAHL and PN were associated with earlier mortality (H.Rs. [95% C.I.]: 1.36 [1.13-1.64] and 1.32 [1.10-1.59] respectively). The combination of moderate or severe AAHL and PN, present in 24% of participants, predicted earlier mortality than predicted by either deficit alone (O.R. [95% C.I.I] 1.55 [1.25-1.92]). In the SEM models, the impacts of both moderate or severe AAHL and PN on survival were mediated, in part, through loss of balance.</p><p><strong>Conclusions: </strong>Hearing loss and PN, both common in older patients, appear to be independently and additively associated with premature mortality. Those associations may be mediated in part by impaired balance. The Mechanisms are likely multiple and complex.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984255","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":"Individual socioeconomic status, neighborhood disadvantage, and cognitive aging: A longitudinal analysis of the CLSA.","authors":"John R Best","doi":"10.1111/jgs.19155","DOIUrl":"10.1111/jgs.19155","url":null,"abstract":"<p><strong>Background: </strong>There are likely many contributors to variation in the rate of cognitive decline in middle and late adulthood, including individual and neighborhood socio-economic factors. This study examines whether individual socio-economic factors, namely income and wealth, correlate with cognitive decline, in part, through neighborhood-level social and material disadvantage.</p><p><strong>Methods: </strong>Using the three waves of data collection from the Canadian Longitudinal Study on Aging (CLSA), this study included 51,338 participants between the age of 45 and 85 years at baseline (51% female). Individual socio-economic status (SES) was assessed by annual household income and by the current value of savings and investments. Neighborhood disadvantage was measured by area-based material and social deprivation indices. Cognition was measured at each wave using verbal fluency, mental alternations, and delayed word recall. Latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of individual SES on cognitive change through area-level disadvantage. Multi-group models were constructed on the basis of age-group (45-64 years; 65-74 years; or 75+ years) to allow for varying estimates across age.</p><p><strong>Results: </strong>Among 45-64-year-olds, income and wealth had indirect effects on initial cognitive level and on rate of cognitive decline through material disadvantage (standardized indirect effects = 0.01, p < 0.001), but only wealth had an indirect effect through social disadvantage (p = 0.019). Among 65-74-year-olds, income and wealth had indirect effects on initial cognitive level (p < 0.01) but not on rate of cognitive decline (p > 0.05), and among 75+ year-olds, no indirect effects were observed (p > 0.05). Wealth and income had direct effects, independent of neighborhood disadvantage, on cognition in all age groups (p < 0.05).</p><p><strong>Conclusions: </strong>Among middle-aged adults, greater individual SES may mitigate cognitive decline, in part, by allowing individuals to live in more materially and socially advantaged neighborhoods.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038126","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":"Veterans' use of inpatient and outpatient palliative care: The national landscape.","authors":"Brystana G Kaufman, Sandra Woolson, Catherine Stanwyck, Madison Burns, Paul Dennis, Jessica Ma, Shelli Feder, Joshua M Thorpe, S Nicole Hastings, David B Bekelman, Courtney H Van Houtven","doi":"10.1111/jgs.19141","DOIUrl":"10.1111/jgs.19141","url":null,"abstract":"<p><strong>Background: </strong>Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters).</p><p><strong>Methods: </strong>This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010-2017) to describe veteran demographics, socioeconomic status, life-limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241-99245).</p><p><strong>Results: </strong>Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (n = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (n = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64).</p><p><strong>Conclusions: </strong>This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one-third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047671","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}