Cari Levy MD, PhD, Aryan Esmaeili MD, PhD, Dawn Smith MS, Robert V. Hogikyan MD, MPH, Vyjeyanthi S. Periyakoil MD, Joan G. Carpenter PhD, CRNP, Anne Sales PhD, RN, Ciaran S. Phibbs PhD, Andrew Murray BS, Mary Ersek PhD, RN, FPCN
Background
Modeled after the Physician Orders for Life Sustaining Treatment program, the Veterans Health Administration (VA) implemented the Life-Sustaining Treatment (LST) Decisions Initiative to improve end-of-life outcomes by standardizing LST preference documentation for seriously ill Veterans. This study examined the associations between LST documentation and family evaluation of care in the final month of life for Veterans in VA nursing homes.
Methods
Retrospective, cross-sectional analysis of data for decedents in VA nursing homes between July 1, 2018 and January 31, 2020 (N = 14,575). Regression modeling generated odds for key end-of-life outcomes and family ratings of care quality.
Results
LST preferences were documented for 12,928 (89%) of VA nursing home decedents. Contrary to our hypothesis, neither receipt of wanted medications and medical treatment (adjusted odds ratio [OR]: 0.85, 95% confidence interval [CI] 0.63, 1.16) nor ratings of overall care in the last month of life (adjusted OR: 0.96, 95% CI 0.76, 1.22) differed significantly between those with and without completed LST templates in adjusted analyses.
Conclusions
Among Community Living Center (CLC) decedents, 89% had documented LST preferences. No significant differences were observed in family ratings of care between Veterans with and without documentation of LST preferences. Interventions aimed at improving family ratings of end-of-life care quality in CLCs should not target LST documentation in isolation of other factors associated with higher family ratings of end-of-life care quality.
{"title":"Life-sustaining treatment decisions and family evaluations of end-of-life care for Veteran decedents in Department of Veterans Affairs nursing homes","authors":"Cari Levy MD, PhD, Aryan Esmaeili MD, PhD, Dawn Smith MS, Robert V. Hogikyan MD, MPH, Vyjeyanthi S. Periyakoil MD, Joan G. Carpenter PhD, CRNP, Anne Sales PhD, RN, Ciaran S. Phibbs PhD, Andrew Murray BS, Mary Ersek PhD, RN, FPCN","doi":"10.1111/jgs.19050","DOIUrl":"10.1111/jgs.19050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Modeled after the Physician Orders for Life Sustaining Treatment program, the Veterans Health Administration (VA) implemented the Life-Sustaining Treatment (LST) Decisions Initiative to improve end-of-life outcomes by standardizing LST preference documentation for seriously ill Veterans. This study examined the associations between LST documentation and family evaluation of care in the final month of life for Veterans in VA nursing homes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective, cross-sectional analysis of data for decedents in VA nursing homes between July 1, 2018 and January 31, 2020 (<i>N</i> = 14,575). Regression modeling generated odds for key end-of-life outcomes and family ratings of care quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LST preferences were documented for 12,928 (89%) of VA nursing home decedents. Contrary to our hypothesis, neither receipt of wanted medications and medical treatment (adjusted odds ratio [OR]: 0.85, 95% confidence interval [CI] 0.63, 1.16) nor ratings of overall care in the last month of life (adjusted OR: 0.96, 95% CI 0.76, 1.22) differed significantly between those with and without completed LST templates in adjusted analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among Community Living Center (CLC) decedents, 89% had documented LST preferences. No significant differences were observed in family ratings of care between Veterans with and without documentation of LST preferences. Interventions aimed at improving family ratings of end-of-life care quality in CLCs should not target LST documentation in isolation of other factors associated with higher family ratings of end-of-life care quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2709-2720"},"PeriodicalIF":4.3,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545684","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}
James Galske BS, Tonya Chera BPH, Ula Hwang MD, MPH, Joan K. Monin PhD, Arjun Venkatesh MD, MBA, MHS, Kenneth Lam MD, MAS, Amanda N. Leggett PhD, MS, Cameron Gettel MD, MHS
{"title":"Daily care hours among caregivers of older emergency department patients with dementia and undiagnosed cognitive impairment","authors":"James Galske BS, Tonya Chera BPH, Ula Hwang MD, MPH, Joan K. Monin PhD, Arjun Venkatesh MD, MBA, MHS, Kenneth Lam MD, MAS, Amanda N. Leggett PhD, MS, Cameron Gettel MD, MHS","doi":"10.1111/jgs.19062","DOIUrl":"10.1111/jgs.19062","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3261-3264"},"PeriodicalIF":4.3,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545682","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":"Don't die with your boots on","authors":"Dean Gianakos MD, FACP","doi":"10.1111/jgs.19059","DOIUrl":"10.1111/jgs.19059","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2866-2867"},"PeriodicalIF":4.3,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545683","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}
Heather R. Kregel MD, MS, Claudia Pedroza PhD, Fatimah Sunez BS, Gina Khraish MD, Ezenwa Onyema MD, David E. Meyer MD, Sasha D. Adams MD, Lillian S. Kao MD, MS, Laura J. Moore MD, Thaddeus J. Puzio MD
Background
Management of geriatric trauma patients requires balancing chronic comorbidities with acute injuries. We developed a care model in which patients are managed by hospitalists with trauma-centered education and hypothesized that clinical outcomes would be similar to outcomes in patients primarily managed by trauma surgeons.
Methods
This was a retrospective study of trauma patients aged ≥65 from January 2020 to December 2021. Groups were defined by admitting service: trauma surgery service (TSS) or geriatric trauma hospitalist service (GTHS). The primary outcome was in-hospital mortality. Regression analyses and inverse probability treatment weighted (IPTW) propensity score (PS) analyses were performed to determine the association between admitting service and outcomes.
Results
A total of 1004 patients were eligible for inclusion—580 GTHS and 424 TSS admissions. GTHS patients were older (82 vs. 74, p < 0.001), more likely to have suffered blunt trauma (99.5% vs. 95%, p < 0.001), more likely to have comorbidities (91.2% vs. 87%, p < 0.001), had higher Charlson Comorbidity Indexes (CCIs), and had lower median injury severity scores (9 vs. 13, p < 0.001). Rates of mortality, delirium, 30-day readmission, and overall complications were low and similar between groups. While TSS patients were likely to be discharged home, GTHS had more discharges to skilled nursing facilities and longer length of stay (LOS). On multivariable analysis adjusted for age, ISS, CCI, and sex, patients admitted to GTHS had lower odds of death with an odds ratio of 0.15 (95% confidence interval [CI] 0.02–0.75, p = 0.03) when compared to TSS. On IPTW PS analysis, patients admitted to GTHS had similar odds of death with an odds ratio of 0.3 (95% CI 0.06–1.6, p = 0.16).
Conclusions
Protocolized admission criteria to a GTHS resulted in similar low mortality rates but longer LOS when compared to patients admitted to a TSS. This care model may inform other trauma centers in developing their strategies for managing the increasing volume of vulnerable injured older adults.
{"title":"The geriatric trauma hospitalist service: An analysis of a management strategy for injured older adults","authors":"Heather R. Kregel MD, MS, Claudia Pedroza PhD, Fatimah Sunez BS, Gina Khraish MD, Ezenwa Onyema MD, David E. Meyer MD, Sasha D. Adams MD, Lillian S. Kao MD, MS, Laura J. Moore MD, Thaddeus J. Puzio MD","doi":"10.1111/jgs.19054","DOIUrl":"10.1111/jgs.19054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Management of geriatric trauma patients requires balancing chronic comorbidities with acute injuries. We developed a care model in which patients are managed by hospitalists with trauma-centered education and hypothesized that clinical outcomes would be similar to outcomes in patients primarily managed by trauma surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study of trauma patients aged ≥65 from January 2020 to December 2021. Groups were defined by admitting service: trauma surgery service (TSS) or geriatric trauma hospitalist service (GTHS). The primary outcome was in-hospital mortality. Regression analyses and inverse probability treatment weighted (IPTW) propensity score (PS) analyses were performed to determine the association between admitting service and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1004 patients were eligible for inclusion—580 GTHS and 424 TSS admissions. GTHS patients were older (82 vs. 74, <i>p</i> < 0.001), more likely to have suffered blunt trauma (99.5% vs. 95%, <i>p</i> < 0.001), more likely to have comorbidities (91.2% vs. 87%, <i>p</i> < 0.001), had higher Charlson Comorbidity Indexes (CCIs), and had lower median injury severity scores (9 vs. 13, <i>p</i> < 0.001). Rates of mortality, delirium, 30-day readmission, and overall complications were low and similar between groups. While TSS patients were likely to be discharged home, GTHS had more discharges to skilled nursing facilities and longer length of stay (LOS). On multivariable analysis adjusted for age, ISS, CCI, and sex, patients admitted to GTHS had lower odds of death with an odds ratio of 0.15 (95% confidence interval [CI] 0.02–0.75, <i>p</i> = 0.03) when compared to TSS. On IPTW PS analysis, patients admitted to GTHS had similar odds of death with an odds ratio of 0.3 (95% CI 0.06–1.6, <i>p</i> = 0.16).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Protocolized admission criteria to a GTHS resulted in similar low mortality rates but longer LOS when compared to patients admitted to a TSS. This care model may inform other trauma centers in developing their strategies for managing the increasing volume of vulnerable injured older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2752-2758"},"PeriodicalIF":4.3,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545720","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}
Inessa Cohen MPH, Rohit B. Sangal MD, MBA, Richard Andrew Taylor MD, MHS, Anna Crawford MS, James M. Lai MD, MHS, Pamela Martin APRN, Sarah Palleschi PA, Craig Rothenberg MPH, Debra Tomasino MA, Ula Hwang MD, MPH
Cover caption: A cartoon image generated with assistance of AI showing a contrast between a busy versus organized geriatric emergency department with (right) and without (left) the GEMS intervention. OpenAI. (2024). ChatGPT [Large language model]. For full details, see “Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition” on page 2017.
{"title":"Cover","authors":"Inessa Cohen MPH, Rohit B. Sangal MD, MBA, Richard Andrew Taylor MD, MHS, Anna Crawford MS, James M. Lai MD, MHS, Pamela Martin APRN, Sarah Palleschi PA, Craig Rothenberg MPH, Debra Tomasino MA, Ula Hwang MD, MPH","doi":"10.1111/jgs.17863","DOIUrl":"https://doi.org/10.1111/jgs.17863","url":null,"abstract":"<p><b>Cover caption</b>: A cartoon image generated with assistance of AI showing a contrast between a busy versus organized geriatric emergency department with (right) and without (left) the GEMS intervention. OpenAI. (2024). ChatGPT [Large language model]. For full details, see “Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition” on page 2017.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 7","pages":"C1"},"PeriodicalIF":4.3,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.17863","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536627","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}
Haoyan Zhong MPA, Jashvant Poeran MD, PhD, Alex Illescas MPH, Lisa Reisinger MD, Crispiana Cozowicz MD, Stavros G. Memtsoudis MD, PhD, MBA, Jiabin Liu MD, PhD, FASA
Background
Studies have demonstrated beneficial outcomes associated with timely surgical treatment of hip fracture. Subsequently, practice recommendations changed with 24–48 h as the recommended time for surgery from admission; however, recent data on timing of hip fracture surgery and how this impacts outcomes are lacking.
Methods
This retrospective cohort study included patients who had a primary diagnosis of hip fracture and underwent a subsequent surgical repair within 3 days of admission (Premier Healthcare claims 2006–2021 data). The primary exposure of interest was time from hip fracture diagnosis to surgery (categorized as 0–1 day, 2 days, and 3 days). Outcomes included any major complication, mortality, and intensive care unit (ICU) admission. Mixed-effects models measured the association between timing of surgery and outcomes. We report odds ratios (OR) and 95% confidence intervals.
Results
Among 501,267 surgical hip fracture patients, 26.0%, 56.0%, and 18.1% of patients received surgery on days 0–1, 2, and 3, respectively. The median ages were 83, 84, and 84 years old, and there were 73.3%, 72.2%, and 68.8% female in each group respectively. Compared with repair on day 0–1, hip fracture surgical treatment on day 2 or day 3 was associated with increased odds of major complications (OR 1.06, 95% CI 1.03–1.08 and OR 1.17, 95% CI 1.13–1.2), mortality (OR 1.08, 95% CI 1.02–1.14 and OR 1.2, 95% CI 1.12–1.28), and ICU admission (OR 1.06, 95% CI 1.04–1.09 and OR 1.36, 95% CI 1.32–1.4) after adjusting major comorbidities; all p < 0.001.
Conclusion
Despite the publication of society guidelines in 2015, most fracture patients still received surgery on day 2 or day 3 of admission and were associated with worse outcomes. Balancing optimization of clinical factors with timing of surgery can be challenging, and further research is needed. Nonetheless, our findings reiterate the importance of timely surgical intervention.
背景：研究表明，及时进行髋部骨折手术治疗有助于提高疗效。随后，实践建议将入院后 24-48 小时作为手术的推荐时间；然而，关于髋部骨折手术时机以及这对治疗效果有何影响的最新数据尚缺：这项回顾性队列研究纳入了初诊为髋部骨折并在入院后 3 天内接受后续手术修复的患者（Premier Healthcare 索赔 2006-2021 年数据）。主要关注点是从髋部骨折诊断到手术的时间（分为 0-1 天、2 天和 3 天）。结果包括任何主要并发症、死亡率和入住重症监护室 (ICU)。混合效应模型测量了手术时间与结果之间的关系。我们报告了几率比（OR）和 95% 的置信区间：在 501,267 例髋部骨折手术患者中，分别有 26.0%、56.0% 和 18.1% 的患者在第 0-1 天、第 2 天和第 3 天接受手术。年龄中位数分别为 83 岁、84 岁和 84 岁，女性比例分别为 73.3%、72.2% 和 68.8%。与在第 0-1 天进行修复相比，在第 2 天或第 3 天进行髋部骨折手术治疗与主要并发症（OR 1.06，95% CI 1.03-1.08 和 OR 1.17，95% CI 1.13-1.2）、死亡率（OR 1.08，95% CI 1.02-1.14 和 OR 1.2，95% CI 1.12-1.28）以及在调整主要合并症后入住 ICU（OR 1.06，95% CI 1.04-1.09 和 OR 1.36，95% CI 1.32-1.4）；所有 p 结论：尽管社会指南已于2015年发布，但大多数骨折患者仍在入院第2天或第3天接受手术，且预后较差。在优化临床因素与手术时机之间取得平衡具有挑战性，需要进一步研究。尽管如此，我们的研究结果重申了及时手术干预的重要性。
{"title":"Time to surgical treatment for hip fracture care","authors":"Haoyan Zhong MPA, Jashvant Poeran MD, PhD, Alex Illescas MPH, Lisa Reisinger MD, Crispiana Cozowicz MD, Stavros G. Memtsoudis MD, PhD, MBA, Jiabin Liu MD, PhD, FASA","doi":"10.1111/jgs.19063","DOIUrl":"10.1111/jgs.19063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Studies have demonstrated beneficial outcomes associated with timely surgical treatment of hip fracture. Subsequently, practice recommendations changed with 24–48 h as the recommended time for surgery from admission; however, recent data on timing of hip fracture surgery and how this impacts outcomes are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included patients who had a primary diagnosis of hip fracture and underwent a subsequent surgical repair within 3 days of admission (Premier Healthcare claims 2006–2021 data). The primary exposure of interest was time from hip fracture diagnosis to surgery (categorized as 0–1 day, 2 days, and 3 days). Outcomes included any major complication, mortality, and intensive care unit (ICU) admission. Mixed-effects models measured the association between timing of surgery and outcomes. We report odds ratios (OR) and 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 501,267 surgical hip fracture patients, 26.0%, 56.0%, and 18.1% of patients received surgery on days 0–1, 2, and 3, respectively. The median ages were 83, 84, and 84 years old, and there were 73.3%, 72.2%, and 68.8% female in each group respectively. Compared with repair on day 0–1, hip fracture surgical treatment on day 2 or day 3 was associated with increased odds of major complications (OR 1.06, 95% CI 1.03–1.08 and OR 1.17, 95% CI 1.13–1.2), mortality (OR 1.08, 95% CI 1.02–1.14 and OR 1.2, 95% CI 1.12–1.28), and ICU admission (OR 1.06, 95% CI 1.04–1.09 and OR 1.36, 95% CI 1.32–1.4) after adjusting major comorbidities; all <i>p</i> < 0.001.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the publication of society guidelines in 2015, most fracture patients still received surgery on day 2 or day 3 of admission and were associated with worse outcomes. Balancing optimization of clinical factors with timing of surgery can be challenging, and further research is needed. Nonetheless, our findings reiterate the importance of timely surgical intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3492-3500"},"PeriodicalIF":4.3,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499967","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}
Reuben Ng PhD, Nicole Indran BSocSci (Hons), Luyao Liu MSc
Background
Ageism is a major but oft-overlooked social determinant of health. In fact, it is widely accepted among scholars that ageism is one of the least acknowledged forms of inequality, although few empirical attempts have been made to substantiate this claim. This is the first study that quantifies the amount of discourse dedicated to ageism, sexism, and racism on Twitter. Specifically, we rely on the usage of hashtags as a proxy for the frequency of discussions surrounding each form of inequality over a 15-year period from 2007 to 2022. We also identify key events that triggered spikes in Twitter activity for each form of inequality.
Methods
Hashtags related to racism and sexism were extracted from past scholarship. We also employed a snowball sampling method whereby we queried the hashtags using Twitter's search function to identify other hashtags. As limited research has been conducted on ageism-related hashtags, we queried hashtags utilized by advocacy groups and adopted a snowball sampling method to compile other relevant hashtags. Tweets collected (N = 154,353,047) spanned 15 years, from August 23, 2007 to December 31, 2022.
Results
From 2007 to 2022, racism-related hashtags were used the most, followed by sexism-related hashtags and ageism-related hashtags. Racism-related hashtags (N = 99,250,348) were mentioned about 60 times more than ageism-related hashtags (N = 1,648,926). Sexism-related hashtags (N = 38,933,113) were mentioned 24 times more than ageism-related hashtags. The increasing linear trend of tweets associated with ageism (p < 0.001), sexism (p < 0.05), and racism (p < 0.05) reached significance. Incidents of racism and sexism often generated widespread public outrage. Conversely, instances of ageism rarely caused spikes in social media activity. Rather, these spikes were mainly observed during events such as the release of a report on ageism, a conference related to aging, or observances such as International Day of Older Persons.
Conclusion
There is a need to hasten moves to raise awareness of ageism. To ensure that discussions on ageism are not confined to academic and policy circles, advocacy campaigns could be held to educate the public on the issue and its negative concomitants.
{"title":"Social media discourse on ageism, sexism, and racism: Analysis of 150 million tweets over 15 years","authors":"Reuben Ng PhD, Nicole Indran BSocSci (Hons), Luyao Liu MSc","doi":"10.1111/jgs.19047","DOIUrl":"10.1111/jgs.19047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ageism is a major but oft-overlooked social determinant of health. In fact, it is widely accepted among scholars that ageism is one of the least acknowledged forms of inequality, although few empirical attempts have been made to substantiate this claim. This is the first study that quantifies the amount of discourse dedicated to ageism, sexism, and racism on Twitter. Specifically, we rely on the usage of hashtags as a proxy for the frequency of discussions surrounding each form of inequality over a 15-year period from 2007 to 2022. We also identify key events that triggered spikes in Twitter activity for each form of inequality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Hashtags related to racism and sexism were extracted from past scholarship. We also employed a snowball sampling method whereby we queried the hashtags using Twitter's search function to identify other hashtags. As limited research has been conducted on ageism-related hashtags, we queried hashtags utilized by advocacy groups and adopted a snowball sampling method to compile other relevant hashtags. Tweets collected (<i>N</i> = 154,353,047) spanned 15 years, from August 23, 2007 to December 31, 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2007 to 2022, racism-related hashtags were used the most, followed by sexism-related hashtags and ageism-related hashtags. Racism-related hashtags (<i>N</i> = 99,250,348) were mentioned about 60 times more than ageism-related hashtags (<i>N</i> = 1,648,926). Sexism-related hashtags (<i>N</i> = 38,933,113) were mentioned 24 times more than ageism-related hashtags. The increasing linear trend of tweets associated with ageism (<i>p</i> < 0.001), sexism (<i>p</i> < 0.05), and racism (<i>p</i> < 0.05) reached significance. Incidents of racism and sexism often generated widespread public outrage. Conversely, instances of ageism rarely caused spikes in social media activity. Rather, these spikes were mainly observed during events such as the release of a report on ageism, a conference related to aging, or observances such as International Day of Older Persons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is a need to hasten moves to raise awareness of ageism. To ensure that discussions on ageism are not confined to academic and policy circles, advocacy campaigns could be held to educate the public on the issue and its negative concomitants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3149-3155"},"PeriodicalIF":4.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494650","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}
Elizabeth Goldberg MD, ScM, Megan Bounds MPH, Peter Serina MD, MPH, Jonathan Gomez Picazo, Daphne Lo BS, Samantha Roberts MS, Hari Dandapani BA, Sarah Keene MD, PhD, Kali Thomas PhD, MA, Andrew Leroux PhD
{"title":"Commercial entities own the online narrative on home care: Impacts on quality, content, and readability","authors":"Elizabeth Goldberg MD, ScM, Megan Bounds MPH, Peter Serina MD, MPH, Jonathan Gomez Picazo, Daphne Lo BS, Samantha Roberts MS, Hari Dandapani BA, Sarah Keene MD, PhD, Kali Thomas PhD, MA, Andrew Leroux PhD","doi":"10.1111/jgs.19041","DOIUrl":"10.1111/jgs.19041","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3253-3256"},"PeriodicalIF":4.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494649","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}
Richard D. Shih MD, Scott M. Alter MD, Mike Wells MBBCh, PhD, Joshua J. Solano MD, Gabriella Engstrom PhD, RN, Lisa M. Clayton DO, Patrick G. Hughes DO, Lara Goldstein MBBCh, PhD, Lawrence Lottenberg MD, Joseph G. Ouslander MD
Background
Several clinical decision rules have been devised to guide head computed tomography (CT) use in patients with minor head injuries, but none have been validated in patients 65 years or older. We aimed to derive and validate a head injury clinical decision rule for older adults.
Methods
We conducted a secondary analysis of an existing dataset of consecutive emergency department (ED) patients >65 years old with blunt head trauma. The main predictive outcomes were significant intracranial injury and Need for Neurosurgical Intervention on CT. The secondary outcomes also considered in the model development and validation were All Injuries and All Intracranial Injuries. Predictor variables were identified using multiple variable logistic regression, and clinical decision rule models were developed in a split-sample derivation cohort and then tested in an independent validation cohort.
Results
Of 5776 patients, 233 (4.0%) had significant intracranial injury and an additional 104 (1.8%) met CT criteria for Need for Neurosurgical Intervention. The best performing model, the Florida Geriatric Head Trauma CT Clinical Decision Rule, assigns points based on several clinical variables. If the points totaled 25 or more, a CT scan is indicated. The included predictors were arrival via Emergency Medical Services (+30 points), Glasgow Coma Scale (GCS) <15 (+20 points), GCS <14 (+50 points), antiplatelet medications (+17 points), loss of consciousness (+16 points), signs of basilar skull fracture (+50 points), and headache (+20 points). Utilizing this clinical decision rule in the validation cohort, a point total ≥25 had a sensitivity and specificity of 100.0% (95% CI: 96.0–100) and 12.3% (95% CI: 10.9–13.8), respectively, for significant intracranial injury and Need for Neurosurgical Intervention.
Conclusions
The Florida Geriatric Head Trauma CT Clinical Decision Rule has the potential to reduce unnecessary CT scans in older adults, without compromising safe emergency medicine practice.
{"title":"The Florida Geriatric Head Trauma CT Clinical Decision Rule","authors":"Richard D. Shih MD, Scott M. Alter MD, Mike Wells MBBCh, PhD, Joshua J. Solano MD, Gabriella Engstrom PhD, RN, Lisa M. Clayton DO, Patrick G. Hughes DO, Lara Goldstein MBBCh, PhD, Lawrence Lottenberg MD, Joseph G. Ouslander MD","doi":"10.1111/jgs.19057","DOIUrl":"10.1111/jgs.19057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Several clinical decision rules have been devised to guide head computed tomography (CT) use in patients with minor head injuries, but none have been validated in patients 65 years or older. We aimed to derive and validate a head injury clinical decision rule for older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a secondary analysis of an existing dataset of consecutive emergency department (ED) patients >65 years old with blunt head trauma. The main predictive outcomes were significant intracranial injury and Need for Neurosurgical Intervention on CT. The secondary outcomes also considered in the model development and validation were All Injuries and All Intracranial Injuries. Predictor variables were identified using multiple variable logistic regression, and clinical decision rule models were developed in a split-sample derivation cohort and then tested in an independent validation cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 5776 patients, 233 (4.0%) had significant intracranial injury and an additional 104 (1.8%) met CT criteria for Need for Neurosurgical Intervention. The best performing model, the Florida Geriatric Head Trauma CT Clinical Decision Rule, assigns points based on several clinical variables. If the points totaled 25 or more, a CT scan is indicated. The included predictors were arrival via Emergency Medical Services (+30 points), Glasgow Coma Scale (GCS) <15 (+20 points), GCS <14 (+50 points), antiplatelet medications (+17 points), loss of consciousness (+16 points), signs of basilar skull fracture (+50 points), and headache (+20 points). Utilizing this clinical decision rule in the validation cohort, a point total ≥25 had a sensitivity and specificity of 100.0% (95% CI: 96.0–100) and 12.3% (95% CI: 10.9–13.8), respectively, for significant intracranial injury and Need for Neurosurgical Intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Florida Geriatric Head Trauma CT Clinical Decision Rule has the potential to reduce unnecessary CT scans in older adults, without compromising safe emergency medicine practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2738-2751"},"PeriodicalIF":4.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499966","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}
Mark A. Espeland PhD, Ann S. M. Harada PhD, Johnathan Ross BS, Michael P. Bancks PhD, Nicholas M. Pajewski PhD, Felicia R. Simpson PhD, Michael Walkup MS, Ian Davis MA, Peter J. Huckfeldt PhD, for the Action for Health in Diabetes Aging Study Group
Background
Type 2 diabetes mellitus and overweight/obesity increase healthcare costs. Both are also associated with accelerated aging. However, the contributions of this accelerated aging to increased healthcare costs are unknown.
Methods
We use data from a 8-year longitudinal cohort followed at 16 U.S. clinical research sites. Participants were adults aged 45–76 years with established type 2 diabetes and overweight or obesity who had enrolled in the Action for Health in Diabetes clinical trial. They were randomly (1:1) assigned to either an intensive lifestyle intervention focused on weight loss versus a comparator of diabetes support and education. A validated deficit accumulation frailty index (FI) was used to characterize biological aging. Discounted annual healthcare costs were estimated using national databases in 2012 dollars. Descriptive characteristics were collected by trained and certified staff.
Results
Compared with participants in the lowest tertile (least frail) of baseline FI, those in the highest tertile (most frail) at Year 1 averaged $714 (42%) higher medication costs, $244 (22%) higher outpatient costs, and $800 (134%) higher hospitalization costs (p < 0.001). At Years 4 and 8, relatively greater increases in FI (third vs. first tertile) were associated with an approximate doubling of total healthcare costs (p < 0.001). Mean (95% confidence interval) relative annual savings in healthcare costs associated with randomization to the intensive lifestyle intervention were $437 ($195, $579) per year during Years 1–4 and $461 ($232, $690) per year during Years 1–8. These were attenuated and the 95% confidence interval no longer excluded $0 after adjustment for the annual FI differences from baseline.
Conclusions
Deficit accumulation frailty tracks well with healthcare costs among adults with type 2 diabetes and overweight or obesity. It may serve as a useful marker to project healthcare needs and as an intermediate outcome in clinical trials.
{"title":"Cross-sectional and longitudinal associations among healthcare costs and deficit accumulation","authors":"Mark A. Espeland PhD, Ann S. M. Harada PhD, Johnathan Ross BS, Michael P. Bancks PhD, Nicholas M. Pajewski PhD, Felicia R. Simpson PhD, Michael Walkup MS, Ian Davis MA, Peter J. Huckfeldt PhD, for the Action for Health in Diabetes Aging Study Group","doi":"10.1111/jgs.19053","DOIUrl":"10.1111/jgs.19053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Type 2 diabetes mellitus and overweight/obesity increase healthcare costs. Both are also associated with accelerated aging. However, the contributions of this accelerated aging to increased healthcare costs are unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We use data from a 8-year longitudinal cohort followed at 16 U.S. clinical research sites. Participants were adults aged 45–76 years with established type 2 diabetes and overweight or obesity who had enrolled in the Action for Health in Diabetes clinical trial. They were randomly (1:1) assigned to either an intensive lifestyle intervention focused on weight loss versus a comparator of diabetes support and education. A validated deficit accumulation frailty index (FI) was used to characterize biological aging. Discounted annual healthcare costs were estimated using national databases in 2012 dollars. Descriptive characteristics were collected by trained and certified staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with participants in the lowest tertile (least frail) of baseline FI, those in the highest tertile (most frail) at Year 1 averaged $714 (42%) higher medication costs, $244 (22%) higher outpatient costs, and $800 (134%) higher hospitalization costs (<i>p</i> < 0.001). At Years 4 and 8, relatively greater increases in FI (third vs. first tertile) were associated with an approximate doubling of total healthcare costs (<i>p</i> < 0.001). Mean (95% confidence interval) relative annual savings in healthcare costs associated with randomization to the intensive lifestyle intervention were $437 ($195, $579) per year during Years 1–4 and $461 ($232, $690) per year during Years 1–8. These were attenuated and the 95% confidence interval no longer excluded $0 after adjustment for the annual FI differences from baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Deficit accumulation frailty tracks well with healthcare costs among adults with type 2 diabetes and overweight or obesity. It may serve as a useful marker to project healthcare needs and as an intermediate outcome in clinical trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2759-2769"},"PeriodicalIF":4.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141474034","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}
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