Journal of the American Geriatrics Society最新文献

{"title":"Coprophagia in Moderately Severe Dementia: Comprehensive Geriatric Assessment, Interdisciplinary Management, and the 5Ms.","authors":"Erwin Martin Hernandez Ocampo, Bayron Valdes Casas","doi":"10.1111/jgs.70776","DOIUrl":"https://doi.org/10.1111/jgs.70776","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167898","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":"Readmission Risk Coming Home After Rehabilitation in a Skilled Nursing Home With Dementia.","authors":"Jennifer L Carnahan, Indrakshi Roy, James E Slaven, Emily Fox Ludden, Wanzhu Tu, Daniel O Clark, Christopher M Callahan, Kathleen T Unroe, Alexia M Torke","doi":"10.1111/jgs.70752","DOIUrl":"https://doi.org/10.1111/jgs.70752","url":null,"abstract":"<p><strong>Background: </strong>Community dwelling people living with dementia (PLWD) are more likely to visit a skilled nursing home (SNH) after an acute hospital stay and have a high risk of readmission to the hospital. Staff in SNHs have familiarity with caring for PLWD that may mitigate readmissions, but dementia's role in readmissions for this high risk population remains unclear.</p><p><strong>Methods: </strong>Using Health and Retirement Study data linked to Medicare claims between 2000 and 2019, this study aimed to investigate the role of dementia in hospital readmissions after a short rehabilitative stay (< 100 days) in the nursing home. Event-level data was analyzed for risk of 30-day hospital readmission following SNH discharge to the community using first Generalized Estimating Equations to estimate individual variables' association with readmission and then constructing a regression model to estimate the risk of readmission to the hospital using adjusted odds ratios.</p><p><strong>Results: </strong>There were 714 readmissions to the hospital out of 4527 discharges to the community following SNH stay (15.8%). A dementia diagnosis identified by Medicare claims, present for 42.2% of the population, was not associated with hospital readmission. Female sex, being married, and living in the Midwest or Western United States were associated with lower odds of readmission. Hospital or emergency department visits in the year prior to the index SNH admission and higher Charlson comorbidity scores were associated with higher odds of post-SNH discharge 30-day readmission.</p><p><strong>Conclusions: </strong>A formal dementia diagnosis may serve as a signal to SNHs to provide enhanced support in their discharge processes. Intrinsic factors related to the patient's health status such as prior hospital use and comorbidity burden, in addition to social support factors such as marital status, play the greatest role in readmission risk. These characteristics should be recognized and mitigated by discharge planners, policy makers, and insurers making care coverage decisions.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170465","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":"Variation in High Value Care for Low Back Pain Among Older Adults Enrolled in Medicare Advantage Plans.","authors":"Amit Kumar, Daniel Deutscher, Lin-Na Chou, Julie M Fritz","doi":"10.1111/jgs.70779","DOIUrl":"https://doi.org/10.1111/jgs.70779","url":null,"abstract":"<p><strong>Importance: </strong>Low back pain (LBP) is a major cause of disability and poor quality of life among older adults. Clinical guidelines recommend non-pharmacological therapies, such as physical therapy (PT), as the first-line treatment for high-value care. Despite the fact that more than half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), there is no knowledge about the patterns of high-value LBP care within this population.</p><p><strong>Objective: </strong>To characterize high- and low-value LBP care among MA beneficiaries and identify factors associated with receipt of high-value care.</p><p><strong>Method: </strong>We conducted a retrospective cohort study using a 20% random sample of 2021 MA outpatient and carrier encounter data. Beneficiaries aged ≥ 66 years with a new LBP diagnosis between April 1 and September 30, 2021, were followed for 90 days. The study outcomes include high- and low-value care, defined by the timing and receipt of physical therapy, imaging, and spinal injections.</p><p><strong>Results: </strong>Among 181,980 beneficiaries with newly diagnosed LBP, 87,305 received additional care within 90 days. Of these, 21.6% received high-value care and 78.4% received low-value care. Imaging without PT was the most common low-value care pattern, whereas PT alone was the most common high-value care pattern. Older age, Hispanic ethnicity, multiple comorbidities, lower MA plan ratings, and index visits with surgeons or pain specialists were associated with lower odds of receiving high-value care. County-level variation was observed, with rural residence and greater neighborhood socioeconomic deprivation associated with lower receipt of high-value care.</p><p><strong>Conclusions: </strong>Most older adults enrolled in MA plans with LBP did not receive guideline-concordant, high-value care. Geographic and socioeconomic disparities highlight opportunities to improve equitable access to evidence-based LBP management in older adults enrolled in MA plans.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139973","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":"Opioid Use Is Associated With Lower Health-Related Quality of Life Among Community-Dwelling Older Australians: A Cross-Sectional Study From STAREE.","authors":"Caroline Turlejski, Brayden Ng Gibson, Harvey Jia Wei Koh, Kendal Chidwick, Danijela Gasevic, Chris Moran, Ingrid Hopper, Mark R Nelson, Christopher M Reid, Andrea J Curtis, Simone Spark, Zachary Flanagan, Rory Wolfe, Sophia Zoungas, Stella Talic","doi":"10.1111/jgs.70708","DOIUrl":"https://doi.org/10.1111/jgs.70708","url":null,"abstract":"<p><strong>Background: </strong>Prescribed opioid use among older adults may have a reciprocal negative association with health-related quality of life (HrQoL), yet evidence on this relationship remains limited. This study evaluated the association between prescription opioid use and HrQoL in community-dwelling older adults.</p><p><strong>Methods: </strong>We conducted a secondary cross-sectional analysis of baseline STAtins in Reducing Events in Elderly (STAREE) trial data, assessing the association between self-reported prescribed opioid use and HrQoL, via the 36-item Short Form Survey. Multivariable linear regression models assessed the association, with progressive adjustment for sociodemographic (Models 1 and 2), clinical (Model 3), and psychosocial factors (Model 4). Propensity score matching (PSM) was conducted to assess the robustness of the association.</p><p><strong>Findings: </strong>The cohort included 479 opioid users and 9492 non-opioid users. users. In unadjusted analyses, opioid users had substantially lower mean HrQoL scores than non-users (β = -14.30; 95% CI: -15.59, -13.02). Adjustment for confounders attenuated the association, but it remained statistically significant in the fully adjusted model (β = -7.58; 95% CI: -8.80, -6.35). Lower scores among opioid users were observed across all HrQoL domains (Physical Functioning, Social Functioning, Role Limitations, Vitality, Bodily Pain, General Health and Mental Health), with the largest differences in physical functioning (approximately 20-25 points lower).</p><p><strong>Conclusion: </strong>Opioid use is associated with significantly poorer HrQoL in community-dwelling older adults, highlighting the importance of routinely assessing quality of life, functional status, and psychosocial factors among persons who use opioids.</p><p><strong>Trial registration: </strong>This study was approved by Monash Human Research Ethics Committee (ID: 21528).</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139961","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":"Trends in Dispensing of Opioids and Benzodiazepines Among Older Adults Admitted for an Acute Hip Fracture Between 2008 and 2024 in Ontario, Canada.","authors":"Anum Ali, Mina Tadrous, Chizaram Eje, Laleh Rashidian, Arrani Senthinathan, Cherry Chu, Kerry Kuluski, Sara J T Guilcher","doi":"10.1111/jgs.70739","DOIUrl":"https://doi.org/10.1111/jgs.70739","url":null,"abstract":"<p><strong>Introduction: </strong>Opioids and benzodiazepines (BZDs) are commonly prescribed for managing pain, anxiety, and sleep-related problems following a hip fracture. Both opioids and BZDs carry risks of persistent dependence, falls, and mortality with long-term use. Despite these risks, Canada lacks standardized prescribing guidelines for older adults with hip fracture. We examined population-level trends in opioids and BZDs dispensing before hospitalization and up to 1-year post-discharge among older adults admitted for hip fractures in Ontario, Canada.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using linked health administrative data from ICES, Ontario, Canada. The cohort included individuals aged 66 years and older, residing in Ontario, admitted for an acute hip fracture between April 1, 2008, and March 31, 2024, and who survived for at least 275 days in the following year. Our primary outcome was post-discharge opioids and BZDs dispensed, defined as ≥ 1 prescription dispensed within 1-365 days following discharge. Secondary outcomes included pre-hospitalization dispensing, concurrent dispensing, and morphine equivalent dose.</p><p><strong>Results: </strong>A total of 114,055 eligible older adults were admitted with hip fractures between 2008 and 2024. Overall, BZDs dispensing declined from 33.7% in 2008 to 13.3% in 2024, while opioids dispensing peaked in 2015 at 55.8% and decreased to 44.6% in 2024. Hydromorphone and combination drug therapy were the most frequently dispensed opioid drug classes during pre-hospitalization and post-discharge periods following a hip fracture. Concurrent opioids and BZDs dispensed following a hip fracture decreased from 3.7% in 2008 to 1% in 2024. Among individuals with 90 days of continuous opioid dispensed, most received < 50 mg average daily morphine equivalents.</p><p><strong>Conclusion: </strong>We observed a substantial reduction in BZDs dispensing. However, opioids dispensing remained consistently high. These findings underscore the need for future research on initiatives to reduce opioids use in post-fracture care, while recognizing that opioids remain an effective pain control drug.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140033","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":"Concerns of the SSVI to Inform Medicare Beneficiaries HealthCare Decisions.","authors":"Joan M Teno, Xiao Wang, Emmanuelle Belanger","doi":"10.1111/jgs.70740","DOIUrl":"https://doi.org/10.1111/jgs.70740","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140024","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":"Hip Fracture Risk of Lemborexant and Suvorexant in Comparison With Z-Drugs: A Target Trial Emulation.","authors":"Yuichiro Matsuo, Hayato Yamana, Yusuke Sasabuchi, Hiroki Matsui, Takahide Kohro, Hideo Yasunaga","doi":"10.1111/jgs.70754","DOIUrl":"https://doi.org/10.1111/jgs.70754","url":null,"abstract":"<p><strong>Background: </strong>Lemborexant and suvorexant are widely used dual orexin receptor antagonists (DORAs) for the pharmacological treatment of insomnia. Although they are generally considered safer than benzodiazepine receptor agonists (Z-drugs) regarding adverse events including hip fractures, evidence from direct comparisons remains limited. This study aimed to examine whether lemborexant and suvorexant are associated with a lower risk of hip fracture than Z-drugs in older individuals.</p><p><strong>Methods: </strong>We conducted a cohort study using databases from Tochigi Prefecture, Japan. We included individuals aged ≥ 65 years who newly initiated either lemborexant or Z-drugs (lemborexant analysis cohort) or either suvorexant or Z-drugs (suvorexant analysis cohort). The primary outcome was hospitalization for hip fracture within 1 year of cohort entry. Per-protocol effects of continuous treatment with the assigned drugs were estimated. Baseline confounding was adjusted using inverse probability of treatment weighting based on propensity scores. Censoring due to discontinuation of the assigned drug or switching to the comparator drug was adjusted for using inverse probability of censoring weights. Adjusted cumulative incidence and hazard ratios (HRs) were estimated using the Kaplan-Meier methods and Cox regression, respectively.</p><p><strong>Results: </strong>The lemborexant analysis cohort included 22,655 individuals (6879 and 15,776 in the lemborexant and Z-drug groups, respectively). After adjustment, lemborexant use was associated with a significantly lower hip fracture incidence (HR, 0.31, 95% confidence interval [CI], 0.16-0.59, p < 0.001). The suvorexant analysis cohort included 22,377 individuals (6699 and 15,678 in the suvorexant and Z-drug groups, respectively). After adjustment, hip fracture incidence was lower in the suvorexant group, but the association was not significant (HR, 0.57, 95% CI, 0.23-1.44, p = 0.234).</p><p><strong>Conclusion: </strong>DORAs, particularly lemborexant, may be safer alternatives to Z-drugs with respect to hip fracture risk.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140007","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":"Experiences With a Combined Meal Delivery and Home-Based Exercise Intervention Among Homebound Older Adults.","authors":"Melissa R Cruz, Lisa Juckett, Paola Robles Cordova, Jessica Lee","doi":"10.1111/jgs.70780","DOIUrl":"https://doi.org/10.1111/jgs.70780","url":null,"abstract":"<p><strong>Background: </strong>Homebound older adults experience high rates of multimorbidity, frailty, and social isolation; yet few interventions target homebound older adults. We completed \"Strength on Wheels\", a randomized controlled trial evaluating a nutrition and exercise intervention for homebound older adults that showed no differences in physical measures but improvements in loneliness for those in the exercise group. We now seek to understand their qualitative experiences with the intervention.</p><p><strong>Methods: </strong>This qualitative study analyzed free-text responses from biweekly surveys and an exit survey within the 12-week Strength on Wheels intervention, which combined home-delivered meals through Meals on Wheels with a home-based exercise program. Structured content analysis was used to identify prominent themes across participant comments.</p><p><strong>Results: </strong>Participants (N = 101, mean age 74 years) reported enjoying meals and engaging with the exercise materials, though many reported ongoing pain and concerns about falls. Experiences with a commercial activity tracker were mixed: some found it motivating, while others reported difficulty charging, interpreting icons, or keeping track of the device. Participants also identified additional supports, such as social engagement, cognitive activities, physical therapy, transportation, and home modifications, as important for maintaining independence.</p><p><strong>Conclusion: </strong>Future work should refine nutrition and exercise programs for homebound older adults to better address their complex needs and support independence at home.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139963","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":"Mobilization Alarms for In-Hospital Falls: Time to Reconsider a Longstanding Practice.","authors":"Bastiaan Van Grootven, Koen Milisen","doi":"10.1111/jgs.70774","DOIUrl":"https://doi.org/10.1111/jgs.70774","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139953","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":"Back Pain and Prospective Frailty Status Among Older Men: Findings From the MrOS Study.","authors":"David T McNaughton, Kristine Ensrud, Lisa Langsetmo, Stephanie Harrison, Jessica J Wong, Javier Muñoz Laguna, James Young, Katie de Luca, Tuo-Yu Chen, Hazel Jenkin, Aron Downie, Casper Nim, Muhammad Thalil, Nancy E Lane, Howard A Fink, Eric J Roseen","doi":"10.1111/jgs.70755","DOIUrl":"https://doi.org/10.1111/jgs.70755","url":null,"abstract":"<p><strong>Background: </strong>The association between back pain and frailty is uncertain. This study examined the association between back pain in older men and prospective frailty status an average of 7 years later.</p><p><strong>Methods: </strong>Prospective cohort study using data from the Osteoporotic Fractures in Men Study. Eligible participants were men who, at study Visit 3 (Year 7), completed a back pain assessment (presence, frequency, severity, activity limitation) and a phenotypic frailty assessment (robust, pre-frail, frail). Among men classified as either robust or pre-frail, phenotypic frailty was again assessed at Visit 4 (Year 14), with deaths between Visits 3 and 4 considered a separate terminal outcome category. The association of Visit 3 back pain with frailty phenotype relative to a robust (and pre-frail) status at Visit 4 was analyzed using multivariable-adjusted multinominal logistic regression models.</p><p><strong>Results: </strong>Among 5994 men enrolled, 2554 men who were considered robust or pre-frail at Visit 3 (mean [SD] age = 71.6 [4.9] years) were included in the current analysis. After accounting for age, study clinic site, race and education, presence of any back pain, moderate-severe severity, high frequency, and activity limiting back pain were prospectively associated with higher odds of being frail vs. robust and of being frail vs. pre-frail an average of 7 years later. However, after adjustment for other characteristics including prefrail vs. robust status at Visit 3, only the activity-limiting back pain phenotype was associated with significantly higher odds of later being classified as frail vs. prefrail (OR = 1.40 [1.03-1.90]), and no back pain phenotypes were associated with higher odds of later being classified as frail vs. robust.</p><p><strong>Conclusion: </strong>Among older community-dwelling men, back pain, particularly activity-limiting back pain, was associated with higher odds of progression to frailty during a 7-year period, suggesting that back pain may be a modifiable risk factor for age-related phenotypic frailty. Further replication and understanding of the mechanisms underpinning the relationship between back pain and frailty are needed to inform targeted interventions in older individuals at risk of frailty.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129713","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}