Journal of the American Geriatrics Society最新文献

{"title":"Nursing Home Guide to Adjusting Nurse Staffing for Resident Case-Mix.","authors":"Charlene A Harrington, Robert A McLaughlin, Debra Saliba, Elizabeth Halifax, Richard J Mollot, Patrick S Romano, Daniel J Tancredi, Dana B Mukamel","doi":"10.1111/jgs.19501","DOIUrl":"https://doi.org/10.1111/jgs.19501","url":null,"abstract":"<p><strong>Background: </strong>Nursing homes (NHs) are required to provide sufficient nursing staff to meet the needs of their residents. This study provides a guide for NHs to align nurse staffing levels with resident needs and calculates the gap between reported and expected NH staffing.</p><p><strong>Methods: </strong>Using the best available research data and recent federal minimum staffing requirements, expected nurse staffing levels were estimated for the 25 resident case-mix index (CMI) groups established by the Centers for Medicare & Medicaid Services (CMS) using nonlinear least-squares regression analyses. We compared the reported to expected staffing for all US NHs (14,420) in 2024.</p><p><strong>Results: </strong>Expected registered RN hours per resident day (HRPD) ranged from 0.55 to 2.39 for the lowest and highest CMIs. Certified nursing assistants HPRD ranged from 2.45 to 3.6 HPRD, and total nursing ranged from 3.48 to 7.68 HPRD. In 2024, US NHs reported that the average facility CMI was 1.35. Reported RN HPRD was 32% below expected staffing, CNA HPRD was 30% below, and total nursing HPRD was 22% below expected staffing. NHs in the three highest CMI groups were more likely to meet expected RN or total HPRD than NHs in lower CMI groups.</p><p><strong>Conclusions: </strong>Most NHs need to increase staffing to meet resident acuity needs.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060001","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":"Have We Forgotten About Therapeutic Failure in Older Adults?","authors":"Jennifer G Naples, Sherrie L Aspinall, Kenneth Schmader, Joseph T Hanlon","doi":"10.1111/jgs.19497","DOIUrl":"https://doi.org/10.1111/jgs.19497","url":null,"abstract":"<p><strong>Background: </strong>Three types of adverse drug events have been identified in studies of medication-related harms among older adults: adverse drug reactions, adverse drug withdrawal events, and therapeutic failures (TFs).</p><p><strong>Methods: </strong>In this narrative review of medical literature through June 2024, we summarize relevant articles and discuss evidence-based approaches and opportunities for future research to address TFs, as they are lesser recognized adverse drug events.</p><p><strong>Results: </strong>Despite more than three decades elapsing since TF was first described in 1991, we identified only 16 studies in our review that evaluated TF in older adults. The median rate of TFs among these 16 studies was 7.4%, and most TFs were considered preventable. Common reasons for TF in this population included medication nonadherence and underprescribing of necessary medications. These studies share several limitations, including weak observational study designs and relatively small samples that may not generalize to all populations of older adults. Finally, only five studies utilized an implicit tool (the Therapeutic Failure Questionnaire) that has been shown to have good interrater reliability.</p><p><strong>Conclusions: </strong>We acknowledge that clinicians should, and often do, attend first to deprescribing and reducing polypharmacy in managing adverse drug reactions among older adults. We must not forget, however, about TFs as an important and predominantly preventable source of harm among our older adult patients. TFs increase the length of hospital stays, promote disease persistence, reduce quality of life, and increase social costs of disease. We believe TFs remain a prevalent and important problem in older adults. More data are needed from up-to-date robust observational studies to further understand the impact of TFs on economic and humanistic outcomes in older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065542","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":"Treatment of Inappropriate Sexual Behavior in Persons With Dementia: A Systematic Review.","authors":"Natasha E Lane, Manan Ahuja, Stacey Hatch, Dallas P Seitz, Jessie McGowan, Jennifer A Watt","doi":"10.1111/jgs.19489","DOIUrl":"https://doi.org/10.1111/jgs.19489","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate sexual behavior (ISB), such as sexual touching and sexual exposure, occurs in up to 25% of people with dementia. This systematic review examines the effectiveness of pharmacologic and non-pharmacologic interventions to manage ISB in persons with dementia.</p><p><strong>Methods: </strong>Systematic review without meta-analysis (PROSPERO: CRD42023469625). We searched MEDLINE, APA PsycInfo, Embase, JBI EBP Database, CENTRAL, CDSR, and Ageline databases, with no limits on study date or language, from inception until September 8, 2023. All study designs were eligible for inclusion if they examined the effectiveness of any pharmacologic or non-pharmacologic intervention in adults with dementia and ISB. Two reviewers independently completed all study screening, data abstraction, and risk of bias assessments. The JBI Critical Appraisal Checklist was used to determine the quality of case studies and case series, and the Cochrane RoB 2 was used to appraise the one randomized controlled trial. Findings were synthesized using vote counting based on the direction of effect.</p><p><strong>Results: </strong>We included 74 studies, of which 60 were case studies, 13 were case series, and one was a randomized trial. Most studies (64%) reported exclusively pharmacologic interventions. Non-pharmacologic interventions (e.g., distraction, environmental modification) were associated with improvement or resolution of ISB in 33 (72%) instances; however, only five (21%) cases improved or resolved without co-prescribed pharmacotherapy. Among men, hormonal treatments, including progestins and anti-androgens, led to a reduction in ISBs more frequently than antipsychotics, antidepressants, or anticonvulsants.</p><p><strong>Conclusions: </strong>Nonpharmacologic interventions can be effective at reducing ISB, though pharmacologic interventions are also frequently needed. Randomized trials of nonpharmacologic and pharmacologic intervention effectiveness and safety are needed to guide practice.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056957","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 Congregational Care Network: Preliminary Data From a Healthcare/Congregational Partnership for At-Risk Older Adults.","authors":"John D Foster, Alexia M Torke, Deanna R Willis, Shadreck W Kamwendo, James E Slaven, Brownsyne Tucker-Edmonds, Erika R Cheng, Tricia Behringer, Notoshia Howard, Sherri Session","doi":"10.1111/jgs.19493","DOIUrl":"https://doi.org/10.1111/jgs.19493","url":null,"abstract":"<p><strong>Background: </strong>Social isolation and loneliness are significant public health crises that can exacerbate stress and diminish health behaviors, leading to overall reductions in well-being. The effects of systemic upstream social determinants of health (SDOH) can worsen these effects. Partnerships between communities of faith and health systems have the potential to reduce social isolation and loneliness, address unmet social needs, and improve access to healthcare.</p><p><strong>Methods: </strong>The Congregational Care Network (CCN), a collaboration between a health system and local congregations in neighborhoods with high poverty and gaps in other SDOH, provided 1 h per week of individual, volunteer companionship to older adult patients for 90 days. The health system provided training and professional support from social workers and chaplains. A program evaluation measured loneliness before and after participation and healthcare utilization in the 90 days before, during, and after the program.</p><p><strong>Results: </strong>CCN recruited 28 congregations representing diverse religious affiliations and 335 patients participated in the CCN program. Patients who received CCN services had a median age of 64.9 years (standard deviation 11.5), were 27.2% male, and 58.8% Black. There were significant reductions in DeJong Gierveld loneliness scores from before to after program engagement (median change score: 1 (interquartile range (IQR) 0-2, p < 0.001)). The proportion with 1+ emergency department visits was significantly lower after CCN compared to before (16.8% vs. 24.6%, p = 0.007); the proportion with inpatient visits was lower during CCN compared to before (12.2% vs. 17.3% vs. p = 0.032). The proportion with outpatient visits was higher during CCN than before (71.0% vs. 63.8%, p = 0.045).</p><p><strong>Conclusion: </strong>The CCN partnership between congregations and a local health system is a feasible model for at-risk older adults that may reduce loneliness and shift healthcare utilization from acute to outpatient settings, providing greater continuity of care and fewer burdensome acute care visits.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063692","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":"What Matters Most: Case Study of Successful Patient-Directed Gabapentin Taper to Improve Mentation, Mobility, and Medications.","authors":"Michelle R Paulsen, Reema Navalurkar, Jennifer Tunoa, Blake Bartlett, Katherine C Ritchey","doi":"10.1111/jgs.19482","DOIUrl":"https://doi.org/10.1111/jgs.19482","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065550","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":"Comparative Safety of Medications for Severe Agitation: A Geriatric Emergency Department Guidelines 2.0 Systematic Review.","authors":"Martin F Casey, Natalie M Elder, Alexander Fenn, Joshua Niznik, Danya Khoujah, Jon B Cole, Zachary Cardon, Ming Ding, Naira Goukasian, Elizabeth Moreton, Jennifer L Koehl, Phillip D Magidson, Rachel M Skains, Katren Tyler, Shan W Liu","doi":"10.1111/jgs.19485","DOIUrl":"https://doi.org/10.1111/jgs.19485","url":null,"abstract":"<p><strong>Background: </strong>Managing undifferentiated, severe agitation in older adults may require antipsychotic or sedative medications to prevent harm to self or others. Unfortunately, these medications are associated with serious adverse events in older adults, and little is known about their comparative safety.</p><p><strong>Methods: </strong>We conducted a systematic review to identify comparative effectiveness studies on the safety of medications used in the treatment of severe agitation among older adults in the prehospital or emergency department (ED) setting. We searched eight databases including PubMed, EMBASE, SCOPUS, Cochrane library, CINAHL, Proquest Central, Ageline, and PsycInfo published in or before February 2024. Studies were included if they examined 1st generation antipsychotics, 2nd generation antipsychotics, benzodiazepines, or ketamine. Data were extracted on adverse respiratory events (apnea, hypoxemia, intubation) and other adverse events (arrhythmia, hypotension, worsening delirium, cardiac arrest, and mortality). We report the aggregate occurrence of any adverse events pooled by drug and report odds ratios (ORs) using haloperidol as the reference group.</p><p><strong>Results: </strong>Among 8600 studies identified, eight observational studies and one randomized clinical trial met eligibility for further qualitative and quantitative analysis. The observational studies included 838 older adults receiving haloperidol (n = 117), droperidol (n = 129), lorazepam (n = 350), midazolam (n = 68), olanzapine (n = 101), quetiapine (n = 56), and ziprasidone (n = 17). Any adverse events were observed in 16.8% of the patients (141/838). Adverse events were most common among patients receiving midazolam (53%; 36/68). Relative to haloperidol, midazolam significantly increased the risk for any adverse events (OR 5.25 [95% CI: 2.64-10.45]). Quetiapine was the only drug observed to have a lower frequency of adverse events (OR 0.27 [95% CI: 0.08, 0.97]).</p><p><strong>Conclusions: </strong>Adverse drug events are common among older adults receiving antipsychotic or anxiolytic medications for severe agitation. Benzodiazepines, particularly midazolam, pose an excessive risk to older adults requiring pharmacologic treatment for severe agitation.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056951","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":"Rosacea Is an Underdiagnosed Disease Among Subjects Aged Over 70 Years.","authors":"Jaakko Jäntti, Jari J Jokelainen, Laura Huilaja, Suvi-Päivikki Sinikumpu","doi":"10.1111/jgs.19488","DOIUrl":"https://doi.org/10.1111/jgs.19488","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063671","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: Venous Thromboembolism in Patients Aged ≥ 90 Years: Trends in Clinical Features, Treatment, and Outcomes-RIETE Registry.","authors":"Merve Yilmaz Kars, Ahmet Onal, Zeynep Iclal Turgut, Ilyas Akkar, Orhan Cicek, Mustafa Hakan Dogan, Muhammet Cemal Kizilarslanoglu","doi":"10.1111/jgs.19483","DOIUrl":"https://doi.org/10.1111/jgs.19483","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046533","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":"Cholecystitis Treatment and Outcomes Among People Living With Dementia.","authors":"Rachel R Adler, Lingwei Xiang, Samir K Shah, Clancy J Clark, Zara Cooper, John Hsu, Stuart R Lipsitz, Joel S Weissman, Emily Finlayson","doi":"10.1111/jgs.19487","DOIUrl":"https://doi.org/10.1111/jgs.19487","url":null,"abstract":"<p><strong>Background: </strong>Cholecystectomy is considered the definitive treatment option for cholecystitis, but the effect of different treatment options among people living with dementia (PLWD) has not been elucidated. This study compares outcomes following cholecystectomy, cholecystostomy tube, and medical management of cholecystitis among this high-risk group.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of Medicare claims data 1/1/2016 to 12/31/2020. The cohort comprised Medicare PLWD aged 66+ admitted to acute care facilities with a new primary diagnosis of cholecystitis. We used inverse propensity weighting regression to adjust for confounding by indication. We compared outcomes during index admission, readmissions, and mortality.</p><p><strong>Results: </strong>Eight thousand and seven hundred and seventy four individuals met inclusion criteria; 7% open cholecystectomy, 49% minimally invasive (MIS) cholecystectomy, 13% cholecystostomy tube, 31% managed medically. After adjustment, PLWD undergoing open or MIS cholecystectomy had a greater risk of intensive interventions (Open OR 3.3, p < 0.001; MIS OR 1.3, p = 0.02) and surgical complications (Open OR 10.6, p < 0.001; MIS OR 3.3, p < 0.001) during the index admission, but a lower risk of readmission (Open HR 0.9, p = 0.009; MIS HR 0.9, p < 0.001) and lower mortality (Open HR 0.6, p < 0.001; MIS 0.6, p < 0.001) compared with PLWD managed medically. PLWD managed with cholecystostomy tube had no difference in intensive interventions or surgical complications during the index admission, but a higher risk of readmission (HR 1.1, p = 0.01), cholecystectomy during readmission (HR 1.8, p < 0.001) and no difference in mortality compared to those managed medically.</p><p><strong>Conclusions: </strong>Over half of PLWD experiencing acute cholecystitis received definitive surgical treatment during the index admission. Open and MIS cholecystectomy were associated with worse outcomes during the index admission, but reduced mortality and readmissions in the 2 years following index admission. Cholecystostomy tube was associated with a greater likelihood of readmission and subsequent cholecystectomy, and no difference in mortality. These findings should be interpreted within the context of administrative data, which has the potential for selection bias and unmeasured confounding.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046466","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 \"Comment on: Venous Thromboembolism in Patients Aged ≥ 90 Years: Trends in Clinical Features, Treatment, and Outcomes-RIETE Registry\".","authors":"Ludovic Lafaie, Manuel Monreal, Laurent Bertoletti","doi":"10.1111/jgs.19484","DOIUrl":"https://doi.org/10.1111/jgs.19484","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039982","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}