Journal of the American Geriatrics Society最新文献

{"title":"Long-Term Exposure to Non-Steroidal Anti-Inflammatory Medication in Relation to Dementia Risk.","authors":"Ilse Vom Hofe, Bruno H Stricker, M Kamran Ikram, Frank J Wolters, M Arfan Ikram","doi":"10.1111/jgs.19411","DOIUrl":"https://doi.org/10.1111/jgs.19411","url":null,"abstract":"<p><strong>Background: </strong>Non-steroidal anti-inflammatory (NSAID) medication could reduce dementia risk due to anti-inflammatory and possibly amyloid-lowering properties. However, the results of observational studies and short-term randomized-controlled trials have been inconsistent, and duration and dose-response relationships are still unclear.</p><p><strong>Methods: </strong>We included 11,745 dementia-free participants from the prospective population-based Rotterdam Study (59.5% female, mean age 66.2 years). NSAID use from 1991 was derived from pharmacy dispensing records, from which we determined cumulative duration and dose. We defined four mutually exclusive categories of cumulative use: non-use, short-term use (< 1 month), intermediate-term use (between 1 and 24 months), and long-term use (> 24 months). We determined the association with dementia risk until 2020 using Cox regression models, including NSAID use as a time-varying exposure. Models were adjusted for lifestyle factors, comorbidity, and comedication use. We repeated the analyses stratified by previously established amyloid-β lowering properties of different NSAIDs.</p><p><strong>Results: </strong>During an average follow-up period of 14.5 years, a total of 9520 (81.1%) participants had used NSAIDs at any given time, and 2091 participants developed dementia. Use of NSAIDs was associated with lower dementia risk for long-term users (HR [95% CI]: 0.88 [0.84-0.91]), and a small increased risk with short-term use (HR [95% CI]: 1.04 [1.02-1.07]) or intermediate-term use (HR: 1.04 [1.02-1.06]). The cumulative dose of NSAIDs was not associated with decreased dementia risk (HR for ≤ 25th percentile: 1.06 [1.03-1.09], 26-50th percentile: 1.02 [0.99-1.05], 51-75th percentile: 1.03 [0.99-1.06], > 75th percentile: 0.99 [0.96-1.02]). Associations were somewhat stronger for long-term use of NSAIDs without known effects on amyloid-β than for amyloid-lowering NSAIDs (HR [95% CI]: 0.79 [0.74-0.85] versus 0.89 [0.85;0.93]).</p><p><strong>Conclusion: </strong>Long-term NSAID use, but not cumulative dose, was associated with decreased dementia risk. This suggests that prolonged rather than intensive exposure to anti-inflammatory medication may hold potential for dementia prevention.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560315","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":"Disparities in Timely Receipt of Home Healthcare: Neighborhood Disadvantage and Delayed Start-of-Care Visits in New York City.","authors":"Sasha M Vergez, Yolanda Barrón, Margaret V McDonald","doi":"10.1111/jgs.19406","DOIUrl":"https://doi.org/10.1111/jgs.19406","url":null,"abstract":"<p><strong>Background: </strong>Research has shown that delayed receipt of home healthcare (HHC) is linked to negative patients' outcomes such as hospitalizations, emergency department visits, and death. Studies have looked at factors contributing to delays including high-unemployment areas and racial/ethnic backgrounds of patients. However, no previous study had examined how the deliverance of timely care differs among levels of neighborhood disadvantage within an urban city. The objective of this study was to assess if there were associations between neighborhood disadvantage and delayed start-of-care (SOC) HHC visits.</p><p><strong>Methods: </strong>We conducted a retrospective observational study on newly admitted HHC patients after a hospital discharge during the years 2021 and 2022. The total sample included 73,536 HHC episodes of care. We used log-binomial regressions to examine the association between a delayed SOC HHC visit, defined as a first HHC visit occurring after 48 h of hospital discharge, and neighborhood disadvantage, adjusting for patients' age, race, sex, and clinical status.</p><p><strong>Results: </strong>Close to one-third (23,712; 32.3%) of HHC episodes experienced a delayed SOC HHC visit. As the level of neighborhood disadvantage increased, so did the risk of experiencing delayed care. After adjusting for covariates, patients living in the most disadvantaged neighborhoods (level 5) had a 13% (RR 1.13; 95% CI 1.10-1.17) higher risk of experiencing delayed care when compared to those in the least disadvantaged neighborhoods (level 1). As the level of neighborhood disadvantage increased, so did the proportion of minority patients.</p><p><strong>Conclusions: </strong>These findings underscore the disparities in receipt of timely HHC among differing levels of neighborhood disadvantage. As HHC is presented as a safer and more comfortable alternative to institutional post-acute care, ensuring the availability and equitable care is essential for maintaining high-quality care especially for already marginalized populations.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545132","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 Nursing Homes Among Medicaid Beneficiaries Newly Diagnosed With Cancer.","authors":"Amanda C Chen, David C Grabowski","doi":"10.1111/jgs.19391","DOIUrl":"10.1111/jgs.19391","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560328","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":"Depression and Antidepressant Prescription in Hospitalized Centenarians.","authors":"Taylor Fistel, Kathryn Lotharius, Gabriella Engstrom, Joseph G Ouslander","doi":"10.1111/jgs.19415","DOIUrl":"https://doi.org/10.1111/jgs.19415","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143559835","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":"\"Nobody Can Be Equipped for This\": Advice From New Residents of Long-Term Care Facilities.","authors":"Kenneth Lam, James D Harrison, Landon Haller, William J Deardorff, Rebecca L Sudore, Kenneth E Covinsky, Dan D Matlock, Daniel Dohan","doi":"10.1111/jgs.19405","DOIUrl":"https://doi.org/10.1111/jgs.19405","url":null,"abstract":"<p><strong>Background: </strong>The transition into a long-term care facility (LTCF) is difficult for older adults, prompting calls for clinicians to help guide and plan. Yet we know little about how those with lived experience of moving into an LTCF would advise others.</p><p><strong>Methods: </strong>We conducted in-person semi-structured interviews with nursing home (NH) and assisted living (AL) residents within 6 months of moving into an urban non-profit continuing care retirement community in California between 2023 and 2024. Interviews were guided by theories of long-term care utilization and asked, \"what advice would you give others considering an LTCF?\" We thematically analyzed interviews using the constant comparative method.</p><p><strong>Results: </strong>We interviewed 8 NH and 6 AL residents. Mean participant age was 82 (range 73-90); 8 were female, 1 participant was Asian, 13 participants were White, and mean Montreal Cognitive Assessment was 19 (range 12-25). Residents talked about LTCF entry within a broader phase of life defined by dependence following sudden unexpected health crises. Advice reflected strategies for this phase of life and highlighted challenges outside of their control. Some residents advised preparation by visiting facilities and budgeting time and resources to plan but discovered care arrangements did not work out as promised; care was fragmented, and dependence caused them to re-evaluate what they wanted. Some advised avoidance as they disliked living in an LTCF but had little control over entry, leading to distrust of those making decisions for them. Others advised acceptance and believed luck or fate dictated how everything worked out in the end.</p><p><strong>Conclusions: </strong>Unanticipated health crises catalyze entry into LTCFs. New residents advised others to prepare for, avoid, or accept LTCF entry, reflecting different strategies for approaching a unique phase of life and highlighting systemic problems that could be improved. Anticipatory guidance for LTCF transitions should acknowledge their sudden nature, these strategies, and the need for system reform.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545131","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 European Geriatric Medicine Society 2024 Annual Congress in Valencia, Spain.","authors":"Paula A Rochon, Darly Dash, Joseph G Ouslander","doi":"10.1111/jgs.19409","DOIUrl":"https://doi.org/10.1111/jgs.19409","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495119","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":"Cancer and Accelerated Aging Research at the National Institutes of Health, 2013-2023: A Grant Portfolio Analysis.","authors":"Lisa Gallicchio, Rachelle Brick, Gina Tesauro, Lindsey Page, Paige Green, Jennifer L Guida","doi":"10.1111/jgs.19414","DOIUrl":"https://doi.org/10.1111/jgs.19414","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to describe the characteristics of the NIH-funded grant portfolio focused on cancer and accelerated aging.</p><p><strong>Methods: </strong>Research project grants focused on cancer survivors and aging trajectories that were newly funded during fiscal years 2013 through 2023 were identified by first using a text mining algorithm from the NIH Research, Condition, and Disease Categorization (RCDC) system with cancer survivorship-relevant terms and then a list of aging-related terms that included aging, neurocognition, and physical function. Included grants were double coded to extract study characteristics.</p><p><strong>Results: </strong>A total of 166 grants were identified, with the National Cancer Institute (NCI) and National Institute on Aging (NIA) funding 62.0% and 23.5% of the grants, respectively. The number of newly funded grants rose from nine in 2013 to 27 in 2023. Overall, the majority were observational studies (65.1%); 45% included study samples of multiple cancer types. The most commonly examined outcomes were cognitive (54.4%) or physical (37.5%) functioning; 30% of grants incorporated an aging-related biomarker. Few grants focused on racial and ethnic minority (3.0%) or rural cancer survivors (2.4%).</p><p><strong>Conclusions: </strong>This portfolio analysis showed an increase in the number of NIH-funded grants focused on cancer survivors and accelerated aging, but notable gaps are evident. Given the rapidly growing survivor population, many of whom will experience accelerated aging trajectories, there is a critical need to better understand accelerated aging phenotypes and mechanisms, so that those at the highest risk for adverse aging-related effects can be identified and interventions developed.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470323","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":"Application of an Electronic Frailty Index to Identify High-Risk Older Adults Using Electronic Health Record Data.","authors":"Bharati Kochar, David Cheng, Hanna-Riikka Lehto, Nelia Jain, Elizabeth Araka, Christine S Ritchie, Rachelle Bernacki, Ariela R Orkaby","doi":"10.1111/jgs.19389","DOIUrl":"https://doi.org/10.1111/jgs.19389","url":null,"abstract":"<p><strong>Background: </strong>Measurement of frailty is limited in clinical practice. Existing electronic frailty indices (eFIs) are derived from routine primary care encounters, with near-complete health condition capture. We aimed to develop an eFI from routinely collected clinical data and evaluate its performance in older adults without complete health condition capture.</p><p><strong>Methods: </strong>Using Electronic Health Record (EHR) data from an integrated regional health system, we created a cohort of patients who were ≥ 60 years on January 1, 2017 with two outpatient encounters in 3 years prior or one outpatient encounter in 2 years prior. We developed an eFI based on 31 age-related deficits identified using diagnostic and procedure codes. Frailty status was categorized as robust (eFI < 0.1), prefrail (0.1-0.2), frail (0.2-0.3), and very frail (> 0.3). We estimated cumulative incidence of mortality, acute care visits and readmissions by frailty, and fit Cox proportional hazards models. We repeated analyses in a sub-cohort of patients who receive primary care in the system.</p><p><strong>Results: </strong>Among 518,449 patients, 43% were male with a mean age of 72 years; 73% were robust, 16% were pre-frail, 7% were frail, and 4% were very frail. Very frail older adults had a significantly higher risk for mortality (HR: 4.1, 95% CI: 4.0-4.3), acute care visits (HR: 5.5, 95% CI: 5.4-5.6), and 90-day readmissions (HR: 2.1, 95% CI: 2.1-2.2) than robust older adults. In a primary care sub-cohort, while prevalence of deficits was higher, associations with outcomes were similar.</p><p><strong>Conclusions: </strong>This eFI identified older adults at increased risk for adverse health outcomes even when data from routine primary care visits were not available. This tool can be integrated into EHRs for frailty assessment at scale.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470321","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":"Individualized Net Benefit of Intensive Blood Pressure Lowering Among Community-Dwelling Older Adults in SPRINT.","authors":"Mitra S Jamshidian, Rebecca Scherzer, Michelle M Estrella, Richard L Kravitz, Rebecca S Boxer, Daniel J Tancredi, Jarett D Berry, James A de Lemos, Charles Ginsberg, Joachim H Ix, Michael G Shlipak, Simon B Ascher","doi":"10.1111/jgs.19395","DOIUrl":"https://doi.org/10.1111/jgs.19395","url":null,"abstract":"<p><strong>Background: </strong>The optimal blood pressure (BP) target for older adults with hypertension remains controversial, particularly among those with advanced age, frailty, or polypharmacy. This study estimated the individualized net benefit of intensive BP lowering among community-dwelling older adults in the Systolic Blood Pressure Intervention Trial (SPRINT).</p><p><strong>Methods: </strong>Among 5143 SPRINT participants age ≥ 65 years, Cox models were internally validated to predict an absolute difference in risk between treating to a systolic BP target of < 120 versus < 140 mm Hg for all-cause death, cardiovascular outcomes, cognitive outcomes, and serious adverse events. Treatment effects were combined using simulated preference weights into individualized net benefits, representing the weighted sum of risk differences across outcomes. Net benefits were compared across categories of age (65-74 vs. ≥ 75 years), SPRINT-derived frailty status (fit, less fit, and frail), and polypharmacy (≥ 5 medications).</p><p><strong>Results: </strong>When simulating preferences for participants who view the benefits of BP lowering (reduction in death, cardiovascular events, and cognitive impairment) as much more important than treatment-related harms (e.g., acute kidney injury and syncope), the median net benefit from intensive BP lowering was 4 percentage points (IQR: 3-6), and 100% had a positive net benefit favoring intensive BP lowering. When simulating benefits and harms to have similar, intermediate importance, the median net benefit was 1 percentage point (IQR: 0-2), and 85% had a positive net benefit. Participants with advanced age and frailty had greater net benefits from intensive BP lowering despite experiencing more harm in both simulations, and those with polypharmacy had greater net benefits when benefits were viewed as much more important than harms (p < 0.001 for all comparisons).</p><p><strong>Conclusions: </strong>Among community-dwelling older adults with hypertension in SPRINT, almost all participants had a net benefit that favored a systolic BP target of < 120 mm Hg, but the magnitude of net benefit varied according to estimated risks and simulated preferences.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451300","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":"Home-Based Comprehensive Geriatric Assessment for Community-Dwelling, At-Risk, Frail Older Adults: A Systematic Review and Meta-Analysis.","authors":"Christina Hayes, Amanuel Yigezu, Sarah Dillon, Christine Fitzgerald, Molly Manning, Aoife Leahy, Dominic Trépel, Katie Robinson, Rose Galvin","doi":"10.1111/jgs.19402","DOIUrl":"https://doi.org/10.1111/jgs.19402","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive geriatric assessment (CGA), an operational model of integrated care, has become a fundamental component of healthcare delivery models for older adults. It is a multidimensional diagnostic process intended to determine a frail elderly person's medical, psychosocial, and functional capabilities and limitations to develop an integrated care plan. The aim of this systematic review and meta-analysis was to update and synthesize the totality of research evidence related to the effectiveness of home-based CGA compared with usual care among community-dwelling at-risk older adults. A secondary aim of the review was to characterize the components of CGA delivered across the included studies.</p><p><strong>Methods: </strong>CENTRAL, MEDLINE, Embase, CINAHL, trial registers (WHO ICTRP, ClinicalTrials.gov, and McMaster Aging Portal), and gray literature were searched. Two independent reviewers conducted screening, data extraction, quality appraisal, and applied the Grading of Recommendations, Assessment, Development, and Evaluations framework to quantify the certainty of evidence. Meta-analyses were performed in Review Manager 5.4. The primary outcome was functional status.</p><p><strong>Results: </strong>Twenty-two trials recruiting 7219 community-dwelling older adults were included. Home-based CGA resulted in improved functional status at 6-24 months (standardized mean difference [SMD] 0.17, 95% confidence interval [CI] 0.09-0.25), at 12 months (SMD 0.24, 95% CI 0.02-0.47), and at 24 months (SMD 0.11, 95% CI 0.01-0.22); an increased health-related quality of life (HRQoL) at 6-24 and 12 months; a reduction in mortality at 36 months; a reduction in hospitalizations at 6-36 months; and improved patient satisfaction with care at 6-12 months. Home-based CGA resulted in little or no difference in nursing home admission, emergency department presentation, or adverse events. Intervention characteristics and multidisciplinary team composition varied across trials.</p><p><strong>Conclusion: </strong>Home-based CGA improves clinical and process outcomes for community dwelling at-risk older adults. CGA delivered by a comprehensive multidisciplinary team enhances functional status among community-dwelling older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443057","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}