Journal of the American Geriatrics Society最新文献

{"title":"Development and Implementation of a Pharmacist-Led Aspirin Deprescribing Algorithm in Older Adults.","authors":"Ugene Sano, Marissa Uricchio, Theresa Redling, Noam Zeffren, Jessica Bente","doi":"10.1111/jgs.19474","DOIUrl":"https://doi.org/10.1111/jgs.19474","url":null,"abstract":"<p><strong>Background: </strong>Recent literature has demonstrated that low-dose aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older adults has been associated with a higher incidence of bleeding events without additional benefit compared to standard prevention strategies. This study evaluated the impact of an aspirin deprescribing algorithm on inappropriate aspirin use in patients older than 70 years across two primary care offices.</p><p><strong>Methods: </strong>This institutional review board-approved, pre- and post-interventional study included patients 70 years and older on low-dose aspirin with office visits scheduled from April 1, 2023-March 30, 2024. An aspirin deprescribing algorithm was developed by an interdisciplinary team to guide prescribers with deprescribing. The pharmacist screened patients eligible for deprescribing via chart review of visits from April 2023-October 2023. Patients eligible for deprescribing in the pre-implementation phase were included as the interventional group of the post-implementation phase (November 2023-March 2024). Follow-up was 5 months total. The primary endpoint was incidence of inappropriate aspirin use, defined as patients taking aspirin without documented diagnosis of ASCVD in patients' electronic health record. A subgroup analysis was performed on patients who were eligible for deprescribing and monitored safety endpoints such as incidence of major and minor bleeds based on the International Society on Thrombosis and Hemostasis criteria, major cardiovascular events, and cardiovascular-related hospitalizations. Duration of follow-up for secondary endpoints was 5 months during the post-implementation period.</p><p><strong>Results: </strong>Four-seventy four patients were included. The incidence of inappropriate aspirin use in the pre-implementation group was 24.9% and 118 patients were eligible for deprescribing. For the post-implementation group, 22 patients had aspirin deprescribed, resulting in 20.3% inappropriate aspirin use (p < 0.01). In the subgroup analysis, no difference of major and minor bleeds, major cardiovascular events, and cardiovascular-related hospitalizations were observed.</p><p><strong>Conclusion: </strong>A deprescribing algorithm was associated with a statistically significant reduction in inappropriate aspirin use in older adults for the indication of primary ASCVD prevention. Algorithm-based deprescribing can reduce bleeding risk and polypharmacy in older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039980","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 Comprehensive Medication Reviews on Medicare Beneficiaries With Type 2 Diabetes.","authors":"Tsung-Hua Shen, Felix Cheuk Wun Ting, Shaquib Al Hasan, Joel F Farley","doi":"10.1111/jgs.19463","DOIUrl":"https://doi.org/10.1111/jgs.19463","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes (T2DM) management, particularly adherence to oral antidiabetic drugs (OAD), is a key focus of the Part D Medicare Medication Therapy Management (MTM) program. Despite potential benefits, evidence on the effectiveness of MTM, specifically Comprehensive Medication Reviews (CMRs), remains mixed. To evaluate the effectiveness of CMRs on patient outcomes, we conducted the largest CMR evaluation to date among Medicare beneficiaries with T2DM.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using Medicare claims and MTM data from 2013 to 2019 to examine the impact of CMR on OAD adherence as measured by the proportion of days covered (PDC), statin utilization, emergency department (ED) visits, and hospitalization. A difference-in-difference (DiD) approach with inverse probability treatment weighting was used to reduce confounding.</p><p><strong>Results: </strong>Although CMR recipients and nonrecipients both experienced a reduction in PDC during the follow-up, CMR recipients experienced 2.4% (95% CI, 1.9%-2.9%) less of a decline than nonrecipients, and 2.0% (95% CI, 1.2%-2.8%) fewer CMR recipients were considered non-adherent after CMR delivery. The proportion of CMR recipients using statin increased 1.4% (95% CI, 0.7%-2.2%) relative to nonrecipients after CMR delivery. The proportion of CMR recipients who experienced an ED visit declined by 0.3% (95% CI, -0.6% to 1.2%) while the proportion of hospitalization increased 1.9% (95% CI, 1.1%-2.8%) following CMR delivery, relative to nonrecipients.</p><p><strong>Conclusion: </strong>Patients with T2DM receiving a CMR experienced improved OAD adherence and statin utilization compared to nonrecipients. Our results demonstrate the potential benefits of collaborating with pharmacists to improve diabetes care.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063562","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":"\"I Don't Wake Up Completely\": Older Adults' Trade-Offs Between Nighttime Ambulation Safety and Sleep Quality.","authors":"Zi Yang Jing, Theodore M Johnson, Alexis A Bender","doi":"10.1111/jgs.19469","DOIUrl":"https://doi.org/10.1111/jgs.19469","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035114","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 Changed Your Mind? Influencers of Older Adults Changing Decisions About Aging-In-Place Versus Long-Term Care.","authors":"Isabel Cohen, Raven Relerford, Charles Olvera, Vanessa Ramirez-Zohfeld, Amber Miller-Winder, Lee A Lindquist","doi":"10.1111/jgs.19475","DOIUrl":"https://doi.org/10.1111/jgs.19475","url":null,"abstract":"<p><strong>Background: </strong>As individuals experience age-related changes, such as cognitive decline or hospitalizations, their ability to live independently at home may be impacted. Decision-making and planning are essential in order to support successful aging-in-place (AIP), which is defined as continuing to live in one's home and community. Despite making plans at one single time-point, prior research has demonstrated that decision-making among older adults is not stagnant.</p><p><strong>Aims: </strong>The objective of this qualitative study was to understand what influences older adults to change their plans about AIP versus living in long-term care (LTC) settings.</p><p><strong>Methods: </strong>We analyzed a subset of the PlanYourLifespan study subjects (a longitudinal cohort study of community dwelling older adults) who have shown a fluctuation in their AIP/LTC decisions over a 6-month period and surveyed what influenced their decisions to change. Decisions related to support needed in the case of a hospitalization and Alzheimer's disease/memory loss (rehabilitation preferences, caregiver support, living preferences, and LTC facilities) were assessed. Three investigators individually coded open-ended survey responses to identify emerging themes using constant comparative analysis with triangulation of themes.</p><p><strong>Results: </strong>Of the 293 PYL study subjects, 134 expressed a change to at least one of their decisions. Through a qualitative analysis of survey responses, five overarching themes emerged that influenced fluctuating decision-making: (1) personal health experience, (2) health experience of a loved one, (3) increased contemplation, (4) social support network influences, and (5) denying change.</p><p><strong>Discussion: </strong>This study was the first to examine the factors that influence fluctuating AIP/LTC decision-making among older adults. The key influencers identified highlight the importance of ongoing discussions to revisit AIP/LTC planning in the case of changing or unexpected life events. Having a strong understanding of what influences seniors in their AIP/LTC decision-making processes will enable us to include these factors and people in decision-making discussions.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040232","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":"Prioritization of Older Adults in Canadian Climate Change Adaptation Policies: A Policy Document Analysis.","authors":"Gabrielle M Katz, Anumita Jain, Kristina M Kokorelias, Nathan M Stall","doi":"10.1111/jgs.19471","DOIUrl":"https://doi.org/10.1111/jgs.19471","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045436","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":"Nutrition-Fortified Texture-Modified Diet Enhances Recovery in Older Adult Patients With Dysphagia.","authors":"Junko Ueshima, Keisuke Maeda, Fumiya Miyoshi, Naoko Takeuchi, Yukitoshi Morita, Hiroaki Kaneda, Akira Fukuda","doi":"10.1111/jgs.19468","DOIUrl":"https://doi.org/10.1111/jgs.19468","url":null,"abstract":"<p><p>In this prospective intervention with older stroke patients experiencing dysphagia, a fortified texture-modified diet increased daily energy intake by approximately 200 kcal while preserving meal volume, thereby enhancing functional recovery and activities of daily living. This approach addresses underfeeding concerns and may help optimize dysphagia care.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047472","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":"Managing Hypercholesterolemia in Adults Older Than 75 years Without a History of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From the National Lipid Association and the American Geriatrics Society.","authors":"Vera Bittner, Sunny A Linnebur, Dave L Dixon, Daniel E Forman, Ariel R Green, Terry A Jacobson, Ariela R Orkaby, Joseph J Saseen, Salim S Virani","doi":"10.1111/jgs.19398","DOIUrl":"https://doi.org/10.1111/jgs.19398","url":null,"abstract":"<p><p>The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated LDL-cholesterol and non-HDL-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75 years and do not adjust for co-morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL-cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available data suggest that statin therapy in older primary prevention patients may reduce atherosclerotic cardiovascular events and that benefits from lipid-lowering with statins outweigh potential risks such as statin-associated muscle symptoms and incident Type 2 diabetes mellitus. While some evidence suggests the possibility that statins may be associated with incident cognitive impairment in older adults, a preponderance of literature indicates neutral or even protective statin-related cognitive effects. Shared decision-making which is recommended for all patients when considering statin therapy is particularly important in older patients. Randomized clinical trial data evaluating the use of non-statin lipid-lowering therapy in older patients are sparse. Deprescribing of lipid-lowering agents may be appropriate for select patients older than 75 years with life-limiting diseases. Finally, a patient-centered approach should be taken when considering primary prevention strategies for older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029859","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":"Editorial for \"Managing Hypercholesterolemia in Adults Older Than 75 Years Without a History of Atherosclerotic Cardiovascular Disease. An Expert Clinical Consensus From the National Lipid Association and American Geriatrics Society\".","authors":"Sunny A Linnebur, Vera Bittner","doi":"10.1111/jgs.19452","DOIUrl":"https://doi.org/10.1111/jgs.19452","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055306","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":"Clin-STAR Corner: Practice-Changing Advances at the Interface of Gastroenterology & Geriatrics.","authors":"Adam S Faye, Bharati Kochar, Aasma Shaukat","doi":"10.1111/jgs.19467","DOIUrl":"https://doi.org/10.1111/jgs.19467","url":null,"abstract":"<p><p>With nearly 60 million Americans aged 65 and older, gastrointestinal (GI) conditions are a leading cause of healthcare utilization in this population. Despite this, older adults remain underrepresented in GI clinical trials and research, limiting evidence-based care. This review highlights three pivotal studies addressing this gap: (1) proton pump inhibitors, which are commonly used to treat gastroesophageal reflux disease, are not associated with the later development of dementia; (2) undertreatment of chronic inflammation among older adults with inflammatory bowel disease is associated with a higher rate of adverse events compared to treatment with anti-TNF therapy, a biologic agent; (3) the majority (85%) of surveillance colonoscopies among older adults with a life expectancy of ≥ 10 years did not yield colorectal cancer, advanced dysplasia, or ≥ 3 polyps.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813265","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":"Incidence of Frailty, Dementia, and Disability Among Community-Living Older Americans According to County-Level Disadvantage.","authors":"Yi Wang, Emma X Zang, Kendra Davis-Plourde, Brent Vander Wyk, Thomas M Gill, Robert D Becher","doi":"10.1111/jgs.19465","DOIUrl":"https://doi.org/10.1111/jgs.19465","url":null,"abstract":"<p><strong>Background: </strong>County-level contextual disadvantage is a novel social determinant of health (SDOH) for older persons. No prior study has evaluated the national incidence of geriatric conditions according to county-level contextual disadvantage among older persons. Our objective was to estimate the incidence of frailty, probable dementia, and disability over a 5-year period on the basis of county-level contextual disadvantage among community-living older Americans.</p><p><strong>Methods: </strong>This prospective, nationally representative longitudinal study used data from the 2015 cohort of the National Health and Aging Trends Study (NHATS), linked to various publicly available, geographically based contextual datasets. County-level disadvantage was assessed using the Geriatric Index of County-Level Multi-Dimensional Contextual Disadvantage (GERi-County), which included nine contextual indicators from these linked datasets. Data on frailty, probable dementia, and activities of daily living (ADL) disability were obtained from the NHATS annual assessments (2015-2020).</p><p><strong>Results: </strong>Totally 7499 participants were included in the analysis, representing 40,728,543 community-living older Americans. The 5-year incidence rates per 1000 person-years were significantly higher in the disadvantaged compared to the non-disadvantaged counties: 52.8 (95% confidence interval (CI), 41.6-64.0) versus 40.3 (95% CI, 37.2-43.3) for frailty; 29.9 (95% CI, 25.4-34.3) versus 21.2 (95% CI, 19.0-23.4) for probable dementia; and 78.1 (95% CI, 70.2-86.0) versus 62.5 (95% CI, 58.2-66.8) for ADL disability. For participants who lived versus did not live in disadvantaged counties, the age- and sex-adjusted HRs were 1.38 (95% CI, 1.08-1.75) for frailty, 1.53 (95% CI, 1.25-1.86) for probable dementia, and 1.30 (95% CI, 1.13-1.49) for ADL disability.</p><p><strong>Conclusions: </strong>Community-living older Americans who reside in disadvantaged counties have a higher incidence of frailty, probable dementia, and ADL disability over a 5-year follow-up period compared to their non-disadvantaged counterparts. Findings underscore the vital, underappreciated role that county-level social contextual disadvantage plays on clinically meaningful outcomes in older persons in the U.S.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805127","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}