Journal of the American Geriatrics Society最新文献

{"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}

{"title":"Local Adaptations of Hospital in Home: Variations in Structure and Implementation Across Six VA Programs.","authors":"Akanksha Samant, Sungjae Park, Emily Franzosa, Orna Intrator, Jennifer L Sullivan, Derek D'Arcy, Porooshat Dadgostar, Reza Yousefi Nooraie, Shivani Jindal, Dayna Cooper, Jessica Barth, Kimberly Judon, Marlena H Shin, Matthew Augustine, William Hung","doi":"10.1111/jgs.70737","DOIUrl":"10.1111/jgs.70737","url":null,"abstract":"<p><strong>Background: </strong>The VA Hospital in Home (HIH) model of care delivers acute-level hospital care to Veterans at home across the country. We aim to examine the similarities and differences in the structure and implementation of existing HIH programs across sites to identify best practices that optimize resources, ensure high-quality care, and enhance sustainability and scalability of the program.</p><p><strong>Methods: </strong>A total of 6 out of 11 existing VA HIH programs reported on their program through structured presentations at Community-of-Practice meetings in 2022. Additional site-level characteristics were retrieved from the VA Corporate Data Warehouse to describe context at each program and to identify HIH encounters, types of stays, and numbers of HIH patients for each site.</p><p><strong>Results: </strong>All sites offered transfer (from hospital-based inpatient service) and substitutive (from other than inpatient) HIH stays, though the proportion of patients for each varied (transfer patients ranging from 6% to 85%). Referral sources for substitutive stays varied across sites including Home-Based Primary Care (HBPC) (67%), outpatient primary care (83%), specialty care clinics (67%), and emergency departments (83%). Each program had interdisciplinary teams, though composition and staff size varied (4-7 full-time equivalent [FTE] RNs; 1.0-2.0 FTE physicians). Programs varied in the number of unique patients served per program (63-146 unique HIH Veterans annually). Programs reported similar procedures in clinical evaluation, informed consent, and maintaining 24/7 access to the HIH team. Outcome metrics tracked include readmission (67%), cost avoidance (50%), and length of stay (50%). Additionally, 50% of sites reported integrating ancillary services and introducing program adaptations during the COVID-19 pandemic period such as virtual follow-up visits.</p><p><strong>Conclusion: </strong>Our study identified similarities and differences across the existing HIH programs, adapting to local contexts while maintaining quality of care. These characteristics may reflect differences in population and site characteristics, patient needs, and program goals.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070926","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":"Use of Dual Orexin Receptor Antagonists for Insomnia and the Risk of Falls and Fractures: A Systematic Review and Meta-Analysis.","authors":"Arianna Paolone, Shehraz Riar, Shajjan Vejayavarnan, Alexandra Papaioannou, George Ioannidis, Justin Lee","doi":"10.1111/jgs.70745","DOIUrl":"https://doi.org/10.1111/jgs.70745","url":null,"abstract":"<p><strong>Background: </strong>Falls are the leading cause of injury in older adults. Sedative-hypnotic use is a known risk factor, but their use for insomnia continues to be common. Dual orexin receptor antagonists (DORAs) are a new, potentially safer class of medications for insomnia. We conducted a systematic review and meta-analysis to assess the effect of DORAs on falls and fractures.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, and CENTRAL from inception to August 2025 for studies reporting falls and fractures in DORA users and non-users. Randomized controlled trials (RCTs) or observational studies that reported data on falls and/or fractures for participants using DORAs in any clinical setting were included. Citation screening, full-text review, and data abstraction were conducted in duplicate. Random-effects model meta-analyses were conducted. The primary outcomes were the incidence or rates of falls and fractures among adults using DORAs compared to non-users. We also calculated the optimal information size (OIS), which is the minimum number of events needed to detect a clinically meaningful effect.</p><p><strong>Results: </strong>Nineteen studies (10 RCTs, 9 observational, 183,595 participants) met inclusion criteria. Across all studies, DORA use did not increase the risk of falls compared to non-use (OR 0.76, 95% CI 0.56-1.04). RCT data suggest a reduction in fall risk (OR 0.59, 95% CI 0.35-0.98) not seen in observational studies (OR 0.88, 95% CI 0.59-1.31). No association was observed between DORAs and fractures (OR 1.05, 95% CI 0.94-1.18).</p><p><strong>Conclusions: </strong>DORAs do not appear to increase the risk of falls or fractures in adults. Although these findings suggest that DORAs may be safer alternatives to traditional insomnia agents, low event rates, failure to meet the OIS, and limited data in older adults warrant cautious interpretation. Further research is needed to validate these findings and better characterize the relationship between DORAs and falls and fractures, particularly in older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067018","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":"Motivation Interviewing to Reduce Elder Abuse and Neglect: Findings From a Randomized Controlled Trial in Hong Kong.","authors":"Elsie Yan, Haze Ng, Daihai He, Daniel Lai, David Burnes, Mark Lachs","doi":"10.1111/jgs.70743","DOIUrl":"https://doi.org/10.1111/jgs.70743","url":null,"abstract":"<p><strong>Background: </strong>Elder abuse and neglect (EAN) can lead to severe consequences among victims. However, older adults are often reluctant to seek help. This study explored the efficacy of using motivational interviewing (MI), a technique used to resolve ambivalence about behavioral change by strengthening one's motivation, in reducing subsequent EAN among older victims in Hong Kong.</p><p><strong>Methods: </strong>This prospective, two-arm randomized controlled trial (RCT) enrolled Chinese-speaking community-dwelling older adults (age ≥ 60 years) at risk of EAN from 2022 to 2025. The intervention involved 4 individual sessions utilizing key MI techniques to identify personal goals and evoke motivation for change. The primary outcome was EAN in the past month as assessed with items modified from the Revised Conflict Tactics Scale and the Old Adult Financial Exploitation Measure; whilst secondary outcomes included subjective physical health, psychological well-being, self-efficacy, and social support. All outcomes were assessed at baseline, post-intervention, and 3 months after the intervention.</p><p><strong>Results: </strong>A total of 359 older adults were eligible for the intervention. While 161 refused to participate, the final sample comprised 198 older adults (mean age: 73.6 years; female: 88.9%), of whom 99 received the intervention and the other 99 were wait-list controls. Findings from the mixed-effects model analysis showed that, compared with the control group, the intervention group experienced greater reductions in minor psychological aggression at the 3-month follow-up assessment (Cohen's d = 0.92, p < 0.001) as well as caregiver neglect at the post-intervention assessment (Cohen's d = 0.57, p < 0.05). Similarly, the intervention group showed greater improvements in self-efficacy (Cohen's d = 0.67-0.83, all p < 0.05) and social support over time (Cohen's d = 2.08, p < 0.05).</p><p><strong>Conclusions: </strong>This study represents one of the first empirical evaluations using MI in EAN interventions. Findings suggest that MI by advocates can be a beneficial approach to help older adults at risk of EAN.</p><p><strong>Trail registration: </strong>This RCT has been registered under the ISRCTN prior to the beginning of the study. The identifying number is ISRCTN35969462. The study protocol can be accessed at https://www.isrctn.com/ISRCTN35969462.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066967","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":"Modes of Cannabis Use and Mental Health Outcomes Among Older Adults in the United States.","authors":"Krish Jagasia, Tyler A Simi, Anderson Lai, Alexandra Z Tien-Smith, Annie L Nguyen, Alison A Moore, Kevin H Yang, Joseph J Palamar","doi":"10.1111/jgs.70748","DOIUrl":"10.1111/jgs.70748","url":null,"abstract":"<p><strong>Background: </strong>Cannabis use among older adults (≥ 65) in the US has increased substantially in recent years. However, physiologic changes associated with aging can complicate cannabis' effects in older populations, particularly as different modes of consumption have distinct pharmacokinetic effects. This study estimates the prevalence of different modes of cannabis use in this population and examines their associations with mental health outcomes.</p><p><strong>Methods: </strong>We analyzed data from older adults aged ≥ 65 years with past-year cannabis use (N = 1515) from the pooled 2022-2024 National Survey on Drug Use and Health, a nationally representative survey of noninstitutionalized US adults. Four generalized linear models using Poisson and log link examined relationships between modes of cannabis use and cannabis use disorder (CUD), major depressive episode (MDE), serious psychological distress (SPD), and suicidal ideation (SI). The modes examined included smoking, ingested forms (eating/drinking or taking pills), inhaled concentrates (vaping or dabbing), and other routes (use of oral drops/lozenges or topicals). The models adjusted for survey year, sociodemographic characteristics, past-year cannabis use frequency, and other past-year substance use.</p><p><strong>Results: </strong>Smoking (66.0%) was the most common mode of cannabis use, followed by ingested forms (42.1%), inhaled concentrates (17.1%), and other routes (16.8%). Compared to males, females had higher prevalence of ingested forms and other routes, while males had higher prevalence of smoking and inhaled concentrates. In multivariable models, smoking (adjusted prevalence ratio [aPR] = 3.99; 95% CI: 1.92-8.28) and ingested forms (aPR = 1.46; 95% CI: 1.03-2.09) were associated with increased prevalence of CUD. No mode was associated with MDE, SPD, or SI.</p><p><strong>Conclusions: </strong>Among older adults, smoking and ingested forms were associated with CUD, whereas no mode was associated with depression, distress, or suicidal ideation. These findings may inform targeted screening and harm reduction strategies for adults aged ≥ 65 years using cannabis.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066925","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}