Journal of the American Geriatrics Society最新文献

{"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}

{"title":"What Comes Next? When and How Medicaid Home- and Community-Based Services End.","authors":"Emmaline Keesee, David Stevenson, Chanee D Fabius, Laura M Keohane","doi":"10.1111/jgs.70761","DOIUrl":"10.1111/jgs.70761","url":null,"abstract":"<p><strong>Background: </strong>As Medicaid long-term services and supports shift towards home-and-community-based settings (HCBS), it is important to understand trajectories of HCBS use among older adults, including duration and living circumstances at cessation, to inform decisions about whether state Medicaid programs can afford to sustain or expand HCBS benefits.</p><p><strong>Methods: </strong>This study examined determinants of HCBS episode duration and how they vary by status at cessation (community discharge, nursing home, or deceased). We used Southern Community Cohort Study (SCCS) data linked with Medicaid and Medicare claims to follow a cohort of older adults who initiated Medicaid-funded HCBS in Southeastern states between 2006 and 2018. We calculated unadjusted incidence of cessation and modeled adjusted rate of cessation using Cox proportional hazard models to understand how demographic characteristics, Medicaid coverage, HCBS program, and health history related to cessation with community discharge, nursing home entry, and death.</p><p><strong>Results: </strong>Among older adults with 5 years of follow-up (n = 591), 25.2% ended HCBS with community discharge, 16.2% with nursing home entry, and 26.2% with death. The remaining 32.3% still used HCBS. Across the entire sample (n = 1304), female cohort members had significantly lower rates of HCBS cessation (HR: 0.7, 95% CI: 0.6, 0.8), while individuals who were older (HR: 1.1, 95% CI: 1.0, 1.1), had more health conditions (HR: 1.1, 95% CI: 1.0, 1.1), or prior nursing home use (HR: 1.3, 95% CI: 1.0, 1.5) had higher rates of HCBS cessation. Individuals initiating HCBS use and Medicaid coverage at the same time had a lower rate of community discharge (HR: 0.7, 95% CI: 0.5, 0.9) than HCBS users with established Medicaid coverage.</p><p><strong>Conclusions: </strong>Extended duration of HCBS use was common across our sample, which may affect Medicaid's ability to fund HCBS programs. Policymakers should consider how care needs may vary when projecting how long older adults will access HCBS benefits.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120925","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 Model to Increase Faculty Competency in Teaching Quality Improvement to Geriatric and Palliative Care Fellows.","authors":"Kelly J Cummings, Kristi Nguyen, Stephanie W Chow, Helen Fernandez, William Hung, Brijen J Shah, Suzanne L Goldhirsch, Christine Chang","doi":"10.1111/jgs.70760","DOIUrl":"https://doi.org/10.1111/jgs.70760","url":null,"abstract":"<p><p>Parallel fellow and faculty quality improvement (QI) curricula.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120917","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":"Telehealth as a Bridge for Palliative and End-of-Life Care in Nursing Homes.","authors":"Rachael Alexander, Rebekah Perkins, Amy Powell-Versteeg, Pamela Barrientos, Laura Block, Rebecca M Goodwin, Megan McClure, Rebecca Utz, Paige Patterson, Theresa A Allison, Lynn Flint, Caroline Stephens","doi":"10.1111/jgs.70765","DOIUrl":"https://doi.org/10.1111/jgs.70765","url":null,"abstract":"<p><strong>Background: </strong>Older adults living in nursing homes experience high rates of serious illness, hospitalization, and death, yet access to specialty palliative care remains limited. The COVID-19 pandemic rapidly expanded telehealth use in nursing homes, creating new opportunities to remotely deliver palliative and end-of-life care. Understanding how telehealth supported or complicated palliative care during this period is critical to informing sustainable post-pandemic clinical and payment models.</p><p><strong>Methods: </strong>We conducted a qualitative descriptive study using semi-structured interviews with 29 multidisciplinary nursing home staff from 22 facilities, including 14 rural, across the United States from June 2021 to July 2022. Interviews explored experiences using telehealth during the pandemic, with attention to symptom management, goals-of-care communication, family involvement, and end-of-life care. Data were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Three themes in relation to telehealth use in palliative and end-of-life care were identified: (1) Adoption of Telehealth: Staff described how the pandemic forced telehealth into nursing home culture. Multiple platform use, family involvement, and provider engagement expanded care access and reduced transportation burdens during this time of crisis with emphasis on improved communication and inclusion of geographically distant family members; (2) Difficult Experiences with Telehealth Implementation: Participants reported technical challenges, workflow strain, and digital literacy gaps along with its limitations for assessment, rapport, and personable end-of-life conversations; (3)The role of Telehealth as a Bridge for Palliative and End-of-Life Care: Telehealth facilitated goals-of-care discussions, supported comfort-focused decision-making, and enabled virtual presence during dying.</p><p><strong>Conclusions: </strong>Telehealth played a critical role in maintaining connection, coordination, and compassionate palliative care for nursing home residents during the pandemic. Findings highlight telehealth's potential as a sustainable strategy to expand access to palliative and end-of-life care in nursing homes, especially in resource-limited settings. Telehealth policy and practice should focus on sustaining telehealth infrastructure, workforce training, payment systems, and ethical guidance for serious illness communication.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121009","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":"Examining the Use of the Area Deprivation Index in EHR-Based Recruitment of African American Women.","authors":"Krishna H Brucia, Rebecca North, Cynthia Coffman, Kathryn N Porter Starr, Connie W Bales, Anna Hung, Nia S Mitchell","doi":"10.1111/jgs.70749","DOIUrl":"https://doi.org/10.1111/jgs.70749","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120980","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 Prognostic Performance of BMI- and Height-Indexed Muscle Mass in Older Patients With Heart Failure: Insights From FRAGILE-HF.","authors":"Taisuke Nakade, Daichi Maeda, Yuya Matsue, Nobuyuki Kagiyama, Yudai Fujimoto, Tsutomu Sunayama, Taishi Dotare, Kentaro Jujo, Kazuya Saito, Kentaro Kamiya, Hiroshi Saito, Yuki Ogasahara, Emi Maekawa, Masaaki Konishi, Takeshi Kitai, Kentaro Iwata, Hiroshi Wada, Takatoshi Kasai, Hirofumi Nagamatsu, Shin-Ichi Momomura, Tohru Minamino","doi":"10.1111/jgs.70766","DOIUrl":"https://doi.org/10.1111/jgs.70766","url":null,"abstract":"<p><p>Among older patients hospitalized for heart failure, height-indexed appendicular skeletal muscle mass, but not BMI-indexed appendicular skeletal muscle mass, was associated with higher 2-year mortality. Height-indexed ASMM may therefore be the more clinically useful marker for post-discharge risk stratification.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120946","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 Complex Relationship of Cognitive and Sensory Impairments With Risk of Hospitalization in Adults With Heart Failure.","authors":"Mayra Tisminetzky, Grace Tabada, Jerry H Gurwitz, Kristi Reynolds, Stephen P Fortmann, Matthew T Mefford, Chengyi Zheng, Elisha Garcia, Aaron Madow, Robert J Goldberg, Alan S Go","doi":"10.1111/jgs.70758","DOIUrl":"https://doi.org/10.1111/jgs.70758","url":null,"abstract":"<p><strong>Background: </strong>Individuals with heart failure (HF) often have multiple complicating comorbidities. We examined whether cognitive and sensory (vision and hearing) impairments were independently associated with the risks of being hospitalized for HF or any cause in adults with HF.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study among adults with HF from four US integrated healthcare delivery systems from 2005 to 2012. The presence of cognitive and sensory impairments were defined based on ICD-9 codes. We evaluated the association of cognitive and sensory impairments with hospitalization for HF and hospitalization for any cause using Fine-Gray subdistribution hazard models, accounting for competing risks of death or health plan disenrollment.</p><p><strong>Results: </strong>Among 43,358 eligible adults with HF, the mean age was 71.6 years, 43% were women, 26% were racial/ethnic minorities; 1104 had both cognitive and sensory impairments; 1079 had only cognitive impairment; 14,207 had only sensory impairment; and 26,968 had neither documented impairment at study entry. Individuals with both impairments had the lowest adherence to HF-related medications as compared to those without impairments. After adjustment for several potential confounders and accounting for competing risk of death, compared to individuals without any documented impairment, those with only cognitive impairment and those with both impairments experienced a lower risk of HF-related hospitalization (adjusted hazard ratio [aHR], 0.71 95% CI: 0.63-0.80) and (aHR 0.70 95% CI: 0.62-0.80), respectively. Similar trends were found for hospitalization for any cause.</p><p><strong>Conclusion: </strong>In a diverse population of adults with HF, we observed a counterintuitive association between cognitive and sensory impairments and risks for hospitalization. Potential reasons include unmeasured confounders and receipt of care at home or through other non-hospital facilities. More detailed studies are needed to fully delineate the impact of these impairments and to elucidate potential effective management strategies in this growing population.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083471","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":"Developing Deprescribing Resources to Optimize Medication Safety and Reduce Fall Risk in Older Adults.","authors":"Yara K Haddad, Elizabeth A Phelan","doi":"10.1111/jgs.70763","DOIUrl":"https://doi.org/10.1111/jgs.70763","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120933","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}