Journal of the American Geriatrics Society最新文献

{"title":"Hospice Visits and Perceived Hospice Quality Among Assisted Living Residents.","authors":"Wenhan Guo, Shubing Cai, Yue Li, Brian E McGarry, Thomas V Caprio, Helena Temkin-Greener","doi":"10.1111/jgs.19532","DOIUrl":"https://doi.org/10.1111/jgs.19532","url":null,"abstract":"<p><strong>Background: </strong>Hospice services are widely used by assisted living residents at the end of life, yet concerns exist about the adequacy and quality of hospice care in this setting.</p><p><strong>Participants and setting: </strong>This cohort study analyzed Medicare claims data from 51,303 assisted living residents who received hospice care and died in 2018-2019. Data were linked to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey to evaluate perceived hospice quality.</p><p><strong>Methods: </strong>The primary exposure was the number of hospice staff visits in the last 3 days of life, categorized as clinical (physicians, nurses) or nonclinical (social workers, hospice aides, chaplains, bereavement counselors). The primary outcome was hospice quality ratings from the CAHPS Hospice Survey. Multivariable regression models were used to examine associations between hospice staff visits and quality ratings, adjusting for resident and hospice characteristics.</p><p><strong>Results: </strong>Among 51,303 assisted living residents, the average CAHPS rating was 80.83. Increased hospice clinical staff visits were associated with improvements in emotional support (0.04-point increase per visit, p < 0.001), family rating of hospice (0.03-point increase, p < 0.001), willingness to recommend (0.03-point increase, p < 0.001), and feeling respected (0.02-point increase, p < 0.001). Increased nonclinical staff visits had stronger associations, including a 0.14-point increase in emotional support (p = 0.01), a 0.28-point increase in willingness to recommend (p < 0.001), and a 0.18-point increase in average scores (p = 0.01).</p><p><strong>Conclusions: </strong>Higher frequency of hospice staff visits was associated with better perceived hospice quality. Policies supporting greater hospice staff engagement, including nonclinical staff, may enhance end-of-life care experiences for assisted living residents.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096482","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":"Making It Count Twice: A Single Age-Friendly Deprescribing Workshop for Either Medical Residents or Geriatric Fellows.","authors":"Chelsea E Hawley, Laura K Triantafylidis, Andrew A Swanner, Sarah C Phillips, Ryan Chippendale, Andrea Wershof Schwartz","doi":"10.1111/jgs.19529","DOIUrl":"https://doi.org/10.1111/jgs.19529","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096485","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":"Beyond Longevity: Prioritizing Individualized Care in Older Adults With NSTE-ACS.","authors":"Yasser Jamil, Abdulla A Damluji, Michael G Nanna","doi":"10.1111/jgs.19525","DOIUrl":"https://doi.org/10.1111/jgs.19525","url":null,"abstract":"<p><p>Four domains guide management choice: geriatric assessment, cardiovascular risk-factor assessment, medical therapy optimization, and angiographic considerations, integrated to tailor management strategies among older adults with NSTE-ACS.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096479","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: The Halo Effect: Perceptions of Information Privacy Among Healthcare Chatbot Users.","authors":"Matthew DeCamp, Jessica R Ellis","doi":"10.1111/jgs.19544","DOIUrl":"https://doi.org/10.1111/jgs.19544","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082899","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":"Engaging Community Reviewers: The Geriatric Emergency Care Applied Research (2.0)-Advancing Dementia Care Network Approach.","authors":"Angela Gifford, Chelsea McClellan, Morgan Daven, Michael Ellenbogen, Beverly Foster, Heidi Gil, Jerry Johnson, Deborah Jobe, Christopher R Carpenter, Scott M Dresden, Andrea Gilmore-Bykovskyi, Ula Hwang, Manish N Shah","doi":"10.1111/jgs.19515","DOIUrl":"https://doi.org/10.1111/jgs.19515","url":null,"abstract":"<p><p>A core tenant of the Geriatric Emergency care Applied Research Network 2.0-Advancing Dementia Care (GEAR 2.0-ADC) is the inclusion of community members during all stages of clinical research. As such, we deliberately integrated and supported patient and public involvement in the evaluation and selection of GEAR 2.0-ADC Pilot Research Grants by developing and adapting traditional grant application review structures, with input from community members, to create the GEAR 2.0-ADC Community Review Committee approach. Community members, including persons living with dementia, effectively participated in all three rounds of research grant application review and selection, complementing the traditional scientific review process. The structure and flexibility of the GEAR 2.0-ADC Community Review Committee approach serve as a model for patient and public grant application review involvement with strong potential for applications across grant reviews in other medical specialties.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082897","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: The Halo Effect: Perceptions of Information Privacy Among Healthcare Chatbot Users.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1111/jgs.19542","DOIUrl":"https://doi.org/10.1111/jgs.19542","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082893","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 Large Language Model Approach to Identifying Preoperative Frailty Among Older Adults From Clinical Notes.","authors":"Ying Qiu Zhou, Onkar Litake, Minhthy N Meineke, Jeffrey L Tully, Nicole Xu, Waseem Abdou, Rodney A Gabriel","doi":"10.1111/jgs.19545","DOIUrl":"https://doi.org/10.1111/jgs.19545","url":null,"abstract":"<p><strong>Background: </strong>Patients with frailty have a higher risk of major postoperative mortality and morbidity. Identifying frailty from the medical record, however, is not straightforward since it is a multifactorial state based on multiple organ systems and a sum of factors accumulated over time. The objective of this study was to develop a large language model-based binary classifier using accurately phenotyped datasets to identify preoperative frailty from clinical notes.</p><p><strong>Methods: </strong>We trained various large language models to identify frailty from anesthesia preoperative clinic notes. There were two development datasets used: (1) patients undergoing spine surgery whose frailty was characterized by patient responses to the Vulnerable Elders-13 Survey (VES-13); and (2) patients undergoing surgery whose frailty was characterized by their calculated electronic frailty index (eFI) score.</p><p><strong>Results: </strong>When trained on our VES-13 development set and tested on our VES-13 validation set, the area under the receiver operating characteristics curve (AUC) for the RoBERTa, BERT, BioBERT, and PubMedBERT models was 0.99, 0.64, 0.67, and 0.73, respectively. When tested on the eFI validation set, the AUCs were 0.63, 0.83, 0.87, and 0.87, respectively. Models trained on the eFI development dataset did not discriminate frailty adequately when tested on the VES-13 validation set.</p><p><strong>Conclusion: </strong>We report the development and validation of a classifier that detects older adults at risk for preoperative frailty from preoperative anesthesia clinical notes. Large language models can be used to accurately identify a difficult-to-quantify and multifactorial characteristic such as frailty in patients by using readily available unstructured information from clinical notes.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082891","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":"Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials.","authors":"Lajjaben Patel, Matthew W Segar, Muhammad S Usman, Ritika Dhruve, Neil Keshvani, Alexander Postalian, Amgad Mentias, Craig D Rubin, Kershaw V Patel, Dharam J Kumbhani, Subhash Banerjee, Ambarish Pandey","doi":"10.1111/jgs.19508","DOIUrl":"https://doi.org/10.1111/jgs.19508","url":null,"abstract":"<p><strong>Background: </strong>Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.</p><p><strong>Methods: </strong>A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).</p><p><strong>Results: </strong>Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (P_interactionfrailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (P_interactionfrailty × intervention arm < 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.</p><p><strong>Conclusion: </strong>Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015466","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":"Hallways Feel Like Homelessness: The Geriatric Boarder Experience.","authors":"Sarah E Perelman, Danielle M Muriel, Anita N Chary, Emily M Hayden, Grace Wang, Shan W Liu","doi":"10.1111/jgs.19518","DOIUrl":"https://doi.org/10.1111/jgs.19518","url":null,"abstract":"<p><strong>Background: </strong>Boarding in the Emergency Department (ED) is associated with increased delirium, morbidity, and mortality. Geriatric patients are especially vulnerable to these harms and are more likely to board for a prolonged time. Although multiple studies have investigated clinical outcomes for older adults, we present the first study examining the subjective experience of geriatric boarders through qualitative methods.</p><p><strong>Methods: </strong>We conducted semi-structured interviews between June 2024 and July 2024 at a large urban academic hospital. We recruited patients over the age of 65 boarding in the ED for over four hours after an inpatient bed request. Patients were located in hallway care spaces, ED rooms, or in a dedicated unit for ED boarding patients. Interviews were transcribed, coded, and discussed for themes using grounded theory. We halted interviews when we reached thematic saturation.</p><p><strong>Results: </strong>We recruited 26 participants (mean age 77). Four themes emerged: (1) Care space location matters, and border units are far preferable to hallways, (2) patients were able to compartmentalize the kindness of the hospital staff and quality of medical care from their environment, (3) boarding elicits feelings of powerlessness, and (4) older adults felt acuity of condition and dementia or frailty, rather than age, should determine who should be prioritized for an inpatient room.</p><p><strong>Conclusion: </strong>Our sample of older adults felt stressed and powerless while boarding. They especially struggled in hallway care spaces and preferred dedicated units for boarding. They felt comorbidities and acuity of condition should determine prioritization for inpatient beds rather than age. These insights can help guide health systems how to improve the boarding experience for geriatric patients. More research is needed to understand the older adult's experience boarding in the ED and how to improve it.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045434","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":"Humility and Medicine, Lessons Learned: Perhaps the Fifth Ethics Principle.","authors":"Michael Gordon","doi":"10.1111/jgs.19538","DOIUrl":"https://doi.org/10.1111/jgs.19538","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045435","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}