Journal of the American Geriatrics Society最新文献

{"title":"Implementation of Lecanemab for Alzheimer's Disease Within the Veterans Health Administration: Facilitators and Barriers.","authors":"Alison J O'Donnell, Alexandra T Fortunato, Brittany L Spitznogle, Naveen M Reddy, Shaye A Kerper, Steven M Handler","doi":"10.1111/jgs.19577","DOIUrl":"https://doi.org/10.1111/jgs.19577","url":null,"abstract":"<p><strong>Background: </strong>Several amyloid targeting therapies have been approved for Alzheimer's disease (AD), including lecanemab (Leqembi). However, real-world implementation of these drugs has uncovered significant challenges.</p><p><strong>Methods: </strong>We conducted a national cross-sectional survey of healthcare professionals from multiple disciplines participating in the Veteran's Health Administration (VHA) AD Therapeutics Community of Practice. The goal of the survey was to identify facilitators and barriers to the implementation of lecanemab within their respective medical centers. The web-based survey was open from September 17, 2024 to October 4, 2024.</p><p><strong>Results: </strong>Surveys were sent to 128 healthcare team members with 44 responders (34% response rate). Of the responders, the majority were physicians (59%, n = 26) or pharmacists (25%, n = 11). In all, 41% indicated that they were currently administering lecanemab (n = 18), 32% were planning on administering lecanemab (n = 14), 20% were unsure if they would be administering lecanemab (n = 9), and 7% did not plan on offering the medication (n = 3). The five most common facilitators to implementation of lecanemab included pharmacist support (57%, n = 25), infusion center access and support (57%, n = 25), having a program champion (43%, n = 19), collaboration with other VHA medical centers implementing lecanemab (43%, n = 19), and access to advanced imaging such as amyloid positron emission tomography (PET) scans (43%, n = 19). The most common barrier to implementation of lecanemab identified by 45% of participants (n = 20) was lack of staff to monitor treatment. Other common barriers included challenges with stakeholder engagement (27%, n = 12), issues with identifying patients who qualify for lecanemab (27%, n = 12), lack of access to advanced imaging (25%, n = 11), and lack of neuroradiology support (23%, n = 10).</p><p><strong>Conclusions: </strong>Attention to identified facilitators and barriers may be helpful for facilities implementing amyloid targeting therapy for AD.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268271","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":"Exploring Antipsychotic Initiation Among Persons Living With Dementia in a Comprehensive Dementia Care Program.","authors":"David R Lee, Grace Sassana-Khadka, Tahmineh Romero, Betsy Yang, Katherine Sy Serrano, Andrea Centeno, David B Reuben","doi":"10.1111/jgs.19569","DOIUrl":"https://doi.org/10.1111/jgs.19569","url":null,"abstract":"<p><strong>Background: </strong>Antipsychotic medications (APMs) are frequently prescribed for persons living with dementia despite limited benefits and increased risks. This study examined patient characteristics of those prescribed APMs, indications for initiation, and survival outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study of community-dwelling patients enrolled in a comprehensive dementia care program (2012-2014) focused on 190 patients not on an APM at baseline, with survival analyses including 200 additional patients on an APM at program entry. Patients were followed for 2 years for APM initiation and until January 2024 for mortality. Baseline measures included patient and caregiver demographics, Mini-Mental State Exam (MMSE), Functional Activities Questionnaire (FAQ), Modified Caregiver Strain Index (MCSI), caregiver Patient Health Questionnaire-9 (PHQ-9), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Indications for APM initiation were abstracted from electronic health records. Logistic regression models examined associations between baseline characteristics and APM initiation. Survival was assessed using Kaplan-Meier estimates and Cox proportional hazards models.</p><p><strong>Results: </strong>Among 190 patients (mean [SD] age, 81.2 [8.4] years; 60% female, and 80% Alzheimer's or dementia not otherwise specified) who were not on APMs at program enrollment, 65 (34%) initiated and 125 (66%) did not initiate an APM. NPI-Q severity (AOR 1.10, 95% CI 1.04-1.16) and NPI-Q distress (AOR 1.06, 95% CI 1.02-1.10) were associated with APM initiation. Agitation and psychotic symptoms were the most common indications, with quetiapine being the most frequently prescribed APM. Median survival was 37.8 months (IQR 19.3-63.2) for patients on an APM at baseline, 63.1 months (IQR 28.4-86.8) for patients initiating an APM, and 68.9 months (IQR 50-97.9) for patients not initiating an APM (p < 0.001).</p><p><strong>Conclusions: </strong>APM initiation was common despite enrollment in a comprehensive dementia care program that prioritizes non-pharmacologic strategies. Survival differences underscore the need for risk-benefit discussions of APMs and goals of care discussions with caregivers.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251657","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":"Ambulatory Care Sensitive Hospitalizations and Disparities Among Older Adults With Dementia Before and During the Pandemic.","authors":"Shubing Cai, Qiuyuan Qin, Peter Veazie, Yeates Conwell, Helena Temkin-Greener","doi":"10.1111/jgs.19573","DOIUrl":"https://doi.org/10.1111/jgs.19573","url":null,"abstract":"<p><strong>Background: </strong>Older adults with Alzheimer's disease and related dementias (ADRD) are frequently hospitalized with ambulatory care-sensitive conditions (ACSCs). Disparities in ACSC hospitalizations have been documented, but the impact of the COVID-19 pandemic on ACSC hospitalizations and disparities of older adults with ADRD is unclear, particularly, across different racial, ethnic, and socioeconomic groups. This study examined changes in ACSC hospitalizations among community-dwelling older adults with ADRD before and during the pandemic and how these changes vary by race, ethnicity, and Medicare-Medicaid dual eligibility status.</p><p><strong>Methods: </strong>This observational study linked Medicare data with publicly available sources. The study sample included Medicare fee-for-service community-dwelling older adults aged 65 and older with ADRD in 2019 or 2021. The primary outcome was whether an individual had any ACSC hospitalizations in a given year (0/1). Secondary outcomes included any non-COVID-19-related hospitalizations and death (0/1). We used linear probability models with zip-code random effects, accounting for individual and community characteristics.</p><p><strong>Results: </strong>The study included 2.35 million beneficiaries in 2019 and 1.85 million in 2021. Non-COVID-19-related hospitalizations decreased from 24.0% in 2019 to 20.4% in 2021, while ACSC hospitalizations fell from 23.0% to 19.0% among those who were hospitalized. In 2019, Black and Hispanic individuals had 2.0 and 1.6 percentage points higher probabilities of ACSC hospitalization (p < 0.001), respectively, compared to White individuals, and dual-eligibles had a 2.8 percentage-point higher probability than non-dual-eligibles (p < 0.001). During the pandemic, overall hospitalizations and ACSC hospitalizations decreased, with dual-eligibles experiencing an additional 2.1 percentage-point reduction in ACSC hospitalizations(p < 0.001). Meanwhile, dual-eligibles experienced a 1.5 percentage-point increase in mortality rate in 2021 compared to 2019 (p < 0.001).</p><p><strong>Conclusion: </strong>Racial and ethnic minorities and the socioeconomically disadvantaged older adults with ADRD were more likely to experience ACSC hospitalizations compared to their counterparts before the pandemic.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251656","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":"AGE-PAIRS: Pilot of an Aging Education Mentorship Program Between Older Medical School Alumni and Medical Students.","authors":"Micayla N Flores, Louise Aronson, Andrea Wershof Schwartz","doi":"10.1111/jgs.19556","DOIUrl":"https://doi.org/10.1111/jgs.19556","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251655","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 Inflammation and Multisensory Impairment Among Older Adults.","authors":"Willa D Brenowitz, Christina R Sheppler, Yue Leng, Kristine Yaffe","doi":"10.1111/jgs.19547","DOIUrl":"https://doi.org/10.1111/jgs.19547","url":null,"abstract":"<p><strong>Background: </strong>Impairment in multiple senses (multisensory impairment) is common in older adults but the underlying mechanisms are unclear. We evaluated whether common blood-based markers of inflammation (e.g., Interleukin 6 (IL-6), C-Reactive Protein (CRP), and Tumor Necrosis Factor Alpha (TNF-α)) were associated with multisensory impairment.</p><p><strong>Methods: </strong>We analyzed data from 1674 participants in the Health, Aging, and Body Composition Study, a prospective cohort study of Black and White older adults who were aged 70-79 at enrollment. IL-6, CRP, and TNF-α were assayed from blood samples at Year 1. Sensory function in 4 domains was assessed in Years 3-5; impairment was defined with clinical cut-points. Vision was measured by visual acuity and contrast sensitivity; hearing by pure tone audiometry (500, 1000, 2000, and 4000 Hz); smell by the 12-item Cross Cultural Smell Identification Test; and touch by vibration detection threshold and monofilament of the big toe. A previously developed multisensory impairment score (0-12) was calculated based on sample quartiles and summed across sensory domains. Regression models evaluated the associations of inflammation markers with individual and multiple sensory impairments (as separate outcomes) with adjustment for demographics, health conditions, and health behaviors.</p><p><strong>Results: </strong>Higher CRP (ß = 0.07; 95% CI: 0.01-0.12; p = 0.01) and IL-6 (ß = 0.11; 95% CI: 0.04-0.18; p = 0.003) levels were associated with the number of sensory impairments. Participants with the highest quartile of IL-6 (OR = 1.45; 95% CI: 1.09-1.92; p = 0.01) and TNF-α (OR = 1.46; 95% CI: 1.12-1.91; p = 0.005) had higher odds of a poor multisensory impairment score. High CRP was associated with impaired vision (OR = 1.45; 95% CI:1.08-1.93; p = 0.01) and high TNF-α was associated with touch impairment (OR = 1.63; 95% CI:1.15-2.30; p = 0.006). Having multiple high markers was also associated with multisensory (OR: 1.76; 95% CI: 1.20-2.58; p = 0.004) and vision impairment (OR: 1.55; 95% CI: 1.13-2.13; p = 0.004).</p><p><strong>Conclusions: </strong>Markers of inflammation were associated with multisensory impairment, but there were fewer associations with individual sensory impairments.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236308","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 Idea of Health.","authors":"Jeremiah A Barondess","doi":"10.1111/jgs.19514","DOIUrl":"https://doi.org/10.1111/jgs.19514","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236311","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":"Mapping the Final Journey: End-Of-Life Frailty Trajectories and Cause of Death.","authors":"Jianhong Xu, Jonathan Ka-Long Mak, Qian-Li Xue, Chenkai Wu","doi":"10.1111/jgs.19567","DOIUrl":"https://doi.org/10.1111/jgs.19567","url":null,"abstract":"<p><strong>Background: </strong>Frailty changes associated with aging have been well-documented in existing research. However, there is limited evidence on how frailty progresses during the end-of-life stage. We aimed to explore trajectories of frailty in the last year of life and explore how the distribution of these trajectories differs according to the conditions leading to death.</p><p><strong>Methods: </strong>Based on national death registries linkage data in the UK Biobank, 37,465 decedents were included in the analytic sample. Monthly frailty scores were obtained for 1 year prior to death using the Hospital Frailty Risk Score (HFRS; a cumulative deficit measure of frailty). Latent class trajectory models were used to estimate trajectories of frailty. We further analyzed the distribution of these frailty trajectories across different conditions leading to death. Multinomial logistic regression models were applied to examine the associations between predictors and frailty trajectories.</p><p><strong>Results: </strong>Among 37,465 decedents, 2895 (7.7%) died from neurodegenerative diseases. Three distinct frailty trajectories were identified among these decedents: rapidly progressive frailty (6.9%), moderate progression of frailty (21.1%), and advanced and stable frailty (72.0%). These patterns differed significantly from those observed in decedents with other causes of death, who exhibited persistently low frailty (24.7%), intermediate and progressive frailty (46.5%), and advanced and progressive frailty (28.8%). Compared to cancer decedents, individuals with neurodegenerative diseases had higher baseline frailty and a dominant trajectory of advanced and stable frailty. Older age, lower education, and greater chronic disease burden were associated with the advanced and progressive frailty trajectory.</p><p><strong>Conclusions: </strong>Frailty trajectories at the end of life varied by cause of death, with neurodegenerative disease decedents exhibiting more severe frailty. These findings underscored the need for early identification of frailty and tailored end-of-life care strategies, particularly for individuals with neurodegenerative diseases who often experienced prolonged and severe frailty.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236310","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":"Under Documentation of Anemia in Older Ambulatory Patients.","authors":"Min Woo Hwang, Hirra A Chaudhary, William B Ershler","doi":"10.1111/jgs.19503","DOIUrl":"https://doi.org/10.1111/jgs.19503","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236313","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":"Does Documenting a Dementia Diagnosis Improve Outcomes?","authors":"Jerry H Gurwitz","doi":"10.1111/jgs.19557","DOIUrl":"https://doi.org/10.1111/jgs.19557","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236309","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":"Transitional Care Management in Persons With Dementia After Heart Failure Hospitalization and Skilled Nursing Facility Care.","authors":"Thomas A Bayer, Hiren Varma, Peter A Hollmann, Pedro L Gozalo","doi":"10.1111/jgs.19563","DOIUrl":"https://doi.org/10.1111/jgs.19563","url":null,"abstract":"<p><strong>Background: </strong>Dementia complicates care transitions, such as discharge from heart failure hospitalization to a skilled nursing facility (SNF) and then to home. Transitional care management (TCM), a bundled service that includes telephone communication within 2 business days and an office visit within 14 days, potentially addresses this problem.</p><p><strong>Methods: </strong>We analyzed trends in TCM among Medicare beneficiaries with dementia hospitalized for heart failure in 2013-2017, comparing hospital-home discharges to hospital-SNF-home discharges. We then used a retrospective cohort study to estimate the risk-adjusted association of TCM with successful discharge home.</p><p><strong>Results: </strong>TCM occurred in 45 (2.3%) of 1990 eligible hospital-SNF-home discharges in year 2013, increasing to 205 (9.8%) of 2095 eligible in year 2017. In a cohort of 11,376 hospital-SNF-home transitions, the relative risk (95% CI) of successful community discharge was 1.24 (1.11-1.40) with TCM compared with no office visit within 14 days of discharge or TCM.</p><p><strong>Conclusions: </strong>Persons with dementia transitioning from heart failure hospitalization to SNF to home receive TCM less frequently than persons discharged directly home from the hospital. Nonetheless, TCM is associated with successful discharge in this vulnerable group of patients.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236312","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}