Journal of the American Geriatrics Society最新文献

{"title":"\"By the Time We Knew …\": Poetic Analysis of End-of-Life Caregiving Experiences for Rapidly Progressive and Slower-Duration Dementia Syndromes.","authors":"Krista L Harrison, Brianna E Morgan, Juliana Friend, Sarah B Garrett, David Looi, Madina Halim, Jennifer E James, Nicole D Boyd, Joni Gilissen, Michael D Geschwind, Christine S Ritchie, Alexander K Smith","doi":"10.1111/jgs.19382","DOIUrl":"10.1111/jgs.19382","url":null,"abstract":"<p><strong>Background: </strong>One in three older adults in the United States dies with or from dementia. Little is known about whether end-of-life caregiving experiences differ by dementia diagnosis.</p><p><strong>Methods: </strong>We conducted a secondary analysis of two qualitative studies. Participants included caregivers of decedents with \"rapid-type\" sporadic Creutzfeldt-Jakob Disease (sCJD, survival prognosis of < 1 year) or \"slow-type\" Alzheimer's disease and related dementias (survival prognosis of 5-20 years). We used reflexive thematic analysis and a novel method, poetic analysis, to compare end-of-life caregiving experiences.</p><p><strong>Results: </strong>\"Rapid-type\" caregivers (n = 12) had a median age of 59 (range 45-73) years; 6 were female, and 9 were spouses. \"Slow-type\" caregivers (n = 15) had a median age of 69 (45-82) years; 9 were female, and 11 were spouses. We identified three main areas of differential experience that were influenced by syndrome rarity and participation in research yet hinged on time. Time enables preparation: Due to the rarity of sCJD, \"rapid-type\" caregivers struggled to obtain accurate diagnoses, which prevented preparation for end-of-life care. Weeks or months before death, specialists simultaneously disclosed sCJD diagnoses and recommended hospice. In contrast, for \"slow-type\" dementia, preparation began years before death. Time complicates conflict: Most \"rapid-type\" caregivers described conflicts, rarely resolved before death, about code status, treatment, or care location decisions. Fewer \"slow-type\" caregivers experienced such conflicts, and these were typically resolved before death; instead, they experienced conflict between needs and what the care system provides. Postmortem experience contrasts with perimortem: For \"rapid-type\" dementia, short perimortem periods contrasted with elongated and often intense postmortem logistics and grief. For \"slow-type\" caregivers, preparation and perimortem grieving typically led to shorter duration and minimally intrusive postmortem logistics and grief.</p><p><strong>Conclusions: </strong>End-of-life care for dementia should attend to and support axes of differential experience based on diagnosis and rarity, time since symptom onset (affecting preparation and conflict resolution), and participation in research studies.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191667","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 of Accelerometer-Measured Physical Activity With Dementia, Anxiety, and Depression Among Older Adults.","authors":"Eric L Stulberg, Lin-Na Chou, Shweta Gore, Molly B Conroy, Jennifer J Majersik, Katherine J Hunzinger, Alexander LaPoint, Mandeep Kaur Sandhu, Andrea L C Schneider, Amit Kumar","doi":"10.1111/jgs.19383","DOIUrl":"https://doi.org/10.1111/jgs.19383","url":null,"abstract":"<p><strong>Background: </strong>Higher physical activity (PA) is associated with better neuropsychiatric health, but prior studies have been limited by cross-sectional designs, self-reported PA measures, and small numbers of older individuals. We examined associations between baseline and changes in accelerometer-measured moderate-vigorous PA (MVPA) with neuropsychiatric health among individuals aged ≥ 70 years in the National Health and Aging Trends Study.</p><p><strong>Methods: </strong>We used the average daily minutes of accelerometer-measured MVPA above a validated threshold of 2184 counts per minute as a continuous measure at baseline for the exposure variable. For longitudinal analyses, we categorized change in MVPA as follows: an increase of > 20 min/day over 1 year, a decrease of > 20 min/day over 1 year, and staying within 20 min/day over 1 year. Our outcomes were possible/probable dementia and anxiety or depression. Associations were estimated using confounder-adjusted logistic regressions.</p><p><strong>Results: </strong>In our survey-weighted analytic sample of 639 individuals aged ≥ 70 years, 56% were ≥ 75 years, and 53% were female. After adjusting for confounders, a 20-min/day higher baseline MVPA was significantly associated with lower odds of possible/probable dementia 1 year later (odds ratio [OR] = 0.89, 95% confidence interval [CI] = 0.83-0.96) but not with depression and anxiety symptoms. Compared to no change in PA over 1 year, an increase in MVPA by > 20 min/day was associated with decreased odds of depression and anxiety symptoms (OR = 0.06, 95% CI = 0.03-0.14) but not with possible/probable dementia. Compared to no change in MVPA over 1 year, a decrease in MVPA by > 20 min/day was associated with higher odds of possible/probable dementia (OR = 3.82, 95% CI = 1.34-10.87) but not with depression and anxiety symptoms.</p><p><strong>Conclusions: </strong>Higher and increasing MVPA over time is associated with better neuropsychiatric health in individuals aged ≥ 70 years. Future studies should prioritize evaluating detailed PA trajectories to better understand how different doses, intensities, and modalities of PA impact neuropsychiatric decline in older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191681","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":"Implementing in VA CLCs Is Complex, We Know!","authors":"Rhonda L Toms, Courtney A Huhn, Scotte R Hartronft","doi":"10.1111/jgs.19380","DOIUrl":"https://doi.org/10.1111/jgs.19380","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191683","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":"Vestibular Suppressant Utilization and Subsequent Falls Among Patients 65 Years and Older With Dizziness in the United States.","authors":"Schelomo Marmor, Pinar Karaca-Mandic, Meredith E Adams","doi":"10.1111/jgs.19377","DOIUrl":"https://doi.org/10.1111/jgs.19377","url":null,"abstract":"<p><strong>Background: </strong>Falls pose a significant public health threat to older adults. Due to potential fall risk, guidelines recommend against the routine prescription of several medications commonly used for vestibular suppression, including meclizine and benzodiazepines.</p><p><strong>Aims: </strong>We aimed to determine the factors associated with vestibular suppressant utilization among patients with dizziness ≥ 65 years of age and subsequent falls.</p><p><strong>Methods and results: </strong>A retrospective longitudinal database of US commercial insurance and Medicare beneficiaries was used to study medical claims data (January 1, 2006, through December 31, 2015). Of 190,348 individuals ≥ 65 years old who presented with dizziness, 60,658 (32%) filled a vestibular suppressant prescription (27% anti-emetics, 73% anxiolytics), of which 20,448 were women (34%) within a month after their dizziness diagnosis. Of those individuals using suppressants, 8% experienced a fall resulting in a medical encounter within 60 days of filling the prescription. After adjusting for sociodemographics and comorbidity, individuals with dizziness who received vestibular suppressants were more likely to experience recorded fall incidents (hazard ratio (HR) 3.33, confidence interval (CI) 1.93-5.72, p < 0.0001), than those who did not receive vestibular suppressants.</p><p><strong>Conclusions: </strong>Although vestibular suppressants may provide immediate relief from symptoms during an acute vestibular crisis, use is incongruent with guideline-concordant care for most vestibular diagnoses and is also potentially counterproductive and injurious. Multi-faceted interventions that engage clinicians and patients are needed to improve the value of care for patients with vestibular disorders to de-implement the routine use of suppressants for dizziness.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191686","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 Comprehensive, Home-Based, Fall Prevention Initiative: Preliminary Data From the Raise'Age Program.","authors":"Amal Aïdoud, Jaques-Alexis Nkodo, Wassim Gana, Camille Debacq, Natacha Michel, Pierre Deneau, Calyssa Trézy, Nicolas Guyot, Matthieu Coulongeat, Bertrand Fougère","doi":"10.1111/jgs.19350","DOIUrl":"https://doi.org/10.1111/jgs.19350","url":null,"abstract":"<p><strong>Background: </strong>Although falls among older adults pose substantial health risks and are often preventable, many fallers do not seek medical care. The Raise'Age program addresses this challenge by offering proactive fall prevention for older adults who require \"lift assistance\" but are not taken to hospital. The program includes (i) screening by emergency medical services (EMSs), (ii) referrals for a comprehensive geriatric assessment, (iii) in-home evaluations by a mobile geriatric team (MGT), and (iv) referrals to primary care physicians (PCPs). Here, we outline the program's design, development, and implementation.</p><p><strong>Methods: </strong>The program's activity in 2023 was assessed with regard to the number of EMS fall reports, the reports' completeness, the program's eligibility, and acceptance by physicians and patients, in-home assessments, adherence to geriatric follow-up programs, and coordination delays.</p><p><strong>Results: </strong>In 2023, the Raise'Age program received 959 reports, accounting for 48% of lift assistances by paramedics. Of these, 37% of the reports were reviewed for eligibility. Reports were often archived due to irrelevance, a recent hospital stay, or difficulty contacting PCPs. Among eligible reports, 77% were approved for in-home evaluations, and the remainder were referred to a geriatrician or scheduled for hospital admission. The median processing time was 26 days. Of 228 patients eligible for home visits, 150 accepted the intervention. Visit acceptance rates were higher when a PCP endorsed the program. Follow-up was provided to 36% of the patients- primarily via teleconsultation. Finally, 15.6% of the patients for whom a lift assistance report was sent to the MGT completed the Raise'Age program.</p><p><strong>Conclusions: </strong>The Raise'Age program demonstrates that EMS screening and collaboration with MGTs are feasible, although some patients may decline the services offered. Continuous evaluations and interventions by MGTs and referrals to community-based medical and social services effectively address the needs of older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191668","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":"Racial and Ethnic Differences in Low-Value Care Among Older Adults in a Large Statewide Health System.","authors":"Carlos Irwin A Oronce, Ray Pablo, Susi Rodriguez Shapiro, Phyllis Willis, Ninez Ponce, John N Mafi, Catherine Sarkisian","doi":"10.1111/jgs.19369","DOIUrl":"10.1111/jgs.19369","url":null,"abstract":"<p><strong>Background: </strong>As value-based payment models incorporate both measures of health equity and low-value care (LVC), understanding how LVC varies by race is vital for interventions. Therefore, we measured racial differences in LVC in a contemporary sample.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of claims from adults ≥ 55 years receiving care at five academic medical centers in California from 2019 to 2021. Our sample included patients who received a service that could be classified as LVC. The primary outcome was whether a service was classified as LVC. Secondary outcomes included clinical categories of LVC (preventive screening, diagnostic testing, prescription drugs, and preoperative testing). We examined associations between race/ethnicity with outcomes using multivariable regression models adjusted for patient characteristics and medical center.</p><p><strong>Results: </strong>Among 15,720 members who received potentially LVC, non-Hispanic White older adults comprised 59% of the sample, followed by Asian (17%), unknown race (8%), Latino (8%), non-Hispanic Black (5%), other race (2%). In adjusted models, Asian (-4.9 percentage points [pp]; 95% CI -5.9, -3.8 pp), Black (-5.4 pp; 95% CI -8.0, -2.7 pp), and Latino (-2.5 pp; 95% CI -4.6, -0.4 pp) older adults were less likely to receive LVC compared to White older adults, specifically preventive and preoperative services. Asian, Black, and Latino older adults, however, were more likely to receive low-value prescriptions.</p><p><strong>Conclusions: </strong>These diverging racial patterns in LVC across different measures likely reflect differential mechanisms, underscoring the need to use clinically specific measures rather than composite measures, which obscure underlying heterogeneity and could lead to potentially harmful and inequity-producing interventions.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082897","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":"Aligning Medications With What Matters Most: Conversations Between Pharmacists, People With Dementia, and Care Partners.","authors":"Ariel R Green, Rosalphie Quiles Rosado, Andrea E Daddato, Aleks Wec, Kathy Gleason, Tobie Taylor McPhail, Jessica Merrey, Linda Weffald, Meghan Swarthout, Scott Feeser, Cynthia M Boyd, Jennifer L Wolff, Marcela D Blinka, Elizabeth A Bayliss, Rebecca S Boxer","doi":"10.1111/jgs.19379","DOIUrl":"10.1111/jgs.19379","url":null,"abstract":"<p><strong>Introduction: </strong>Successful deprescribing for people with dementia (PWD) depends on communication about medication-related priorities between PWD, care partners and clinicians. The objective of this study was to gain in-depth knowledge of how elicitation of PWD and care partner medication-related priorities during a deprescribing intervention shaped discussions with pharmacists about medications.</p><p><strong>Methods: </strong>Qualitative analysis of audio-recorded interactions between pharmacists and patient-care partner dyads in a pilot study of a pharmacist-led deprescribing intervention for PWD in primary care. Patients ≥ 65 years taking ≥ 7 medications and care partners were recruited from an integrated delivery system in Colorado and a community-based medical practice in Maryland. Qualitative content analysis was used to analyze 82 transcripts from encounters with 55 patient-care partner dyads.</p><p><strong>Results: </strong>The mean (SD) age of PWD was 81 (8.1) years; 45% were women, 33% Black, and 15% Hispanic. PWD took an average of 13 (±5.3) medications at baseline. Care partners were on average 66 (13) years of age and most were spouses/partners of the PWD. Content analysis identified five themes: (1) Reducing medication-related treatment burden; (2) Alleviating burdensome symptoms; (3) Maintaining cognition and function; (4) Discussion of tradeoffs; (5) Challenges to deprescribing. After eliciting patient and care partner priorities, pharmacists recommended both deprescribing and prescribing.</p><p><strong>Conclusion: </strong>Findings from this secondary analysis of a pilot deprescribing intervention suggest eliciting medication-related priorities of PWD and care partners can support goal-concordant care. These results can inform development of interventions to optimize medications for this population.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082872","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":"Enhancing Geriatric Assessment in Cancer Rehabilitation: Suggestions for Future Research.","authors":"Qing Su, Xiaofeng Zeng","doi":"10.1111/jgs.19384","DOIUrl":"https://doi.org/10.1111/jgs.19384","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076792","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":"Response to: \"Enhancing Geriatric Assessment in Cancer Rehabilitation: Suggestions for Future Research\".","authors":"Supriya Mohile, Rachelle Brick, Marielle Jensen-Battaglia, Brennan P Streck, Lindsey Page, Eva Culakova","doi":"10.1111/jgs.19385","DOIUrl":"https://doi.org/10.1111/jgs.19385","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076793","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":"Prevalence and Determinants of Sarcopenia Among Older Adults in India: Insights From the Longitudinal Aging Study in India.","authors":"Abhijith R Rao, Manjusha Bhagwasia, Vishwajeet Singh, Swati Bajpai, Sunny Singhal, Prasun Chatterjee, Avinash Chakrawarty, Sharmishtha Dey, Aparajit Ballav Dey","doi":"10.1111/jgs.19373","DOIUrl":"https://doi.org/10.1111/jgs.19373","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia, characterized by declining muscle mass and function, is a growing concern among India's aging population. This study investigates sarcopenia's prevalence and determinants using the nationally representative LASI dataset.</p><p><strong>Methods: </strong>This analysis included 26,780 community-dwelling adults aged 60 and above, with informed consent obtained from all participants. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Demographic, socioeconomic, health, and geriatric factors, including age, sex, living arrangements, economic status, comorbidities, and geriatric syndromes, were examined. Multinomial logistic regression was used to analyze associations with sarcopenia and severe sarcopenia, and results were expressed as relative risk ratios (RRR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>The prevalence of sarcopenia was 43.6% (n = 11,665), and 19.4% (n = 5202) had severe sarcopenia. Sociodemographic factors significantly associated with sarcopenia and severe sarcopenia included being widowed (RRR: 1.24, 95% CI: 1.12-1.37 for sarcopenia; RRR: 1.82, 95% CI: 1.64-2.03 for severe sarcopenia) or divorced (RRR: 1.68, 95% CI: 1.12-2.54 for severe sarcopenia). Additionally, a higher BMI and higher education level were associated with a lower risk of sarcopenia. Among comorbidities, joint and bone diseases were linked to both sarcopenia (RRR: 1.21, 95% CI: 1.07-1.35) and severe sarcopenia (RRR: 1.4, 95% CI: 1.23-1.58), while hypertension (RRR: 1.22, 95% CI: 1.1-1.36), chronic lung disease (RRR: 1.22, 95% CI: 1.02-1.44), and cerebrovascular accident (RRR: 1.5, 95% CI: 1.09-2.08) were specifically associated with severe sarcopenia. Geriatric syndromes such as tooth loss, impaired vision and hearing, history of falls, and depression were significantly associated with increased risk of sarcopenia.</p><p><strong>Conclusion: </strong>This study reveals significant associations between sarcopenia and various sociodemographic factors, comorbidities, and geriatric syndromes in older adults in India, suggesting potential areas for targeted intervention. However, further longitudinal studies are needed to validate these findings and clarify the causal relationships of the observed associations.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070568","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}