Journal of the American Geriatrics Society最新文献

{"title":"How to Communicate What's Important Among the Many Geriatrics Care Models.","authors":"Michael L Malone, Heidi K White, Jonny Macias Tejada, Marie Boltz","doi":"10.1111/jgs.19370","DOIUrl":"https://doi.org/10.1111/jgs.19370","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018995","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":"Models of Care for Older People: A Scoping Review.","authors":"Ann Dadich, Angela Lan, Suhasini Shanmugarajan, Sarah Childs, Jennifer Alford, Danielle Ní Chróinín","doi":"10.1111/jgs.19371","DOIUrl":"https://doi.org/10.1111/jgs.19371","url":null,"abstract":"<p><strong>Background: </strong>International recognition of the increasing importance of care for older people has seen growing interest in models of care for older people. Yet there is limited information about the scope and breadth of models of care for older people. This article clarifies what is known about models of care for older people by summarizing relevant publications, describing the models depicted in these publications, and synthesizing the outcomes and impact presented in the publications.</p><p><strong>Method: </strong>A scoping review was conducted that involved searching multiple databases to identify relevant publications, published in English, which presented a model of care for older people-specifically, non-Indigenous people aged ≥ 65 years and/or Indigenous people aged ≥ 50 years; and included evidence, broadly defined, about the utility or otherwise of the model. Commentaries, narrative letters, editorials, and reviews were excluded.</p><p><strong>Results: </strong>From 21,767 publications, 276 were deemed relevant. From these, four key findings are apparent. First, models of care for older people are understood in disparate ways and are typically devoid of clear stepwise guidance. Second, most of the publications reported on a multidisciplinary approach. Third, they generally failed to involve carers. Fourth, very few publications reported on studies conducted in a rural area, and none involved Indigenous people.</p><p><strong>Conclusion: </strong>Given the heterogeneity and breadth of models of care for older people, further research is needed to establish: a definition of a model of care for older people; reporting standards; the factors that help or hinder their effectiveness; how to ensure carer involvement; and how to adapt models of care for older people for priority populations.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018998","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":"Data Resource Profile: The Veterans Affairs-Health and Retirement Study Aging Veteran Cohort.","authors":"Lily Stalter, Manasa Venkatesh, Josephine Jacobs, Amanda Stype, Kenneth M Langa, Amy L Byers, Mary F Wyman","doi":"10.1111/jgs.19368","DOIUrl":"10.1111/jgs.19368","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018987","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 Framework for Behavioral Health Integration in the Program of All-Inclusive Care for the Elderly (PACE).","authors":"Alexa Fleet, Alya Simoun, Daniel Shalev, Brigitta Spaeth-Rublee, Taryn Patterson, Liane Wardlow, Tessa Roth, Harold Alan Pincus","doi":"10.1111/jgs.19327","DOIUrl":"https://doi.org/10.1111/jgs.19327","url":null,"abstract":"<p><strong>Background: </strong>The Program of All-inclusive Care for the Elderly (PACE) is a comprehensive care model that aims to promote aging in the home and community for older adults who are nursing-home eligible needs-wise. Older adults experience age-related barriers to accessing behavioral health (BH) services. PACE programs play an important role in providing all-inclusive health care for individuals over 55 who are dually eligible for Medicaid and Medicare. This article investigates behavioral health integration (BHI) within PACE Organizations (POs), produces a conceptual framework for BHI within PACE, and reports on current BH practices and programmatic needs to support the growing BH needs of participants.</p><p><strong>Methods: </strong>The team adapted the BH-Serious Illness Care (BH-SIC) Model, to produce a conceptual framework for BHI within PACE (BHI-PACE Model). The model informed a mixed-methods sequential approach to assess BHI at POs that include (i) a survey, (ii) use-case interviews of POs, and (iii) qualitative analyses of interviews.</p><p><strong>Results: </strong>We present the domains and subdomains for the BHI-PACE Model. With respect to the national BH in PACE assessment, 38 POs representing 119 sites and 25,806 participants participated in the survey and 15 POs representing 58 sites and 10,029 participants participated in interviews. Survey results revealed a high rate of BH comorbidities among PACE participants (60% median rate, IQR: 70-44). The most common reasons for referral to BH specialists were depression and mood disorders 92.1%, behavioral and psychological symptoms of dementia (BPSD) 57.9%, and anxiety disorders 55.3%.</p><p><strong>Conclusion: </strong>POs' current BH practices and challenges can guide other POs to better integrate BH. Integrating BH into the PACE model requires policy-level action, though quality measurement and value-based care efforts can support this endeavor.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018981","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":"Associations Between Peak Expiratory Flow and Community Mobility Loss Among Older Adults in the United States.","authors":"Lindsey M Mathis, Na Sun, Simon K Ho, Lane S White, Odessa Addison, Douglas N Savin, Jason R Falvey","doi":"10.1111/jgs.19367","DOIUrl":"10.1111/jgs.19367","url":null,"abstract":"<p><strong>Background: </strong>Community mobility is a vital patient-centered outcome for older adults living in the community. These deficits in mobility are linked to social isolation, increased hospitalizations, and higher mortality rates. Impaired pulmonary function may be a modifiable risk factor for mobility decline, with existing inequities in lung health potentially contributing disproportionately to mobility loss among Black older adults.</p><p><strong>Materials/methods: </strong>A cohort of 4742 community-dwelling older adults (weighted n = 29,180,893) with self-reported ability to walk 3 or more blocks in their community was drawn from the National Health and Aging Trends Study (NHATS). Pulmonary function was measured by PEF in NHATS. Community mobility loss was defined as self-reported inability to walk ≥ 3 blocks in the 1-year follow-up assessment. Hierarchical multivariable logistic regression was used and adjusted for demographics, comorbidities, pain, and assistive device use.</p><p><strong>Results: </strong>Overall, 73.7% of the sample had normal PEF, 18.6% had moderate impairment, and 7.7% had severe impairment. Those with severe impairment were more likely to be male and identify as Black. In unadjusted analyses, 8.8% of older adults with normal PEF experienced mobility loss, compared with 12.7% of those with moderate impairment, and 19.7% with severe impairment. Odds of mobility loss were 111% higher for those with severe PEF impairment as compared to those with normal PEF (OR = 2.1, 95% CI 1.2-3.7) in fully adjusted models, with weaker relationships being observed for those with moderately impaired PEF (OR = 1.2, 95% CI 0.8-1.8).</p><p><strong>Conclusions: </strong>Nearly 8%, or an estimated 1 million community-ambulating U.S. older adults, had severe impairments in peak expiratory flow in 2015; these older adults have a substantially higher risk of losing the ability to ambulate community distances over the subsequent year.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967243","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: Differences in Setting of Initial Dementia Diagnosis Among Fee-For-Service Medicare Beneficiaries.","authors":"Yujiao Wu, Zhengyu Zhang, Yaling Li, Jun Li","doi":"10.1111/jgs.19344","DOIUrl":"https://doi.org/10.1111/jgs.19344","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960633","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":"Medicare Part D: Major Shifts With the Inflation Reduction Act and a Way Forward.","authors":"Gina Upchurch, Debra Saliba","doi":"10.1111/jgs.19355","DOIUrl":"https://doi.org/10.1111/jgs.19355","url":null,"abstract":"<p><p>The Inflation Reduction Act (IRA) of 2022 introduced major changes in the Part D benefit that aim to improve medication access and correct several of the financial misalignments in the current Part D benefit. The changes address financial obligations of Medicare beneficiaries, the federal government, Part D plan sponsors (i.e., insurance companies), and drug manufacturers. The changes include new brand and biologic manufacturer obligations to beneficiaries eligible for the low-income subsidy. Effects on the drug supply chain and stakeholder behaviors remain to be seen but current financial arrangements inform likely responses. Currently, the Pharmacy Benefit Managers (PBMs) nestled between the plans, drug manufacturers, and pharmacies heavily influence manufacturers' list prices and squeeze community pharmacies. With the IRA restructuring of Part D, plans are likely to interject more administrative obstacles before beneficiaries can obtain higher-cost therapies, while drug manufacturers might alter their patient assistance programs. Manufacturers have already begun to change their assistance programs at many safety net pharmacies. Many Medicare beneficiaries who relied on these deeply discounted medications will face significant late enrollment penalties if they do enroll in Part D plans, creating a major barrier to participation. Providers and policymakers should understand the Part D changes and leverage the skills of pharmacists to support community and team-based care that improves access to medications and ensures that medications are doing more good than harm.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960648","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: Differences in Setting of Initial Dementia Diagnosis Among Fee-for-Service Medicare Beneficiaries\".","authors":"Elizabeth White, Thomas Bayer, Momotazur Rahman","doi":"10.1111/jgs.19341","DOIUrl":"10.1111/jgs.19341","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960656","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":"Long-Term Trajectories of Older Adults Served by an Emergency Department/Hospital-Based Elder Mistreatment Response Program.","authors":"Daniel Baek, Elaine Gottesman, Lena K Makaroun, Alyssa Elman, Michael E Stern, Amy Shaw, Mary R Mulcare, Jennine McAuley, Veronica M LoFaso, Jaclyn Itzkowitz, E-Shien Chang, David Hancock, Elizabeth M Bloemen, Daniel M Lindberg, Rahul Sharma, Mark S Lachs, Karl Pillemer, Tony Rosen","doi":"10.1111/jgs.19351","DOIUrl":"https://doi.org/10.1111/jgs.19351","url":null,"abstract":"<p><strong>Background: </strong>An emergency department (ED) visit or hospitalization provides an opportunity to identify elder mistreatment and initiate intervention, but this seldom occurs. To address this, we developed the Vulnerable Elder Protection Team (VEPT), a novel interdisciplinary consultation service. We explored the long-term trajectories of patients receiving VEPT evaluation and intervention.</p><p><strong>Methods: </strong>We followed up at multiple intervals for 12 months older adults seen by VEPT from 9/1/2020-3/27/2023 with high or moderate concern for mistreatment who were discharged to the community, an elder abuse shelter, or rehabilitation facilities. We collected information through telephone calls to the older adult and others involved. We also analyzed separately cases in which the patient re-presented to the ED/hospital with VEPT consultation during the follow-up period.</p><p><strong>Results: </strong>A total of 157 older adults met criteria for follow-up, and 30 of these (16.4%) died within 12 months. At 1 month, elder mistreatment was no longer occurring in 47.5% and still occurring but reduced in 20.3%, with 29.7% having no contact with the perpetrator and 17.8% having reduced contact. At 12 months, elder mistreatment was no longer occurring in 60.9% and still occurring but reduced in 14.5%, with 34.8% having no contact with the perpetrator and 17.4% having reduced contact. During the 12-month follow-up period, 16 (10.2%) patients re-presented to the ED with VEPT consultation, with 12 having persistent concern for ongoing elder mistreatment. Reasons included older adults/caregivers not accepting intervention or being willing to separate as well as VEPT reliance on community-based agencies and programs after discharge.</p><p><strong>Conclusions: </strong>We observed improved post-discharge safety for elder mistreatment victims who engaged with the VEPT program, with this increased safety durable over 1 year. Re-presentations highlighted the complexity of elder mistreatment intervention. Overall, these findings demonstrate the potential value of an ED/hospital-based elder mistreatment response team, a promising new geriatric care model.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960646","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":"Sociodemographic and Linguistic Disparities in Tube Feeding Among Canadian Nursing Home Residents With Advanced Dementia.","authors":"Nathan M Stall, John Hirdes, Darly Dash, Kieran L Quinn, Christina Reppas-Rindlisbacher, John N Morris, Susan L Mitchell, Luke A Turcotte","doi":"10.1111/jgs.19337","DOIUrl":"https://doi.org/10.1111/jgs.19337","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934193","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}