Journal of the American Geriatrics Society最新文献

{"title":"Association Between Frailty and Patients' Experience of Cancer Treatment and Care.","authors":"Tomohiro F Nishijima, Mototsugu Shimokawa, Kohei Arimizu, Taito Esaki, Masaru Morita, Hyman B Muss","doi":"10.1111/jgs.70157","DOIUrl":"https://doi.org/10.1111/jgs.70157","url":null,"abstract":"<p><strong>Background: </strong>The relationship between frailty and patient experiences of cancer care and treatment remains underexplored. This study evaluated this association using validated tools to assess frailty and various aspects of patient experience.</p><p><strong>Methods: </strong>We conducted a prospective observational study of 584 patients with cancer who underwent comprehensive geriatric assessment (CGA) at a geriatric oncology service prior to treatment decision-making (August 2020-July 2022). Frailty was classified using a CGA-based frailty index as fit (< 0.2), pre-frail (0.2-0.35), or frail (> 0.35). Patient experience was assessed using the Control Preference Scale (CPS), Patient Assessment of Care for Chronic Conditions (PACIC) subscales (delivery system design/decision support and problem-solving/contextual counseling), and Decision Regret Scale (DRS). Logistic regression examined associations between frailty and outcomes, adjusting for relevant covariates.</p><p><strong>Results: </strong>The median age was 80 years (range, 51-97). Twenty percent of the patients were fit, 38% were pre-frail, and 42% were frail. Frailty was not associated with discordance between preferred and actual CPS roles (p = 0.14). However, frail patients were less likely than fit patients to report high-quality care based on PACIC scores at 3 and 6 months (p < 0.05). Moderate to strong regret (DRS score > 25) was expressed by 115 patients (28%) at 3 months and 109 patients (31%) at 6 months. Adjusted odds ratios for moderate to strong regret in frail versus fit patients were 2.61 (95% CI, 1.40-4.91; p = 0.003) at 3 months and 2.41 (95% CI, 1.30-4.50; p = 0.005) at 6 months.</p><p><strong>Conclusion: </strong>Frailty was associated with lower perceived quality of care and higher decision regret following cancer treatment but not with differences in decision-making roles. Further research is warranted to understand the mechanisms underlying these associations to improve care experiences for older adults with cancer.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254280","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 Long Shadow of Incarceration: The Association of Incarceration History With Self-Reported Health Among Older Adults.","authors":"Louisa W Holaday, Brita Roy, Brie Williams, Pranav Gwalani, Kim Stone, Albert L Siu, Emily A Wang","doi":"10.1111/jgs.70069","DOIUrl":"https://doi.org/10.1111/jgs.70069","url":null,"abstract":"<p><strong>Background: </strong>The United States has one of the highest incarceration rates in the world. Prior incarceration is associated with adverse health effects. While the era of \"mass incarceration\" began in 1973, little work has focused on older adults, whose lives have spanned the five decades of mass incarceration.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using data on adults 50 or older from the nationally representative Family History of Incarceration Survey to test the independent association between prior incarceration and self-reported physical and mental health. In logistic regression models, we controlled for age, gender, race/ethnicity, education, income, employment, and marital status. We also tested for effect modification by race/ethnicity, gender, and time since last incarceration, as well as financial and social wellbeing.</p><p><strong>Results: </strong>Among 1318 older adults, 21% had been incarcerated. Formerly incarcerated older adults were more likely to be men; non-Hispanic Black or \"other\" race/ethnicity; meet criteria for disability; be unmarried; and have lower income and education compared with those never incarcerated. In fully adjusted models, prior incarceration was independently associated with greater odds of reporting \"fair\" or \"poor\" physical health (aOR:1.88, 95% CI: 1.19-2.98; p = 0.007). Prior incarceration was associated with reporting \"fair\" or \"poor\" mental health after adjusting for demographic covariates (aOR: 2.12, 95% CI: 1.24-3.65; p = 0.006) but was nonsignificant after adding socioeconomic covariates. Length of time from last incarceration did not moderate the observed association, meaning that even those incarcerated > 10 years ago had poor self-reported health. Financial wellbeing moderated the association between incarceration and mental health.</p><p><strong>Conclusion: </strong>Prior incarceration is a social determinant of health for older adults, even those with distant incarceration history, and is strongly associated with current poverty and meeting criteria for disability. Further research is needed to understand the mechanisms of these associations and means to mitigate health harms associated with prior incarceration.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246000","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":"Impact of Skilled Nursing Facility (SNF) Network Participation and Transitional Care Management on SNF Length of Stay.","authors":"Amy W Baughman, Michelle L Frits, Kathleen Strand, Jenna Morrisey, Katie Carr, Atharva Vaidya, Kerry Markert, Mallika L Mendu","doi":"10.1111/jgs.70114","DOIUrl":"https://doi.org/10.1111/jgs.70114","url":null,"abstract":"<p><strong>Background: </strong>This evaluation highlights potential strategies to decrease unnecessary skilled-nursing facility (SNF) utilization. We evaluated the impact of a SNF network and transitional care management program (TCM) on SNF length of stay (LOS) for beneficiaries in a Medicare Shared Savings Plan (MSSP) Accountable Care Organization (ACO).</p><p><strong>Methods: </strong>Design: Retrospective claims-based cohort study.</p><p><strong>Setting: </strong>Mass General Brigham (MGB) is a large integrated healthcare system. MGB Population Health develops value-based strategies to improve performance in shared savings ACOs, including nearly 130,000 Medicare beneficiaries.</p><p><strong>Participants: </strong>Adult MSSP ACO beneficiaries admitted to a SNF between January 2022 and September 2023. Exclusions included death, admission to hospice or long-term care hospital; patients were excluded from the SNF LOS analysis if they experienced hospital readmission.</p><p><strong>Intervention: </strong>The MGB SNF Collaborative Network included 60 SNFs in 2022 and 63 SNFs in 2023 based on quality metrics and collaboration with MGB hospitals. The TCM Program included 14 care managers, who optimize SNF utilization for beneficiaries discharged to MGB Network SNFs.</p><p><strong>Main outcome and measure: </strong>The primary outcome of interest was SNF LOS. We conducted univariate regression analyses with variables that could impact SNF LOS; covariates with a p value ≤ 0.1 were included in the multivariable regression model. We assessed for collinearity with model diagnostics, including variance of inflation measures.</p><p><strong>Results: </strong>Multivariable regression demonstrated that admission to a SNF network facility without TCM was associated with a reduction in LOS of 4 days, and admission to a SNF network facility with TCM resulted in a 5-day LOS reduction. Based on LOS reduction, we estimate a programmatic impact of $556 per beneficiary per day [1], with savings of $2224-$2780 per admission.</p><p><strong>Conclusion: </strong>SNF networks and care management can mitigate unnecessary SNF utilization, offering a high-value approach for ACOs and other value-based care organizations.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254270","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 Neighborhood Deprivation Impact Readmission and Associated Costs After Hip Fracture Surgery?","authors":"Mikhail A Bethell, Hannah R Mahoney, Lulla V Kiwinda, Adam A Sassoon, Milton T Little, Amy G Clark, Bradley G Hammill, Malcolm R DeBaun, Christian A Péan","doi":"10.1111/jgs.70123","DOIUrl":"https://doi.org/10.1111/jgs.70123","url":null,"abstract":"<p><strong>Introduction: </strong>In the context of value-based care, the influence of racial and socioeconomic factors on hip fracture care outcomes remains underexplored. This study investigates the association of the area deprivation index (ADI) on readmission rates and Centers for Medicare and Medicaid Services (CMS) payments following hip fracture surgery.</p><p><strong>Methods: </strong>We conducted an analysis using United States Medicare fee-for-service claims from 2019 to 2021, identifying patients hospitalized for hip fracture surgery based on Diagnosis-Related Groups criteria. Our primary outcomes were 90-day unplanned readmissions and CMS payments. ADI was our primary exposure of interest, calculated at the census block level. The analysis adjusted for multiple factors using logistic regression models.</p><p><strong>Results: </strong>The study included 248,691 patients with an average age of 82.3 ± 8.5 years. We noted a 20.7% (51,603/248,691) rate of 90-day unplanned readmissions. Adjusted findings showed a modest, independent association between unplanned readmission and neighborhood deprivation, especially in the most deprived groups (OR: 1.26 [95% CI 1.19, 1.35]). Fully adjusted analysis showed a null association between CMS payments and neighborhood deprivation. Black race had a stronger association with unplanned 90-day readmissions (OR: 1.06 [95% CI 1.00, 1.13]) compared to White race. Males had a stronger association with readmission (OR: 1.26 [95% CI 1.24, 1.29]) and higher CMS payments (OR: 1.07 [95% CI 1.06, 1.07]) compared to females.</p><p><strong>Conclusion: </strong>Neighborhood deprivation is independently associated with higher odds of unplanned 90-day readmission after hip fracture surgery, though no significant association with CMS payments was identified. These findings support the need to address social drivers of health in clinical care and inform value-based payment and policy reform aimed at reducing disparities.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254264","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":"Cataract Surgery Under General Anesthesia in Older Adults With Advanced Cataracts and Dementia: Visual Acuity and Visual Function Outcomes.","authors":"Hiroki Sano, Ryoji Yanai, Yoshinori Mitamura","doi":"10.1111/jgs.70151","DOIUrl":"https://doi.org/10.1111/jgs.70151","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254282","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 \"Prevalence and Prognostic Implication of Sarcopenia Among Patients With Stage B Heart Failure: The PAPRIKA-HF Cohort Study\".","authors":"Koichiro Matsumura, Gaku Nakazawa","doi":"10.1111/jgs.70149","DOIUrl":"https://doi.org/10.1111/jgs.70149","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240642","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: Prevalence and Prognostic Implication of Sarcopenia Among Patients With Stage B Heart Failure: The PAPRIKA-HF Cohort Study.","authors":"Théodore Decaix, Clémentine Rivière, Matthieu Lilamand","doi":"10.1111/jgs.70150","DOIUrl":"https://doi.org/10.1111/jgs.70150","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240636","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":"SGLT2 Inhibitors in Older Adults With Cardiovascular Disease: A Systematic Review and Meta-Analysis.","authors":"Kota Minami, Rika Terashima, Lina Freeman, Yuji Yamada, Amanda R Vest, Yuichiro Yano, Toshio Naito, Satoshi Miyashita","doi":"10.1111/jgs.70143","DOIUrl":"https://doi.org/10.1111/jgs.70143","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter-2 (SGLT2) inhibitors, developed for type 2 diabetes mellitus (T2DM), have demonstrated cardiorenal benefits in conditions including cardiovascular (CV) disease. However, few meta-analyses have synthesized outcomes in older adults with CV disease.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials published from January 2015 to January 2025 was conducted using MEDLINE (PubMed), Embase (Ovid), and CENTRAL. We included studies that reported the risk of CV outcomes for subgroups of older adults (≥ 65 years) with CV disease. The primary outcome was a composite of hospitalization for heart failure (HHF), urgent heart failure (HF) visits, and cardiovascular death (CVD). Secondary outcomes included all-cause mortality, CVD, and HHF individually. Subgroup analyses were conducted in patients with HF, T2DM, age strata (65-74 vs. ≥ 75), SGLT2 inhibitor agent, and adverse events.</p><p><strong>Results: </strong>Analyzing nine studies, SGLT2 inhibitors were associated with reducing the risk of composite outcome (HR: 0.75, 95% CI: 0.67-0.83, I² = 51%), all-cause mortality (HR: 0.80, 95% CI: 0.66-0.97, I² = 68%), CVD (HR: 0.78, 95% CI: 0.65-0.94, I² = 61%), and HHF (HR: 0.73, 95% CI: 0.65-0.83, I² = 0%). Benefits were consistent in subgroups of HF only, T2DM only, and those aged ≥ 75 years. No significant differences were observed by SGLT2 inhibitor type (p = 0.090). SGLT2 inhibitors increased the risk of genital infections (RR: 3.18, 95% CI: 2.35-4.30, I² = 0%) but decreased that of other serious adverse events (RR: 0.92, 95% CI: 0.86-0.97, I² = 64%).</p><p><strong>Conclusions: </strong>In adults aged ≥ 65 years with CV disease, SGLT2 inhibitors significantly reduce the composite risk of HHF, urgent HF visits, and CVD and secondary outcomes of all-cause mortality, CVD, and HHF, supporting their use in this population with careful monitoring of age-related risks.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240623","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":"Latino Caregiver Experiences With Dementia Care and Healthcare Navigation.","authors":"Leah V Estrada, Thalia Porteny, Deanna Margius, Sasha Perez, Albert Siu, Nathan E Goldstein, Jennifer M Reckrey","doi":"10.1111/jgs.70138","DOIUrl":"https://doi.org/10.1111/jgs.70138","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of dementia among Latinos in the United States is growing. We explored the experiences of Latino family caregivers of Latino persons living with moderate to advanced dementia (PLWD), drawing on their extensive experience as caregivers navigating the healthcare system to identify opportunities to improve dementia care.</p><p><strong>Participants and setting: </strong>Nineteen Latino caregivers of PLWD who spoke English or Spanish were recruited from outpatient geriatrics clinics and a home-based primary care program in New York City.</p><p><strong>Methods: </strong>We conducted one-on-one semi-structured interviews with family caregivers of PLWD. Interviews were conducted via phone, in-person, or virtual. Interviews were audio recorded, professionally transcribed, translated (if needed), and analyzed using thematic analysis.</p><p><strong>Results: </strong>We identified two main themes (each with subthemes) that influence Latino dementia caregiver experiences with healthcare: (1) caregiving and understanding of dementia shaped by individual, family, and social factors (subthemes: Caregiver's own understanding of dementia; Lack of support and understanding from family; Latino cultural perspectives on dementia); and (2) navigating formal services amid gaps in cultural alignment and support (subthemes: Trial and error: education and resource gaps; Cultural tension with healthcare).</p><p><strong>Conclusions: </strong>Culture and family dynamics shape Latino family caregivers' understanding of dementia. Although some had positive experiences, most faced challenges navigating healthcare and experienced gaps in culturally concordant information and support. A culturally centered approach is needed to address these challenges and gaps for the Latino dementia community, including culturally relevant education, resources, and support from the healthcare system and community.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234746","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 Does Not Influence Postoperative Lactate Values in Older Adult Trauma Patients.","authors":"Kristin Salottolo, Alexander Knippenberg, Michael Fisher, Timbre Backen, Alexandra Moody, Kaysie Banton, David Bar-Or","doi":"10.1111/jgs.70152","DOIUrl":"https://doi.org/10.1111/jgs.70152","url":null,"abstract":"<p><strong>Background: </strong>Lactate monitoring is used to dynamically identify patients with a higher risk of poor outcomes. However, elevated lactate levels are interpreted using the same stratification regardless of patient age. Age could be a modifying factor for circulating lactate levels that has not been adequately examined. We hypothesized that there would be a negative association between age and lactate values in the geriatric population.</p><p><strong>Methods: </strong>This retrospective observational study included patients ≥ 65 years old undergoing operative intervention between 1/1/2023 and 8/1/2023. Postoperative venous lactate (pVL) values and patients' age were examined continuously and categorically (pVL: < 2, 2-3, ≥ 3 mmol/L; age: 65-74, 75-84, ≥ 85 years). The association between pVL and age was analyzed overall and after stratifying by potential confounders: nonsurvival (morgue/hospice vs. other hospital disposition), ICU admission, injury severity (ISS ≥ 16 vs. < 16), and frailty (modified frailty index-5 ≥ 2 vs. < 2).</p><p><strong>Results: </strong>There were 284 surgically managed older adults; the median age was 80 (73-88) years and 37% were ≥ 85 years old. Overall, 218 (77%) patients had a pVL, assessed 8 (7-11) hours postoperatively. The median pVL was 1.8 (1.3-2.5) mmol/L and 13% had pVL ≥ 3 mmol/L. Age and pVL values were not associated when examined continuously (r² = 0.08, p = 0.20) nor categorically (p = 0.44). Age and pVL were not associated when stratified by ICU admittance (ICU: r² = 0.17, p = 0.44; non-ICU: r² = 0.07, p = 0.33), by ISS (≥ 16, r² = -0.03, p = 0.92; < 16: r² = 0.12, p = 0.09), by survival (survivors: r² = 0.08, p = 0.23; nonsurvivors: r² = -0.13, p = 0.64), and by frailty (frail: r² = 0.14, p = 0.15; not frail: r² = -0.07, p = 0.48).</p><p><strong>Conclusions: </strong>These results suggest that age is not an important consideration or concern when interpreting postoperative lactate values of older adult trauma patients.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240644","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}