Kristin Salottolo, Alexander Knippenberg, Michael Fisher, Timbre Backen, Alexandra Moody, Kaysie Banton, David Bar-Or
Background
Lactate monitoring is used to dynamically identify patients with a higher risk of poor outcomes. However, elevated lactate levels are interpreted using the same stratification regardless of patient age. Age could be a modifying factor for circulating lactate levels that has not been adequately examined. We hypothesized that there would be a negative association between age and lactate values in the geriatric population.
Methods
This retrospective observational study included patients ≥ 65 years old undergoing operative intervention between 1/1/2023 and 8/1/2023. Postoperative venous lactate (pVL) values and patients' age were examined continuously and categorically (pVL: < 2, 2–3, ≥ 3 mmol/L; age: 65–74, 75–84, ≥ 85 years). The association between pVL and age was analyzed overall and after stratifying by potential confounders: nonsurvival (morgue/hospice vs. other hospital disposition), ICU admission, injury severity (ISS ≥ 16 vs. < 16), and frailty (modified frailty index-5 ≥ 2 vs. < 2).
Results
There were 284 surgically managed older adults; the median age was 80 (73–88) years and 37% were ≥ 85 years old. Overall, 218 (77%) patients had a pVL, assessed 8 (7–11) hours postoperatively. The median pVL was 1.8 (1.3–2.5) mmol/L and 13% had pVL ≥ 3 mmol/L. Age and pVL values were not associated when examined continuously (r2 = 0.08, p = 0.20) nor categorically (p = 0.44). Age and pVL were not associated when stratified by ICU admittance (ICU: r2 = 0.17, p = 0.44; non-ICU: r2 = 0.07, p = 0.33), by ISS (≥ 16, r2 = −0.03, p = 0.92; < 16: r2 = 0.12, p = 0.09), by survival (survivors: r2 = 0.08, p = 0.23; nonsurvivors: r2 = −0.13, p = 0.64), and by frailty (frail: r2 = 0.14, p = 0.15; not frail: r2 = −0.07, p = 0.48).
Conclusions
These results suggest that age is not an important consideration or concern when interpreting postoperative lactate values of older adult trauma patients.
背景：乳酸监测用于动态识别预后不良风险较高的患者。然而，无论患者年龄如何，升高的乳酸水平都可以用相同的分层来解释。年龄可能是循环乳酸水平的一个修改因素，但尚未得到充分的研究。我们假设在老年人群中，年龄和乳酸值之间存在负相关。方法：本回顾性观察研究纳入2023年1月1日至2023年8月1日期间接受手术干预的≥65岁患者。连续分类检测术后静脉乳酸（pVL）值和患者年龄(pVL：结果：284例手术处理的老年人，中位年龄为80（73-88）岁，37%年龄≥85岁。总体而言，218例（77%）患者术后8（7-11）小时出现pVL。中位pVL为1.8 (1.3-2.5)mmol/L， 13%的患者pVL≥3mmol /L。当连续检查时，年龄和pVL值没有相关性（r2 = 0.08, p = 0.20），也没有分类相关性（p = 0.44）。按ICU入院（ICU: r2 = 0.17, p = 0.44；非ICU: r2 = 0.07, p = 0.33）、ISS（≥16,r2 = -0.03, p = 0.92; 2 = 0.12, p = 0.09）、生存率（幸存者：r2 = 0.08, p = 0.23；非幸存者：r2 = -0.13, p = 0.64）和虚弱程度（虚弱：r2 = 0.14, p = 0.15；不虚弱：r2 = -0.07, p = 0.48）分层，年龄和pVL无相关性。结论：这些结果表明，在解释老年创伤患者术后乳酸值时，年龄不是一个重要的考虑因素或关注点。
{"title":"Age Does Not Influence Postoperative Lactate Values in Older Adult Trauma Patients","authors":"Kristin Salottolo, Alexander Knippenberg, Michael Fisher, Timbre Backen, Alexandra Moody, Kaysie Banton, David Bar-Or","doi":"10.1111/jgs.70152","DOIUrl":"10.1111/jgs.70152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lactate monitoring is used to dynamically identify patients with a higher risk of poor outcomes. However, elevated lactate levels are interpreted using the same stratification regardless of patient age. Age could be a modifying factor for circulating lactate levels that has not been adequately examined. We hypothesized that there would be a negative association between age and lactate values in the geriatric population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study included patients ≥ 65 years old undergoing operative intervention between 1/1/2023 and 8/1/2023. Postoperative venous lactate (pVL) values and patients' age were examined continuously and categorically (pVL: < 2, 2–3, ≥ 3 mmol/L; age: 65–74, 75–84, ≥ 85 years). The association between pVL and age was analyzed overall and after stratifying by potential confounders: nonsurvival (morgue/hospice vs. other hospital disposition), ICU admission, injury severity (ISS ≥ 16 vs. < 16), and frailty (modified frailty index-5 ≥ 2 vs. < 2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 284 surgically managed older adults; the median age was 80 (73–88) years and 37% were ≥ 85 years old. Overall, 218 (77%) patients had a pVL, assessed 8 (7–11) hours postoperatively. The median pVL was 1.8 (1.3–2.5) mmol/L and 13% had pVL ≥ 3 mmol/L. Age and pVL values were not associated when examined continuously (<i>r</i><sup>2</sup> = 0.08, <i>p</i> = 0.20) nor categorically (<i>p</i> = 0.44). Age and pVL were not associated when stratified by ICU admittance (ICU: <i>r</i><sup>2</sup> = 0.17, <i>p</i> = 0.44; non-ICU: <i>r</i><sup>2</sup> = 0.07, <i>p</i> = 0.33), by ISS (≥ 16, <i>r</i><sup>2</sup> = −0.03, <i>p</i> = 0.92; < 16: <i>r</i><sup>2</sup> = 0.12, <i>p</i> = 0.09), by survival (survivors: <i>r</i><sup>2</sup> = 0.08, <i>p</i> = 0.23; nonsurvivors: <i>r</i><sup>2</sup> = −0.13, <i>p</i> = 0.64), and by frailty (frail: <i>r</i><sup>2</sup> = 0.14, <i>p</i> = 0.15; not frail: <i>r</i><sup>2</sup> = −0.07, <i>p</i> = 0.48).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These results suggest that age is not an important consideration or concern when interpreting postoperative lactate values of older adult trauma patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"488-492"},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"On the Street Where You Live","authors":"Karen Bensinger","doi":"10.1111/jgs.70140","DOIUrl":"10.1111/jgs.70140","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3586-3587"},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edgar Vásquez-Carrasco, Braulio Henrique Magnani Branco, Jordan Hernandez-Martinez, Cristian Sandoval, Pablo Valdés-Badilla
Background
This systematic review and meta-analysis aimed to evaluate the efficacy of mindfulness-based treatments for older people with mild cognitive impairment (MCI) who also experience depression and cognitive difficulties.
Methods
Seven databases were searched: PubMed, EBSCOhost, CINAHL Complete, Cochrane Library, ProQuest, Scopus, and Web of Science, up to July 2025. PRISMA guidelines, the Oxford Centre for Evidence-Based Medicine scale, the RoB 2 tool, and GRADEpro were employed to evaluate the methodological quality and evidence reliability. The review plan was pre-registered in the PROSPERO database (CRD420251080874).
Results
Initially, 1738 records were identified in the databases. Thirteen studies that met the inclusion criteria were included in the analysis. The PICOS framework was employed for the subsequent analysis. The meta-analysis indicated that participants receiving mindfulness therapies experienced a significant reduction in depression symptoms, as assessed by the Geriatric Depression Scale (GDS, p = 0.045). In contrast, the Montreal Cognitive Assessment (p = 0.061) and the Mini-Mental State Examination (p = 0.713) did not demonstrate statistically significant changes in cognitive ability.
Conclusions
The findings suggest that mindfulness-based training may reduce depressive symptoms in older individuals with MCI; however, the impact on cognitive abilities remains inconclusive.
背景：本系统综述和荟萃分析旨在评估以正念为基础的治疗对患有轻度认知障碍（MCI）且患有抑郁症和认知困难的老年人的疗效。方法：检索截至2025年7月的PubMed、EBSCOhost、CINAHL Complete、Cochrane Library、ProQuest、Scopus、Web of Science等7个数据库。采用PRISMA指南、牛津循证医学中心量表、RoB 2工具和GRADEpro来评估方法学质量和证据可靠性。评审计划在PROSPERO数据库中预注册（CRD420251080874）。结果：最初，在数据库中确定了1738条记录。13项符合纳入标准的研究被纳入分析。随后的分析采用PICOS框架。荟萃分析表明，接受正念疗法的参与者抑郁症状显著减轻，通过老年抑郁量表（GDS, p = 0.045）进行评估。相比之下，蒙特利尔认知评估（p = 0.061）和迷你精神状态检查（p = 0.713）没有显示认知能力有统计学意义的变化。结论：研究结果表明，正念训练可以减轻老年轻度认知障碍患者的抑郁症状；然而，对认知能力的影响仍然没有定论。
{"title":"Effects of Mindfulness Training on Depression and Cognition in Older People With Mild Cognitive Impairment: A Systematic Review and Meta-Analysis","authors":"Edgar Vásquez-Carrasco, Braulio Henrique Magnani Branco, Jordan Hernandez-Martinez, Cristian Sandoval, Pablo Valdés-Badilla","doi":"10.1111/jgs.70154","DOIUrl":"10.1111/jgs.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This systematic review and meta-analysis aimed to evaluate the efficacy of mindfulness-based treatments for older people with mild cognitive impairment (MCI) who also experience depression and cognitive difficulties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven databases were searched: PubMed, EBSCOhost, CINAHL Complete, Cochrane Library, ProQuest, Scopus, and Web of Science, up to July 2025. PRISMA guidelines, the Oxford Centre for Evidence-Based Medicine scale, the RoB 2 tool, and GRADEpro were employed to evaluate the methodological quality and evidence reliability. The review plan was pre-registered in the PROSPERO database (CRD420251080874).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Initially, 1738 records were identified in the databases. Thirteen studies that met the inclusion criteria were included in the analysis. The PICOS framework was employed for the subsequent analysis. The meta-analysis indicated that participants receiving mindfulness therapies experienced a significant reduction in depression symptoms, as assessed by the Geriatric Depression Scale (GDS, <i>p</i> = 0.045). In contrast, the Montreal Cognitive Assessment (<i>p</i> = 0.061) and the Mini-Mental State Examination (<i>p</i> = 0.713) did not demonstrate statistically significant changes in cognitive ability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings suggest that mindfulness-based training may reduce depressive symptoms in older individuals with MCI; however, the impact on cognitive abilities remains inconclusive.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"566-574"},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We read with great interest the study by Wondimkun et al., which leveraged the Registry of Senior Australians to quantify 12-month hospitalizations for acute glycemic events after entry to long-term care facilities (LTCFs) [<span>1</span>]. While the authors should be commended for analyzing a national cohort of ≥ 55,000 residents, we believe three methodological issues merit attention to maximize the translational value of their findings.</p><p>First, the true incidence may be higher than reported. When the analysis relied only on principal public-hospital diagnosis codes, 12-month rates were 1.0% for hypoglycemia and 0.5% for hyperglycemia; adding secondary codes tripled these figures, and private-hospital data were not available. Moreover, many acute glycemic events may be misclassified at presentation—as falls, near syncope, stroke, myocardial infarction, or altered mental status—which can further obscure detection and understate the true burden. Linking emergency-department and private-hospital records or using glucose logs kept by nursing staff in LTCFs could capture events that never reach a public-hospital discharge sheet.</p><p>Second, key markers of glycemic control are missing. HbA1c, glucose variability, and insulin dose—all powerful predictors of both hypo- and hyperglycemia in frail older adults—are not captured in ROSA [<span>2</span>], even though the 2024 ADA Standards of Care for Older Adults explicitly recommend tailoring therapeutic targets on the basis of HbA1c and day-to-day glucose swings [<span>3</span>]. Linking ROSA to central laboratory feeds or point-of-care testing systems inside LTCFs would make it possible to run HbA1c-stratified analyses and produce more accurate medication-safety estimates.</p><p>Third, generalizability and equity deserve attention. Aboriginal and Torres Strait Islander residents were excluded, and residents whose preferred language was not English faced a higher hyperglycemia risk in the study; language barriers are known to impair diabetes control and cardiovascular risk-factor management [<span>4</span>]. Including Indigenous Australians and adding culture-specific variables would broaden applicability and help tailor prevention programmers for communities carrying a disproportionate diabetes burden.</p><p>In conclusion, Wondimkun et al. provide a valuable snapshot of glycemic emergencies in Australian LTCFs. Addressing event capture, adding laboratory data, and broadening the sample would make the work even more useful for policymakers and bedside teams alike.</p><p>Z.X. conceived the idea for the commentary, performed the literature review, and drafted the manuscript. H.Z. and F.Z. revised the manuscript critically for important intellectual content, approved the final version, and are accountable for all aspects of the work.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p><p>This publication is linked to a related article by Wondimkun et al
{"title":"Enhancing Glycemic Risk Assessment in Long-Term Care: Suggestions for Future Research","authors":"Zhen Xu, Fan Zhang, Huachun Zhang","doi":"10.1111/jgs.70124","DOIUrl":"10.1111/jgs.70124","url":null,"abstract":"<p>We read with great interest the study by Wondimkun et al., which leveraged the Registry of Senior Australians to quantify 12-month hospitalizations for acute glycemic events after entry to long-term care facilities (LTCFs) [<span>1</span>]. While the authors should be commended for analyzing a national cohort of ≥ 55,000 residents, we believe three methodological issues merit attention to maximize the translational value of their findings.</p><p>First, the true incidence may be higher than reported. When the analysis relied only on principal public-hospital diagnosis codes, 12-month rates were 1.0% for hypoglycemia and 0.5% for hyperglycemia; adding secondary codes tripled these figures, and private-hospital data were not available. Moreover, many acute glycemic events may be misclassified at presentation—as falls, near syncope, stroke, myocardial infarction, or altered mental status—which can further obscure detection and understate the true burden. Linking emergency-department and private-hospital records or using glucose logs kept by nursing staff in LTCFs could capture events that never reach a public-hospital discharge sheet.</p><p>Second, key markers of glycemic control are missing. HbA1c, glucose variability, and insulin dose—all powerful predictors of both hypo- and hyperglycemia in frail older adults—are not captured in ROSA [<span>2</span>], even though the 2024 ADA Standards of Care for Older Adults explicitly recommend tailoring therapeutic targets on the basis of HbA1c and day-to-day glucose swings [<span>3</span>]. Linking ROSA to central laboratory feeds or point-of-care testing systems inside LTCFs would make it possible to run HbA1c-stratified analyses and produce more accurate medication-safety estimates.</p><p>Third, generalizability and equity deserve attention. Aboriginal and Torres Strait Islander residents were excluded, and residents whose preferred language was not English faced a higher hyperglycemia risk in the study; language barriers are known to impair diabetes control and cardiovascular risk-factor management [<span>4</span>]. Including Indigenous Australians and adding culture-specific variables would broaden applicability and help tailor prevention programmers for communities carrying a disproportionate diabetes burden.</p><p>In conclusion, Wondimkun et al. provide a valuable snapshot of glycemic emergencies in Australian LTCFs. Addressing event capture, adding laboratory data, and broadening the sample would make the work even more useful for policymakers and bedside teams alike.</p><p>Z.X. conceived the idea for the commentary, performed the literature review, and drafted the manuscript. H.Z. and F.Z. revised the manuscript critically for important intellectual content, approved the final version, and are accountable for all aspects of the work.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p><p>This publication is linked to a related article by Wondimkun et al","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"282-283"},"PeriodicalIF":4.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kayla P. Carpenter, Fernanda Bellolio, Manuela Bartolacci, Molly M. Jeffery, Susan M. Bower, Lauren T. Southerland, Aidan F. Mullan, Jennifer L. Ridgeway
Background
The Geriatric Emergency Department (ED) guidelines recommend screening older adults for delirium using evidence-based screening tools, but these tools are often underutilized. We aimed to identify barriers and facilitators to implementing an electronic health record (EHR)-based delirium screening tool as intended.
Methods
This mixed methods and focused ethnographic study combined a review of structured delirium screening data with observations of real-time delirium screenings and semi-structured in-person interviews at an academic ED that previously implemented the Delirium Triage Screen (DTS) and Brief Confusion Assessment Method (bCAM) tool. Content analysis of field notes from observations and interview transcripts was guided by the Exploration, Preparation, Implementation, and Sustainment implementation framework.
Results
From a total of 40,818 ED visits, 6196 (15.2%) had incomplete screens (i.e., without fidelity). We observed 62 encounters, of which 25 (40.3%) screenings were implemented without fidelity due to (1) not asking the required screening questions, (2) assuming patient responses, or (3) not completing the screen due to uncertainty regarding a patient's baseline mentation. We conducted 32 interviews. Identified barriers included staff prioritization of other tasks (e.g., stroke code, cleaning patients), limited knowledge of the screen's importance and utility, and language discordance. Facilitators included care partners providing baseline mental status information and nurses prefacing the screening to increase patient engagement.
Conclusion
The fidelity of ED delirium screening is influenced by an interplay of environmental, patient, provider, and caregiver factors. Fidelity may be improved by focusing education on the importance of screening, training screeners on how to determine whether a patient's mentation is acutely changed, providing clear action steps when a patient screens positive, and addressing how to administer the delirium screen to patients who do not speak English fluently.
{"title":"Barriers and Facilitators to the Fidelity of Delirium Screening in the Emergency Department: An Ethnographic Approach","authors":"Kayla P. Carpenter, Fernanda Bellolio, Manuela Bartolacci, Molly M. Jeffery, Susan M. Bower, Lauren T. Southerland, Aidan F. Mullan, Jennifer L. Ridgeway","doi":"10.1111/jgs.70142","DOIUrl":"10.1111/jgs.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Geriatric Emergency Department (ED) guidelines recommend screening older adults for delirium using evidence-based screening tools, but these tools are often underutilized. We aimed to identify barriers and facilitators to implementing an electronic health record (EHR)-based delirium screening tool as intended.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This mixed methods and focused ethnographic study combined a review of structured delirium screening data with observations of real-time delirium screenings and semi-structured in-person interviews at an academic ED that previously implemented the Delirium Triage Screen (DTS) and Brief Confusion Assessment Method (bCAM) tool. Content analysis of field notes from observations and interview transcripts was guided by the Exploration, Preparation, Implementation, and Sustainment implementation framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From a total of 40,818 ED visits, 6196 (15.2%) had incomplete screens (i.e., without fidelity). We observed 62 encounters, of which 25 (40.3%) screenings were implemented without fidelity due to (1) not asking the required screening questions, (2) assuming patient responses, or (3) not completing the screen due to uncertainty regarding a patient's baseline mentation. We conducted 32 interviews. Identified barriers included staff prioritization of other tasks (e.g., stroke code, cleaning patients), limited knowledge of the screen's importance and utility, and language discordance. Facilitators included care partners providing baseline mental status information and nurses prefacing the screening to increase patient engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The fidelity of ED delirium screening is influenced by an interplay of environmental, patient, provider, and caregiver factors. Fidelity may be improved by focusing education on the importance of screening, training screeners on how to determine whether a patient's mentation is acutely changed, providing clear action steps when a patient screens positive, and addressing how to administer the delirium screen to patients who do not speak English fluently.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"43-54"},"PeriodicalIF":4.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Malaz A. Boustani, Steven R. Counsell, Anthony Perkins, Abdelfattah Alhader, Kathryn I. Frank, Diana P. Summanwar, Karen L. Fortuna
Objectives
The primary purpose of the present study was the implementation and evaluation of the ABC Community program, a community-based and telephonically administered version of the Aging Brain Care model delivered by Area Agencies on Aging (AAAs) staff.
Design
This study employed a prospective pre-post implementation design with pre-specified effectiveness and fidelity goals, with the main outcome measure being the total score of the Health Aging Brain Care (HABC) Monitor at 3- and 6-month follow-up. The HABC Monitor has demonstrated excellent reliability and validity in monitoring and measuring the burden of dementia symptoms and the quality of life and stress of the informal caregivers.
Results
The program served 422 Medicaid Home and Community-Based Services participants living with dementia and their caregivers. Participants' mean age was 78 years, with 67% identifying as female and 30% as belonging to minority groups, including 6% Hispanic or Latino and 28% Black or African American. In comparison to baseline, the total score of the HABC Monitor decreased from 24.6 to 15.4 at 6 months, representing a 37% reduction with an effect size of 0.64 standard deviation (p value < 0.001). Approximately 46% of informal caregivers who had at least mild burden at baseline had no such burden at 6 months, and 92% of those who had no stress at baseline remained burden-free at 6 months.
Conclusion
The ABC community program might be a scalable collaborative dementia care model targeting socially vulnerable people living with dementia.
{"title":"Effectiveness of a Telephonic Aging Brain Care Model for Medicaid Home and Community Services for Dementia Patients and Their Caregivers","authors":"Malaz A. Boustani, Steven R. Counsell, Anthony Perkins, Abdelfattah Alhader, Kathryn I. Frank, Diana P. Summanwar, Karen L. Fortuna","doi":"10.1111/jgs.70146","DOIUrl":"10.1111/jgs.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The primary purpose of the present study was the implementation and evaluation of the ABC Community program, a community-based and telephonically administered version of the Aging Brain Care model delivered by Area Agencies on Aging (AAAs) staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This study employed a prospective pre-post implementation design with pre-specified effectiveness and fidelity goals, with the main outcome measure being the total score of the Health Aging Brain Care (HABC) Monitor at 3- and 6-month follow-up. The HABC Monitor has demonstrated excellent reliability and validity in monitoring and measuring the burden of dementia symptoms and the quality of life and stress of the informal caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The program served 422 Medicaid Home and Community-Based Services participants living with dementia and their caregivers. Participants' mean age was 78 years, with 67% identifying as female and 30% as belonging to minority groups, including 6% Hispanic or Latino and 28% Black or African American. In comparison to baseline, the total score of the HABC Monitor decreased from 24.6 to 15.4 at 6 months, representing a 37% reduction with an effect size of 0.64 standard deviation (<i>p</i> value < 0.001). Approximately 46% of informal caregivers who had at least mild burden at baseline had no such burden at 6 months, and 92% of those who had no stress at baseline remained burden-free at 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The ABC community program might be a scalable collaborative dementia care model targeting socially vulnerable people living with dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"547-554"},"PeriodicalIF":4.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12911546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anita Chary, Sumin Yoon, Victor Lara, Annika Bhananker, Michelle Suh, Kei Ouchi, Maura Kennedy, Aanand D. Naik
Background
Over half of the people with dementia visit the emergency department (ED) each year. Little is known about how people with dementia and their care partners conceptualize or communicate about health outcome goals or care preferences during acute care episodes.
Participants and Setting
We conducted interviews with 14 Hispanic people with dementia and 19 care partners recruited from a public safety net hospital system in the southeastern United States. Participants were community-dwelling and had recently visited the ED.
Methods
We used a qualitative study design informed by phenomenology and guided by the patient priorities care (PPC) framework. Interviews elicited patients' health priorities, including their care preferences and health outcome goals, as well as their experiences communicating with ED and hospital care teams. We used a deductive content analysis to identify health priorities and inductive thematic analysis regarding communication experiences.
Results
We identified three key themes. First, participants' health priorities were grounded in values of maintaining social connection and independence. Second, hospitalizations were distressing, disorienting, and physically burdensome for both patients and care partners, leading to preferences to avoid admission whenever possible. Third, communication with ED and hospital teams felt unidirectional, with care plans delivered rather than discussed. Participants felt that care preferences were rarely elicited or incorporated into clinical decision-making.
Conclusions
Hospital admission is a critical decision point during acute care episodes for people with dementia. Incorporating brief conversations about health priorities at this juncture may improve alignment between emergency care and what matters most to patients and care partners. Adapting existing frameworks like PPC for time-pressured acute care settings may help promote shared decision-making about hospital admission.
{"title":"A Qualitative Study of Health Priorities of People With Dementia and Care Partners in Emergency Department and Hospital Care in a Public Safety-Net Setting","authors":"Anita Chary, Sumin Yoon, Victor Lara, Annika Bhananker, Michelle Suh, Kei Ouchi, Maura Kennedy, Aanand D. Naik","doi":"10.1111/jgs.70136","DOIUrl":"10.1111/jgs.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Over half of the people with dementia visit the emergency department (ED) each year. Little is known about how people with dementia and their care partners conceptualize or communicate about health outcome goals or care preferences during acute care episodes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants and Setting</h3>\u0000 \u0000 <p>We conducted interviews with 14 Hispanic people with dementia and 19 care partners recruited from a public safety net hospital system in the southeastern United States. Participants were community-dwelling and had recently visited the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a qualitative study design informed by phenomenology and guided by the patient priorities care (PPC) framework. Interviews elicited patients' health priorities, including their care preferences and health outcome goals, as well as their experiences communicating with ED and hospital care teams. We used a deductive content analysis to identify health priorities and inductive thematic analysis regarding communication experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified three key themes. First, participants' health priorities were grounded in values of maintaining social connection and independence. Second, hospitalizations were distressing, disorienting, and physically burdensome for both patients and care partners, leading to preferences to avoid admission whenever possible. Third, communication with ED and hospital teams felt unidirectional, with care plans delivered rather than discussed. Participants felt that care preferences were rarely elicited or incorporated into clinical decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hospital admission is a critical decision point during acute care episodes for people with dementia. Incorporating brief conversations about health priorities at this juncture may improve alignment between emergency care and what matters most to patients and care partners. Adapting existing frameworks like PPC for time-pressured acute care settings may help promote shared decision-making about hospital admission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3719-3728"},"PeriodicalIF":4.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12748019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We read with great interest the article by Hetherington-Rauth et al., which highlights the prognostic utility of automated CT-derived muscle area and density across anatomical regions in older men [<span>1</span>]. The findings underscore the value of automated opportunistic imaging for assessing sarcopenia and mortality risk in aging populations [<span>2</span>].</p><p>We commend the study's analysis and emphasis on functional outcomes, including grip strength, leg power, and walking speed. Nonetheless, the interpretation of results may benefit from a more thorough consideration of age as a potential residual confounder. Older participants naturally face a higher 10-year mortality risk. While age was included as a covariate, muscle size and density are strongly inversely correlated with age. Without accounting for age through matching or stratification, especially with the benefit of having a large cohort, the observed association between muscle metrics and mortality may be confounded by age.</p><p>Propensity score matching or age-stratified subgroup analyses could have further strengthened causal inference and minimized residual confounding. This is especially pertinent since the survival analyses showed consistent associations across regions—but without deeper exploration of whether these held across narrower age bands. It remains unclear whether poorer muscle metrics are independently predictive of mortality or simply reflect age-related risk of mortality.</p><p>From the health economic angle, where the cost of healthcare consumption is a pertinent marker of health in a given population, the authors could also consider analyzing, by decade bands of age, the association of muscle size and density with 1-year mortality, hospital attendance, or mean sick days, which would allow readers to better appreciate the impact of muscle size and quality on shorter term health-related outcomes. These parameters, with the strength of sample size, would allow more emphasis on muscle health in health promotion policies.</p><p>It was good of the authors to highlight differences with previous studies. The contrary findings regarding the association between muscle density and leg power in Korean older adults [<span>3</span>] compared with the MrOS study participants highlight important ethnic and regional differences in the assessment, cut-offs, and variations in muscle strength, density, and intermuscular adipose tissue (IMAT) in different populations. Validation in diverse populations, especially older women and multi-ethnic Asian cohorts, is crucial for generalizability.</p><p>It would have been interesting for the authors to consider and highlight the associations between muscle mass, muscle function, muscle quality, and health-related outcomes [<span>4</span>]. With increasing emphasis on muscle quality as a measurement metric for muscle health [<span>5, 6</span>], future studies pertaining to muscle health should be encouraged to assess and present thes
我们怀着极大的兴趣阅读了hetherington - rath等人的文章，该文章强调了自动ct获得的老年男性肌肉面积和跨解剖区域密度的预后效用。研究结果强调了自动机会成像在评估老年人群肌肉减少症和死亡风险方面的价值[10]。我们赞扬该研究的分析和对功能结果的强调，包括握力、腿部力量和步行速度。尽管如此，对结果的解释可能受益于更彻底地考虑年龄作为潜在的残留混杂因素。年龄较大的参与者自然面临更高的10年死亡风险。虽然年龄是一个协变量，但肌肉大小和密度与年龄呈强烈的负相关。如果没有通过匹配或分层来考虑年龄，特别是考虑到有一个大队列的好处，观察到的肌肉指标和死亡率之间的关联可能会因年龄而混淆。倾向评分匹配或年龄分层亚组分析可以进一步加强因果推理和最小化残留混淆。这是特别相关的，因为生存分析显示了跨地区的一致关联，但没有深入探索这些是否适用于更窄的年龄范围。目前尚不清楚较差的肌肉指标是独立预测死亡率还是仅仅反映与年龄相关的死亡率风险。从健康经济学的角度来看，医疗保健消费成本是特定人群健康状况的相关标志，作者还可以考虑按年龄的十年来分析肌肉大小和密度与1年死亡率、住院率或平均病假的关系，这将使读者更好地了解肌肉大小和质量对短期健康相关结果的影响。随着样本量的增加，这些参数将使健康促进政策更加重视肌肉健康。作者很好地强调了与以往研究的差异。与mri研究参与者相比，韩国老年人肌肉密度和腿部力量之间的关系的相反发现突出了不同人群在肌肉力量、密度和肌间脂肪组织（IMAT）的评估、截止值和变化方面的重要种族和地区差异。在不同人群中进行验证，特别是老年妇女和多种族亚洲人群，对于普遍性至关重要。对于作者来说，考虑和强调肌肉质量、肌肉功能、肌肉质量和健康相关结果之间的联系是很有趣的。随着越来越多的人强调肌肉质量是肌肉健康的测量指标[5,6]，应该鼓励与肌肉健康有关的未来研究评估和呈现肌肉健康的这些组成部分，让读者全面了解这种日益被认可的健康状态的复杂性，这意味着无数的疾病。虽然对肌肉质量的评估方式仍然存在争议，但在文献中有更多的报道将允许进行回顾性评估，以帮助该领域的研究人员确定哪种方法的准确性最高。尽管如此，这项研究通过证明利用CT扫描进行的机会性自动评估可以产生与临床相关的肌肉健康见解，做出了有价值的贡献。将自动分割整合到放射学工作流程中，有望更早地识别肌肉减少症，但需要进一步的工作来确保这些关联在性别、种族和年龄层之间是稳健的。李峰谭和Frederick H. Koh构思并撰写了最初的手稿。所有作者都对原稿进行了修改和编辑。这份手稿没有赞助者。作者声明无利益冲突。本出版物与Megan hetherington - rath等人的相关信件相关联。要查看本文，请访问https://doi.org/10.1111/jgs.70129。
{"title":"Comment on: Associations of CT Muscle Area and Density With Functional Outcomes and Mortality Across Anatomical Regions in Older Men","authors":"Li Feng Tan, Xizhen Low, Frederick H. Koh","doi":"10.1111/jgs.70133","DOIUrl":"10.1111/jgs.70133","url":null,"abstract":"<p>We read with great interest the article by Hetherington-Rauth et al., which highlights the prognostic utility of automated CT-derived muscle area and density across anatomical regions in older men [<span>1</span>]. The findings underscore the value of automated opportunistic imaging for assessing sarcopenia and mortality risk in aging populations [<span>2</span>].</p><p>We commend the study's analysis and emphasis on functional outcomes, including grip strength, leg power, and walking speed. Nonetheless, the interpretation of results may benefit from a more thorough consideration of age as a potential residual confounder. Older participants naturally face a higher 10-year mortality risk. While age was included as a covariate, muscle size and density are strongly inversely correlated with age. Without accounting for age through matching or stratification, especially with the benefit of having a large cohort, the observed association between muscle metrics and mortality may be confounded by age.</p><p>Propensity score matching or age-stratified subgroup analyses could have further strengthened causal inference and minimized residual confounding. This is especially pertinent since the survival analyses showed consistent associations across regions—but without deeper exploration of whether these held across narrower age bands. It remains unclear whether poorer muscle metrics are independently predictive of mortality or simply reflect age-related risk of mortality.</p><p>From the health economic angle, where the cost of healthcare consumption is a pertinent marker of health in a given population, the authors could also consider analyzing, by decade bands of age, the association of muscle size and density with 1-year mortality, hospital attendance, or mean sick days, which would allow readers to better appreciate the impact of muscle size and quality on shorter term health-related outcomes. These parameters, with the strength of sample size, would allow more emphasis on muscle health in health promotion policies.</p><p>It was good of the authors to highlight differences with previous studies. The contrary findings regarding the association between muscle density and leg power in Korean older adults [<span>3</span>] compared with the MrOS study participants highlight important ethnic and regional differences in the assessment, cut-offs, and variations in muscle strength, density, and intermuscular adipose tissue (IMAT) in different populations. Validation in diverse populations, especially older women and multi-ethnic Asian cohorts, is crucial for generalizability.</p><p>It would have been interesting for the authors to consider and highlight the associations between muscle mass, muscle function, muscle quality, and health-related outcomes [<span>4</span>]. With increasing emphasis on muscle quality as a measurement metric for muscle health [<span>5, 6</span>], future studies pertaining to muscle health should be encouraged to assess and present thes","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"286-287"},"PeriodicalIF":4.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan Hetherington-Rauth, Ashley A. Weaver, Peggy M. Cawthon
<p>We appreciate Tan et al.'s interest and comment on our recent manuscript, “Associations of CT Muscle Area and Density With Functional Outcomes and Mortality Across Anatomical Regions in Older Men” [<span>1</span>]. They raise an important question about the role of age in the relationship of muscle area and density with risk of mortality. Although all models were adjusted for age, we acknowledge that standard covariate adjustment may not fully address or disentangle the confounding influence of age.</p><p>In response to the comments, we performed additional analyses to assess age as a potential effect modifier. We examined interactions between age and both muscle area and muscle density at two trunk levels (Trunk-L1 and Trunk-L3) and in the right (Thigh-RT) and left (Thigh-LT) thigh, using Cox proportional hazards models with age modeled both continuously and in tertiles. We also conducted age-stratified subgroup analyses based on age tertiles of our sample.</p><p>Figure 1 presents hazard ratios (HRs) (95% CI) per standard deviation increase in muscle density and area for 10-year all-cause mortality, stratified by age tertile and anatomical region. No significant age interactions were observed when age was modeled as a continuous variable (<i>p</i>-interaction > 0.05), and similar HRs were found across all the age tertiles, as indicated by overlapping 95% CIs. However, some region-specific patterns emerged. Trunk muscle density at both Trunk-L1 and Trunk-L3 was most strongly associated with lower mortality risk in the youngest age tertile, with weaker associations in older tertiles, although no statistically significant interaction was detected (<i>p</i>-interaction > 0.05). In contrast, thigh muscle density was most strongly associated with mortality in the middle tertile, with a significantly greater effect than in the youngest tertile for the Thigh-RT (<i>p</i>-interaction = 0.006) and a borderline difference for the Thigh-LT (<i>p</i>-interaction = 0.06). Unlike muscle density, muscle area was not significantly associated with mortality in the overall sample or within most age tertiles, except for the Thigh-RT, where a significant association was observed only in the youngest tertile and the full cohort.</p><p>These findings suggest that the impact of muscle density on mortality risk varies by both anatomical region and stage of aging. The stronger association observed in the youngest-old age tertile for trunk muscles, but in the middle-old age tertile for thigh muscles, may reflect differences in the onset and progression of age-related muscle quality decline across regions. Lumbar paraspinal muscles are particularly vulnerable to early degenerative changes, such as fat infiltration, even in relatively healthy adults, likely due to their sensitivity to disuse and neuromuscular dysfunction [<span>2, 3</span>]. As a result, lower muscle density in the trunk, primarily driven by decreased muscle density of the paraspinal muscles, may s
{"title":"Reply to Comment on: Associations of CT Muscle Area and Density With Functional Outcomes and Mortality Across Anatomical Regions in Older Men","authors":"Megan Hetherington-Rauth, Ashley A. Weaver, Peggy M. Cawthon","doi":"10.1111/jgs.70129","DOIUrl":"10.1111/jgs.70129","url":null,"abstract":"<p>We appreciate Tan et al.'s interest and comment on our recent manuscript, “Associations of CT Muscle Area and Density With Functional Outcomes and Mortality Across Anatomical Regions in Older Men” [<span>1</span>]. They raise an important question about the role of age in the relationship of muscle area and density with risk of mortality. Although all models were adjusted for age, we acknowledge that standard covariate adjustment may not fully address or disentangle the confounding influence of age.</p><p>In response to the comments, we performed additional analyses to assess age as a potential effect modifier. We examined interactions between age and both muscle area and muscle density at two trunk levels (Trunk-L1 and Trunk-L3) and in the right (Thigh-RT) and left (Thigh-LT) thigh, using Cox proportional hazards models with age modeled both continuously and in tertiles. We also conducted age-stratified subgroup analyses based on age tertiles of our sample.</p><p>Figure 1 presents hazard ratios (HRs) (95% CI) per standard deviation increase in muscle density and area for 10-year all-cause mortality, stratified by age tertile and anatomical region. No significant age interactions were observed when age was modeled as a continuous variable (<i>p</i>-interaction > 0.05), and similar HRs were found across all the age tertiles, as indicated by overlapping 95% CIs. However, some region-specific patterns emerged. Trunk muscle density at both Trunk-L1 and Trunk-L3 was most strongly associated with lower mortality risk in the youngest age tertile, with weaker associations in older tertiles, although no statistically significant interaction was detected (<i>p</i>-interaction > 0.05). In contrast, thigh muscle density was most strongly associated with mortality in the middle tertile, with a significantly greater effect than in the youngest tertile for the Thigh-RT (<i>p</i>-interaction = 0.006) and a borderline difference for the Thigh-LT (<i>p</i>-interaction = 0.06). Unlike muscle density, muscle area was not significantly associated with mortality in the overall sample or within most age tertiles, except for the Thigh-RT, where a significant association was observed only in the youngest tertile and the full cohort.</p><p>These findings suggest that the impact of muscle density on mortality risk varies by both anatomical region and stage of aging. The stronger association observed in the youngest-old age tertile for trunk muscles, but in the middle-old age tertile for thigh muscles, may reflect differences in the onset and progression of age-related muscle quality decline across regions. Lumbar paraspinal muscles are particularly vulnerable to early degenerative changes, such as fat infiltration, even in relatively healthy adults, likely due to their sensitivity to disuse and neuromuscular dysfunction [<span>2, 3</span>]. As a result, lower muscle density in the trunk, primarily driven by decreased muscle density of the paraspinal muscles, may s","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"288-289"},"PeriodicalIF":4.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nancy E. Lundebjerg, Megan Young, Helen M. Fernandez, Eric Widera, Peter M. Abadir
In the early 20th century, Geriatric Medicine emerged as a specialty with a focus on improving the health and quality of life of older adults. Almost since inception, geriatricians have worked in collaboration with other medical specialties and health professionals to achieve this goal. This focus on collaboration has led to innovations that are improving care for older adults across settings of care, some of which are being led by other specialties (e.g., the Geriatric Surgery Verification Program). In 2015, Geriatric Medicine began to recruit fellows through the National Resident Matching Program (NRMP), and data from the past 10 years (2015–2024) reflect stable recruitment into the field with approximately 300 fellows entering geriatrics fellowship annually. The field has been innovative in its efforts to create training pathways that support physicians to complete geriatrics fellowship, including national pilots that combine geriatrics and palliative care training and offer clinical geriatrics experiences during internal and family medicine residency training underway at the Accreditation Council for Graduate Medical Education. In research, the field has contributed to extending our collective healthspan, championed inclusion of older adults in all research, and led efforts to develop investigators who are focused on the geriatrics aspects of their research. Opportunities for geriatricians to build on the foundations they have laid include leading Age-Friendly Health Systems and artificial intelligence into healthcare implementation with a continued focus on partnering with others to achieve meaningful change in the health and well-being of others.
{"title":"Geriatricians Leading Innovation: Collaborating to Enhance Care as We Age","authors":"Nancy E. Lundebjerg, Megan Young, Helen M. Fernandez, Eric Widera, Peter M. Abadir","doi":"10.1111/jgs.70102","DOIUrl":"10.1111/jgs.70102","url":null,"abstract":"<div>\u0000 \u0000 <p>In the early 20th century, Geriatric Medicine emerged as a specialty with a focus on improving the health and quality of life of older adults. Almost since inception, geriatricians have worked in collaboration with other medical specialties and health professionals to achieve this goal. This focus on collaboration has led to innovations that are improving care for older adults across settings of care, some of which are being led by other specialties (e.g., the Geriatric Surgery Verification Program). In 2015, Geriatric Medicine began to recruit fellows through the National Resident Matching Program (NRMP), and data from the past 10 years (2015–2024) reflect stable recruitment into the field with approximately 300 fellows entering geriatrics fellowship annually. The field has been innovative in its efforts to create training pathways that support physicians to complete geriatrics fellowship, including national pilots that combine geriatrics and palliative care training and offer clinical geriatrics experiences during internal and family medicine residency training underway at the Accreditation Council for Graduate Medical Education. In research, the field has contributed to extending our collective healthspan, championed inclusion of older adults in all research, and led efforts to develop investigators who are focused on the geriatrics aspects of their research. Opportunities for geriatricians to build on the foundations they have laid include leading Age-Friendly Health Systems and artificial intelligence into healthcare implementation with a continued focus on partnering with others to achieve meaningful change in the health and well-being of others.</p>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"316-325"},"PeriodicalIF":4.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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