Journal of the American Geriatrics Society最新文献

{"title":"The Piano Lesson.","authors":"Biren B Kamdar","doi":"10.1111/jgs.19546","DOIUrl":"https://doi.org/10.1111/jgs.19546","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":"144060003","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 Fate of Older Adults in Antiquity: Senicide and Its Cultural Legacies.","authors":"Michele Augusto Riva, Stefano Todisco, Maria Emilia Paladino","doi":"10.1111/jgs.19537","DOIUrl":"https://doi.org/10.1111/jgs.19537","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056953","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":"Emergency Department Utilization Among Co-Residing Family Caregivers of Persons Living With Dementia.","authors":"Pei-Chun Cha, Craig Rothenberg, Anita N Chary, Justine Seidenfeld, Ula Hwang, Terri Fried, Joan K Monin, Arjun K Venkatesh, Cameron J Gettel","doi":"10.1111/jgs.19522","DOIUrl":"https://doi.org/10.1111/jgs.19522","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033046","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":"Development of an Annual Mobility Screen for Preclinical Mobility Limitation: Test Selection and Interpretation Guidelines.","authors":"Michelle M Lusardi, Victoria Hamby, Sterling Eckert, Jason Dring","doi":"10.1111/jgs.19521","DOIUrl":"https://doi.org/10.1111/jgs.19521","url":null,"abstract":"<p><strong>Background: </strong>Preclinical mobility limitation (PCML) is an emerging public health issue in the United States. A standardized assessment to identify those with PCML has not been established. A Task Force of the American Physical Therapy Association's Academy of Geriatric Physical Therapy (APTA Geriatrics) developed an evidence-based protocol for an Annual Mobility Screen (AMS) with the potential to meet this gap in practice. Early identification of PCML increases the potential for remediation, improved function, and a slower rate of decline. Because mobility is key for independence and quality of life, aging adults would value access to mobility screening. Physical therapists, experts in movement, are uniquely qualified to provide this service.</p><p><strong>Methods: </strong>This report reviews decision-making for the selection of test/measures and the development of an interpretation rationale for an AMS. Test selection criteria included ratio level measures (time, distance, repetition), time or equipment requirements, ability to predict adverse health events, and availability of reference values.</p><p><strong>Results: </strong>Four performance-based measures met inclusion criteria: self-selected and fast walking speed (overall mobility and functional reserve), 30 s Chair Stand (lower extremity muscle performance), Four Square Step test (dynamic balance stepping over low obstacles and changing direction), and Timed Up Go cognitive (ability to dual task while moving). Classification of mobility was based on normal distribution of performance across the population of aging adults as follows: PCML unlikely (at or above-0.5 SD or more from mean for age/gender), PCML likely (between -0.5 SD and - 1.0 SD from mean), and impending mobility limitation (-1 SD below the mean).</p><p><strong>Conclusion: </strong>The AMS was developed to identify older adults with PCML. The reliability and validity of the AMS and its interpretation strategies will be evaluated as the screening protocol is piloted.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061372","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":"Support and Internet Use in Navigating Medicare Plans Among Older Americans.","authors":"Lianlian Lei, Kierstdea Petzold, Julie Strominger, Donovan T Maust","doi":"10.1111/jgs.19516","DOIUrl":"https://doi.org/10.1111/jgs.19516","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015467","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- and Community-Based Service Use Among Veterans: The National Landscape.","authors":"Katherine E M Miller, Megan Price, Katherine O'Malley, Sooyeon Song, Melissa M Garrido","doi":"10.1111/jgs.19492","DOIUrl":"https://doi.org/10.1111/jgs.19492","url":null,"abstract":"<p><strong>Background: </strong>The Veteran population is aging rapidly, with already higher rates of disability compared to non-Veteran peers. Consequently, demand for home- and community-based long-term services and supports (HCBS) is increasing. Understanding who needs and uses HCBS is particularly important in the Veterans Health Administration (VHA)-a payer for HCBS. Our objective is to describe the characteristics of Veterans who use HCBS, how Veterans who use HCBS differ from those who do not use HCBS, and how Veterans who use different types of HCBS differ from each other.</p><p><strong>Methods: </strong>We use administrative data for VHA-provided and VHA-purchased care for 2021-2023 in a cohort of Veterans aged 65+. We describe Veteran HCBS users versus nonusers, services used, and the association of Veteran demographic characteristics, health status, and prior health care use on the probability of receiving HCBS using generalized estimating equations with binomial family, logit link, and exchangeable correlation structure.</p><p><strong>Results: </strong>One in 10 older Veterans uses at least one HCBS service, and this share is growing over time. Veterans use home health care and homemaker/home health aide services the most. Most Veterans receive one service. We find that Veterans who are female, Black, or diagnosed with dementia are more likely to use HCBS, while Veterans residing in rural areas are less likely.</p><p><strong>Conclusions: </strong>Like the challenges facing the aging civilian population, the VHA faces the test of meeting the growing demand for HCBS. Understanding these dynamics is essential to ensuring that HCBS is both accessible and effective in supporting Veterans.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061221","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":"An Objective Method to Determine Nurse Staffing for an Acute Care for Elders (ACE) Hospital Unit: Discrete Event Simulation.","authors":"Sandra F Simmons, Emily K Hollingsworth, Jason M Slagle, Jennifer Kim, Lucy Wilson, Avantika Shah, Mariu C Duggan, John F Schnelle","doi":"10.1111/jgs.19507","DOIUrl":"https://doi.org/10.1111/jgs.19507","url":null,"abstract":"<p><strong>Background: </strong>Many hospitals have acute care for elders (ACE) units or engage in programs to enhance care for older inpatients. However, few studies have objectively evaluated nurse staffing models to support care for older inpatients.</p><p><strong>Methods: </strong>This study applied discrete event simulation (DES) to an ACE unit to objectively evaluate registered nurse (RN) and nursing assistant (NA) staffing allocations. Research staff collected standardized, objective data related to nursing tasks and time requirements to model the ACE unit clinical care environment and evaluate varying RN and NA staffing allocations on measures of nursing workload, care quality, and care efficiency.</p><p><strong>Results: </strong>On a 22-bed ACE unit, 85% of patients were aged 65 or older, 37% had cognitive impairment, and 89% required toileting and/or mobility assistance. Nurse care routines were interrupted frequently by unscheduled patient care requests, with an average frequency of 6.1 (±1.6) requests per hour. DES was used to simulate four different RN and NA staffing allocations. Results showed the most common staffing (four RNs and one NA) resulted in the highest nursing workload rates (89% and 88% for RNs and NAs, respectively) and the highest rate of predicted care omissions (6.2%). Additionally, RNs were predicted to help with 83% of NA care tasks related to toileting and mobility assistance. Alternative allocations of four RNs and three NAs or five RNs and two NAs resulted in more feasible workload rates, lower rates of care omissions, and less reliance on RNs for NA care tasks.</p><p><strong>Conclusions: </strong>DES provides an objective method to identify nurse staffing needs for an ACE hospital unit. This approach can be used to safely evaluate the potential impact of varying nurse staffing allocations. The DES model for the ACE unit is adaptable to other types of hospital units that care for older patients.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061359","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":"Post-Discharge COVID-19 Symptoms Predict 1-Year Functional Decline, Falls, and Emergency Department Visits: A Cohort Study.","authors":"Murilo Bacchini Dias, Thiago J Avelino-Silva, Eduardo Ferriolli, Leandro Utino Taniguchi, Wilson Jacob-Filho, Claudia Kimie Suemoto, Márlon Juliano Romero Aliberti","doi":"10.1111/jgs.19490","DOIUrl":"https://doi.org/10.1111/jgs.19490","url":null,"abstract":"<p><strong>Background: </strong>Hospitalization frequently results in persistent symptoms among older adults, raising concerns about the long-term impacts of acute events-a problem amplified by COVID-19. We investigated the effects of persistent symptoms on functional decline and unplanned events over 1 year in older patients recovering from COVID-19 hospitalization.</p><p><strong>Methods: </strong>This prospective cohort included patients aged ≥ 50 years who survived COVID-19 hospitalization between March and December 2020 as part of the CO-FRAIL study at Brazil's largest academic medical center. Persistent symptoms were defined as those reported at admission and continuously present at one-, three-, six-, nine-, and 12-month post-discharge, covering 16 symptoms. Outcomes included functional decline in basic activities of daily living (ADL), mobility activities, instrumental activities of daily living (IADL), number of falls, emergency department (ED) visits, and hospital readmissions. Associations between persistent symptoms and outcomes were examined using mixed-effects negative binomial regression models adjusted for sociodemographic, clinical, hospitalization-related factors, and post-discharge rehabilitation.</p><p><strong>Results: </strong>Among 1019 patients (mean age = 65 ± 10 years; women = 45%; White = 62%), 324 (32%) experienced persistent symptoms throughout the year. Fatigue (28%), myalgia (19%), and dyspnea (13%) were the most common. Patients with ≥ 2 symptoms had an increased risk of functional decline in mobility activities (IRR = 2.11; 95% CI = 1.50-2.96), IADL (IRR = 2.00; 95% CI = 1.44-2.79), falls (IRR = 2.56; 95% CI = 1.14-5.75), and ED visits (IRR = 2.69; 95% CI = 1.27-5.70), but not readmissions. Among women, ≥ 1 persistent symptom was associated with a twofold increased risk of ADL decline. One year after discharge, patients with ≥ 2 persistent symptoms developed 1.27 more new disabilities (3.26 vs. 1.99 on a 15-point functional scale) and had 31 more unplanned events per 100 person-years (54.3 vs. 23.2) than those without symptoms.</p><p><strong>Conclusions: </strong>Persistent symptoms after hospitalization are common and contribute to functional decline, falls, and ED visits in older COVID-19 survivors. These findings suggest that greater attention to symptom burden may support risk identification and improve post-discharge care planning.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035115","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":"Disease and Race-Based Differences in Inpatient Palliative Care Consultation in Cancer and Noncancer Serious Illnesses.","authors":"Emily E Moin, Brian Bayes, Vanessa Madden, Scott D Halpern, Katherine R Courtright","doi":"10.1111/jgs.19509","DOIUrl":"https://doi.org/10.1111/jgs.19509","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend timely palliative care consultation (PCC) for hospitalized patients with serious illness, but adherence to such guidelines and variability in access are not well described.</p><p><strong>Methods: </strong>Prospective cohort study from March 21, 2016 to August 8, 2018 during the usual care period of a cluster-randomized trial at 11 hospitals in 8 US states. We included adults age 45 and older with cancer, chronic obstructive pulmonary disease (COPD), dementia, heart failure, or kidney failure. Exposures included diagnoses, demographics, and hospital characteristics, and outcomes included predicted probability and timing of PCC.</p><p><strong>Results: </strong>Among 40,074 inpatient encounters (median age 72 years [IQR 62-82], 46.9% male, 22.7% Black, 4.6% Hispanic), the most common serious illness was heart failure (66.0%), followed by COPD (39.3%), kidney failure (12.4%), cancer (12.3%), and dementia (11.6%). The overall rate of PCC was 11.6% (95% CI 11.3%-11.9%), ranging across hospitals from 4.2% (95% CI 3.3%-5.3%) to 23.3% (95% CI 19.6%-27.4%). Patients with dementia (20.6%, 95% CI 19.4%-21.7%) and cancer (19.5%, 95% CI 18.5%-20.7%) received PCC the most, and those with kidney failure the least (8.2%, 95% CI 7.5%-9.0%). Median time to PCC after admission was 3 days (IQR 1-6); patients with heart failure, COPD, and kidney failure received PCC 1 day later at the median compared to cancer and dementia. Predictors of increased odds of receiving PCC included being Black or Asian (aOR 1.12, 95% CI 1.02-1.23; aOR 1.67, 95% CI 1.31-2.12, respectively) and being admitted to a hospital with a higher overall rate of PCC orders (aOR 1.11, 95% CI 1.08-1.13).</p><p><strong>Conclusion: </strong>PCC was underutilized overall and varied substantially in frequency and timing across hospitals, diseases, and patient race. These findings underscore the need to implement standardized approaches to improve adherence to guideline-recommended PCC.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061220","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 Proposed Universal \"Home Time\" Quality of Life Measure for Older Adults.","authors":"Courtney H Van Houtven, Nathan A Boucher, Kasey Decosimo, Chelsea L Whitfield, Paul A Dennis, Valerie A Smith, Karen M Stechuchak, Brystana G Kaufman, S Nicole Hastings, Semra Ozdemir, Nina R Sperber","doi":"10.1111/jgs.19506","DOIUrl":"https://doi.org/10.1111/jgs.19506","url":null,"abstract":"<p><strong>Background: </strong>Researchers and insurers use \"home time,\" or an individual's time at home compared to time in different health care settings, as a population-level quality of life (QoL) or quality of care measure. With varying definitions, it is unknown which components of a home time measure most closely reflect QoL. Our objective is to develop a person-centered universal home time measure agnostic to condition.</p><p><strong>Methods: </strong>We used an iterative, structured approach based on Delphi methods to obtain expert input on what a measure should include, using qualitative and quantitative evidence from prior work. A total of 28 expert panelists, including Veterans Affairs (VA) leaders, clinician researchers, and non-clinician researchers, participated. In the first round, panelists voted on components (settings, weights, timeframes) to include in a home time measure. In the second round, panelists discussed results. The third round was final voting and explanations of choices and caveats.</p><p><strong>Results: </strong>Qualitative and quantitative data suggested that emergency department, inpatient care, and post-acute care settings all affect older adults' QoL in different ways, supporting inclusion; 75% of the experts endorsed all settings, and discussion suggested that future work should limit ED days to visits resulting in an inpatient admission. Our data did not reveal a clear indication for weighting settings: 56% of the expert panel suggested continuing to explore the use of weights to arrive at values that would reflect qualitative differences in settings, and 44% did not support the use of any weights. Our 6-month models resulted in QoL outcomes for all settings, and 30% of experts endorsed a 6-month timeframe, while 65% said that timeframe would depend on the situation.</p><p><strong>Conclusion: </strong>A \"1.0\" universal person-centered home time measure that reflects QoL should include days in the emergency department, inpatient care, and post-acute care. Expert input revealed domains of agreement and disagreement. Future validation efforts that incorporate expert input are needed to iterate and arrive at the optimal measure.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063359","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}