Journal of the American Geriatrics Society最新文献

{"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}

{"title":"Appetite Loss, Inflammation, and Incident Functional Loss Among Community-Dwelling Older Adults.","authors":"Germine Soliman, Xiaomin Lu, Emil Coman, Zeyu Hu, Berno Diniz, Anne B Newman, Eleanor Simonsick, Shanshan Yao, George A Kuchel, Lisa C Barry","doi":"10.1111/jgs.70778","DOIUrl":"https://doi.org/10.1111/jgs.70778","url":null,"abstract":"<p><strong>Background: </strong>Aging is associated with both reduced appetite and increased inflammation. Whether and how these factors contribute to or exacerbate functional decline in older adults is unclear.</p><p><strong>Methods: </strong>Data from 3073 men and women aged 70-79 years participating in the Health, Aging, and Body Composition (Health ABC) with reported appetite (good or poor) and inflammatory markers (Interleukin (IL)-6, tumor necrosis factor (TNF)-α and C-reactive protein (CRP)) at baseline were followed for up to 6 years to determine if they developed Persistent Lower Extremity Limitation (PLL), defined as two consecutive reports of difficulty walking a quarter mile and/or climbing 10 steps without resting 6 months apart, using Fine-Gray Proportional hazards models adjusted for demographics, chronic diseases, anxiety, depression, medications, and sensory factors.</p><p><strong>Results: </strong>A total of 388 (12.6%) participants reported impaired appetite. These individuals were mainly female (59%), Black (54%), with a mean age of 73.9 (±3) years. Those with impaired appetite vs. good appetite were more likely to develop PLL (64% vs. 47%; p < 0.001) and had higher IL-6, TNF-α, and CRP levels (p < 0.001 for each). Cumulative incidence curves showed that 40% and 20% of those with impaired and good appetite, respectively, developed PLL by 18 months. Subjects with impaired appetite experienced a higher risk of developing PLL (hazard ratio, adjusted = 1.44; 95% CI = 1.2, 1.7), as did those with elevated inflammatory markers. Cumulative incidence curves indicated that individuals with impaired appetite and elevated CRP, IL-6, and TNF-α experienced the fastest onset of functional loss, reaching 50% at around 12 months, and nearly all had mobility limitations by 32 months.</p><p><strong>Conclusion: </strong>Impaired appetite and increased inflammatory biomarkers are independently linked to mobility loss. Appetite impairment might signal early nutritional and supportive care needs, but inflammation-targeted interventions require further study.</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":"149170970","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":"Effect of Recognition of Hearing Loss Among Care Recipients on Caregiver Reported Care Outcomes.","authors":"Gianna Rodriguez, Wuyang Zhang, Emmanuel E Garcia Morales, Nicholas S Reed, Danielle S Powell","doi":"10.1111/jgs.70756","DOIUrl":"https://doi.org/10.1111/jgs.70756","url":null,"abstract":"<p><strong>Background: </strong>Hearing loss (HL) is common in older adults, but many do not recognize how it affects communication. This lack of recognition may limit caregivers' ability to provide effective support, since communication is central to caregiving. This study examined whether care recipients' HL recognition is associated with caregiver burden and psychosocial well-being.</p><p><strong>Methods: </strong>We used the Round 13 (2023) data from NHATS and NSOC, including 1480 caregivers assisting 960 older adults. HL status was classified as: unrecognized HL (audiometric HL without self-reported difficulty), recognized HL (audiometric HL with self-reported difficulty or hearing aid use), and no HL (normal audiometry). Caregiver outcomes included emotional, financial, and physical burden; relationship quality; PHQ-4 well-being; and restrictions in leisure and social activities. We further examined differences by HL severity and hearing aid use.</p><p><strong>Results: </strong>Among caregivers, 47% supported older adults with unrecognized HL, 34% recognized HL, and 19% had no HL. Compared with caregivers of older adults without HL, caregivers of those with unrecognized HL were more likely to report depressive symptoms, including little interest or pleasure in doing things (OR 1.85; 95% CI: 1.19-2.87) and feeling down or depressed (OR 2.07; 95% CI: 1.31-3.25). A trend toward fewer depressive symptoms was observed among caregivers of individuals with managed HL, though it was not statistically significant. No differences were found in caregiving burden, relationship quality, or activity restriction.</p><p><strong>Conclusion: </strong>Despite expectations otherwise, associations between HL recognition and caregiver well-being were modest, suggesting current measures may not fully capture the communication challenges shaping caregiving experiences.</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":"149171592","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":"Reply to: \"Vitamin D and Risk of Falls: A Multidisciplinary Intervention\".","authors":"Toni Rikkonen, Sari Hantunen, Heikki Kröger, Christel Lamberg-Allardt, JoAnn E Manson, Tarja Nurmi, Marjo Tuppurainen, Ari Voutilainen, Tomi-Pekka Tuomainen, Jyrki K Virtanen","doi":"10.1111/jgs.70742","DOIUrl":"https://doi.org/10.1111/jgs.70742","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169214","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":"Association Between Interhospital Transfer, Readmission, and Inpatient Mortality Among Older Adults.","authors":"Rachel A Hadler, Sara Nahon, David W Boorman, Dio Kavalieratos, Rebecca A Aslakson, Sara Turbow","doi":"10.1111/jgs.70762","DOIUrl":"https://doi.org/10.1111/jgs.70762","url":null,"abstract":"<p><strong>Background: </strong>Interhospital transfer (IHT) is a key strategy for providing access to specialty care; however, it is associated with multiple adverse outcomes, including prolonged length of stay, increased risk of inpatient mortality, and reduced rates of discharge home, particularly among older adults. We hypothesized that older patients who experience IHT would have a higher rate of acute-care hospital readmissions compared to older adults who do not experience IHT.</p><p><strong>Methods: </strong>We used the Healthcare Cost and Utilization Project's 2019 National Readmissions Database to identify adults 65+ who had and had not undergone IHT. We used unadjusted and adjusted logistic regression stratified by region, clustered by hospital and weighted by individual to measure the association between IHT and the odds of readmission and in-hospital mortality.</p><p><strong>Results: </strong>Of the 11,836,556 older adults included in the weighted analysis, 0.9% experienced IHT. After adjusting for confounders including mortality risk, risk of readmission, admitting service, insurer, procedure characteristics, and others, IHT was associated with increased readmission rates (AOR 1.09, 95% CI: 1.01-1.18) and with increased risk of in-hospital mortality (AOR 1.91, 95% CI: 1.81-2.02). In a sensitivity analysis, odds of readmission within 30 days were 29% higher for older adults who had undergone IHT compared to those who had not (AOR 1.29, 95% CI: 1.19-1.40). All comparisons are p < 0.001.</p><p><strong>Conclusion: </strong>IHT is associated with increased readmission and mortality risk among older adults. These findings add to a burgeoning evidence base suggesting that IHT is associated with many long-term risks to older adults. Further research is needed to characterize the underlying drivers of these findings and to develop evidence-based practices to improve IHT processes for older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171668","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 Community's Voice: Community Advisory Boards in ADRD Biomarker Research Among Older Black Women.","authors":"Michelle L Jackson, Seth Sangalang, Nadine C Heyworth, Joy Stradford, Cozzette Lyons-Jones, Tia Delaney-Stewart, Asoniti Foster, Patricia Williams, Thelma Harris, Wendy McKinney, Catherine Baker, April D Thames, Marc Norman, Erin E Sundermann, Sarah J Banks","doi":"10.1111/jgs.70721","DOIUrl":"10.1111/jgs.70721","url":null,"abstract":"<p><p>Alzheimer's Disease and Related Dementias (ADRD) disproportionately affect Black/African American (BAA) women, yet this afflicted population remains underrepresented in ADRD biomarker research. As ADRD blood-based biomarkers become increasingly available, research must prioritize equity and inclusivity to determine their diagnostic specificity in minoritized groups. Community Advisory Boards (CABs) are pivotal in ensuring culturally responsive and community-engaged research. This article outlines the formation, operation, and maintenance of the Black Women: Inflammation and Tau Study (BWITS) CAB, which has played a crucial role in guiding the BWITS Research Team by refining research protocols and safeguarding the cultural contexts of the communities it represents. Motivated by a commitment to the BAA community, we advocate for a transformative shift in ADRD research on minoritized populations, emphasizing the need for CAB input to ensure accountability and the implementation of culturally responsive methods, benefiting both the scientific and target communities.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171327","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}