Benjamin A. Y. Cher, Nicole Lunardi, Melissa Thornton, Ava Hitzeman, Jocelyn Baker, Cameron Macdonald, Celette Sugg Skinner, Cynthia J. Brown, Don Mai, Elisa L. Marten, Konstantinos Makris, Maria Luisa Machado Heredia, Miles Berger, C. Munro Cullum, Simon C. Lee, Thai H. Pham, Courtney J. Balentine
Background
Patients aged 65+ are underrepresented in surgical clinical trials, and few studies have explored the unique barriers that limit participation of older adults in surgical trials. We aimed to identify barriers and facilitators to participation in surgical randomized trials among adults aged 65+.
Participants and Setting
Patients aged 65+ years having hernia surgery at two high-volume Veterans' Affairs hospitals.
Methods
We conducted semi-structured interviews to identify barriers and facilitators to participation in clinical trials. Interviews were analyzed with directed content analysis.
Results
We interviewed 40 Veterans aged 65+ years. The most frequently cited barriers to participation were logistical (e.g., needing to visit the hospital more frequently) and emotional (e.g., medical mistrust, fear of hospitals, and fear of bodily harm). COVID-19 pandemic-related misinformation was commonly cited by these participants as a justification for medical mistrust. The most frequently cited motivators to participate in trials were altruism, access to novel treatments, increased time with clinicians, and advancing scientific knowledge. Patients uncertain about participation were potentially persuadable by referencing the impact of the trial on their friends and family, or by increasing transparency around trial purpose and design. Notably, using virtual visits to minimize travel to the hospital was not regarded as a viable way to address logistical barriers.
Conclusions
Increasing the participation of older adults in surgical clinical trials will require a multi-factorial strategy that emphasizes communication of benefits to more than just the patient and includes deliberate planning to combat misperceptions and misinformation.
{"title":"Identifying Barriers and Motivators to Increase Surgical Clinical Trial Participation for Older Veterans","authors":"Benjamin A. Y. Cher, Nicole Lunardi, Melissa Thornton, Ava Hitzeman, Jocelyn Baker, Cameron Macdonald, Celette Sugg Skinner, Cynthia J. Brown, Don Mai, Elisa L. Marten, Konstantinos Makris, Maria Luisa Machado Heredia, Miles Berger, C. Munro Cullum, Simon C. Lee, Thai H. Pham, Courtney J. Balentine","doi":"10.1111/jgs.70218","DOIUrl":"10.1111/jgs.70218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients aged 65+ are underrepresented in surgical clinical trials, and few studies have explored the unique barriers that limit participation of older adults in surgical trials. We aimed to identify barriers and facilitators to participation in surgical randomized trials among adults aged 65+.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants and Setting</h3>\u0000 \u0000 <p>Patients aged 65+ years having hernia surgery at two high-volume Veterans' Affairs hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews to identify barriers and facilitators to participation in clinical trials. Interviews were analyzed with directed content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 40 Veterans aged 65+ years. The most frequently cited barriers to participation were logistical (e.g., needing to visit the hospital more frequently) and emotional (e.g., medical mistrust, fear of hospitals, and fear of bodily harm). COVID-19 pandemic-related misinformation was commonly cited by these participants as a justification for medical mistrust. The most frequently cited motivators to participate in trials were altruism, access to novel treatments, increased time with clinicians, and advancing scientific knowledge. Patients uncertain about participation were potentially persuadable by referencing the impact of the trial on their friends and family, or by increasing transparency around trial purpose and design. Notably, using virtual visits to minimize travel to the hospital was not regarded as a viable way to address logistical barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Increasing the participation of older adults in surgical clinical trials will require a multi-factorial strategy that emphasizes communication of benefits to more than just the patient and includes deliberate planning to combat misperceptions and misinformation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"161-168"},"PeriodicalIF":4.5,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145608019","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}
Samir K. Shah, Lingwei Xiang, Rachel R. Adler, Clancy J. Clark, Zara Cooper, Emily Finlayson, Susan L. Mitchell, Dae Hyun Kim, Kueiyu Joshua Lin, Stuart R. Lipsitz, Joel S. Weissman
Cover caption: Outcomes of high-risk surgery in patients living with ADRD compared to those without. See the related article by Shah et al., pages 3434–3443.
{"title":"Cover","authors":"Samir K. Shah, Lingwei Xiang, Rachel R. Adler, Clancy J. Clark, Zara Cooper, Emily Finlayson, Susan L. Mitchell, Dae Hyun Kim, Kueiyu Joshua Lin, Stuart R. Lipsitz, Joel S. Weissman","doi":"10.1111/jgs.70194","DOIUrl":"https://doi.org/10.1111/jgs.70194","url":null,"abstract":"<p><b>Cover caption</b>: Outcomes of high-risk surgery in patients living with ADRD compared to those without. See the related article by Shah et al., pages 3434–3443.\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":"73 11","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585130","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}
{"title":"Playlist Prescriptions","authors":"Sophia J. Ruser, Jody Sharninghausen","doi":"10.1111/jgs.70214","DOIUrl":"10.1111/jgs.70214","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"249-251"},"PeriodicalIF":4.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145608031","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}
Kathryn G. Burford, Kathryn M. Neckerman, James W. Quinn, Michael D. M. Bader, Gina S. Lovasi, Stephen J. Mooney, Nicole G. Itzkowitz, Dirk Kinsey, Andrew G. Rundle
Background
Population-level interventions are needed to address the overrepresentation of older pedestrians in deaths from traffic crashes. Data are absent on whether specific publicly licensed or public establishments are associated with increased risk to older pedestrians, despite their attractiveness as partners for government efforts. We conducted a nationwide location-based case–control study to examine the associations between publicly licensed or public establishments of daily living for older adults and the location of pedestrian fatalities in motor vehicle crashes. We also assessed etiological heterogeneity by pedestrian age and time of day.
Methods
Between 2017 and 2018, there were 10,529 locations where a pedestrian was killed (case location) across the 380 Metropolitan Statistical Areas of the conterminous United States. For each case location two matched control locations were selected. The density of residential living facilities and walkable destinations for older adults was measured within a 1-km radial buffer of each location. Data were analyzed using conditional logistic regression models, adjusting for matching factors, neighborhood composition and walkability metrics.
Results
There was a dose–response relationship between the density of older adult walkable destinations (hospitals, health care delivery venues, health services, pharmacies, senior centers, libraries, community centers) and location case–control status by age group of the fatally struck pedestrian. The strongest pattern was observed for the 65+ age group: Adjusted Odds Ratio (AOR) = 1.61 (95% CI: 1.26–2.06) for Q2; AOR = 2.58 for Q3 (95% CI: 1.99–3.34); and AOR = 3.44 for Q4 (95% CI = 2.61–4.52). Only among the age 50–64 and 65+ age groups was the highest category of density of residential facilities (assisted living facilities, skilled nursing facilities, continuing care retirement communities) associated with fatality location case–control status.
Conclusions
Future research might explore whether prioritizing traffic safety programs near destinations where older adults commonly frequent, such as medical centers, prevents older adult pedestrian fatalities.
{"title":"Where Do Older Pedestrians Experience a Risk of Being Killed in a Motor Vehicle Crash?","authors":"Kathryn G. Burford, Kathryn M. Neckerman, James W. Quinn, Michael D. M. Bader, Gina S. Lovasi, Stephen J. Mooney, Nicole G. Itzkowitz, Dirk Kinsey, Andrew G. Rundle","doi":"10.1111/jgs.70198","DOIUrl":"10.1111/jgs.70198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Population-level interventions are needed to address the overrepresentation of older pedestrians in deaths from traffic crashes. Data are absent on whether specific publicly licensed or public establishments are associated with increased risk to older pedestrians, despite their attractiveness as partners for government efforts. We conducted a nationwide location-based case–control study to examine the associations between publicly licensed or public establishments of daily living for older adults and the location of pedestrian fatalities in motor vehicle crashes. We also assessed etiological heterogeneity by pedestrian age and time of day.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2017 and 2018, there were 10,529 locations where a pedestrian was killed (case location) across the 380 Metropolitan Statistical Areas of the conterminous United States. For each case location two matched control locations were selected. The density of residential living facilities and walkable destinations for older adults was measured within a 1-km radial buffer of each location. Data were analyzed using conditional logistic regression models, adjusting for matching factors, neighborhood composition and walkability metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a dose–response relationship between the density of older adult walkable destinations (hospitals, health care delivery venues, health services, pharmacies, senior centers, libraries, community centers) and location case–control status by age group of the fatally struck pedestrian. The strongest pattern was observed for the 65+ age group: Adjusted Odds Ratio (AOR) = 1.61 (95% CI: 1.26–2.06) for Q2; AOR = 2.58 for Q3 (95% CI: 1.99–3.34); and AOR = 3.44 for Q4 (95% CI = 2.61–4.52). Only among the age 50–64 and 65+ age groups was the highest category of density of residential facilities (assisted living facilities, skilled nursing facilities, continuing care retirement communities) associated with fatality location case–control status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Future research might explore whether prioritizing traffic safety programs near destinations where older adults commonly frequent, such as medical centers, prevents older adult pedestrian fatalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"132-142"},"PeriodicalIF":4.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566838","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}
Amresh D. Hanchate, Mia Yang, Stephanie K. Nothelle, Lindsey Abdelfattah, Michael P. Bancks, Emilie D. Duchesneau, Zhang Zhang, Bruce Kinosian
Background
As more older adults become homebound, home-based medical care (HBMC) has increased, but little is known about the HBMC workforce. This study analyzes national data on the size and structural features of HBMC providers from 2016 to 2022.
Methods
We analyzed annual primary care data for all traditional Medicare enrollees, classifying visits as HBMC (private residence or assisted living facility [ALF]) or non-HBMC (office or telemedicine). We evaluated trends in HBMC providers and visits by HBMC practice exclusivity (only-HBMC or both HBMC and non-HBMC), care setting (private residence, ALF), provider type (physician, nurse practitioner [NP], physician assistant [PA]), and visit volume. We assessed geographic variation in HBMC's share of primary care and payment differences between HBMC and non-HBMC services.
Results
In 2022, 16,125 of 304,326 (5%) primary care clinicians delivered 5.6 million HBMC visits, with most visits (66%) in ALFs. From 2016 to 2022, HBMC providers increased by 40% and visits by 29%. The proportion of only-HBMC providers rose from 50.2% to 61.7%, whereas providers with volume > 1000 visits/year fell from 46.8% to 38.9%. The increase in providers was higher in private residences (49%) than ALFs (33%), though average provider volume decreased in private residences (−24%) and rose in ALFs (7%). NPs among HBMC providers increased from 42.2% to 63.0%, PAs from 6.6% to 8.2%, and physicians dropped from 51.3% to 28.9%. HBMC's share of all visits increased from 3.9% to 5.4%, driven more by ALF visits. Non-HBMC service payments grew faster than those for HBMC services.
Conclusions
Against the backdrop of an expanding HBMC workforce and rising visit volumes from 2016 to 2022, our findings highlight significant shifts in the structural composition of providers. These shifts emphasize the need for ongoing research to address their implications for access, quality, and outcomes in homebound older adults.
{"title":"The Changing Landscape of the Providers of Home-Based Medical Care in Traditional Medicare","authors":"Amresh D. Hanchate, Mia Yang, Stephanie K. Nothelle, Lindsey Abdelfattah, Michael P. Bancks, Emilie D. Duchesneau, Zhang Zhang, Bruce Kinosian","doi":"10.1111/jgs.70203","DOIUrl":"10.1111/jgs.70203","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As more older adults become homebound, home-based medical care (HBMC) has increased, but little is known about the HBMC workforce. This study analyzes national data on the size and structural features of HBMC providers from 2016 to 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed annual primary care data for all traditional Medicare enrollees, classifying visits as HBMC (private residence or assisted living facility [ALF]) or non-HBMC (office or telemedicine). We evaluated trends in HBMC providers and visits by HBMC practice exclusivity (only-HBMC or both HBMC and non-HBMC), care setting (private residence, ALF), provider type (physician, nurse practitioner [NP], physician assistant [PA]), and visit volume. We assessed geographic variation in HBMC's share of primary care and payment differences between HBMC and non-HBMC services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2022, 16,125 of 304,326 (5%) primary care clinicians delivered 5.6 million HBMC visits, with most visits (66%) in ALFs. From 2016 to 2022, HBMC providers increased by 40% and visits by 29%. The proportion of only-HBMC providers rose from 50.2% to 61.7%, whereas providers with volume > 1000 visits/year fell from 46.8% to 38.9%. The increase in providers was higher in private residences (49%) than ALFs (33%), though average provider volume decreased in private residences (−24%) and rose in ALFs (7%). NPs among HBMC providers increased from 42.2% to 63.0%, PAs from 6.6% to 8.2%, and physicians dropped from 51.3% to 28.9%. HBMC's share of all visits increased from 3.9% to 5.4%, driven more by ALF visits. Non-HBMC service payments grew faster than those for HBMC services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Against the backdrop of an expanding HBMC workforce and rising visit volumes from 2016 to 2022, our findings highlight significant shifts in the structural composition of providers. These shifts emphasize the need for ongoing research to address their implications for access, quality, and outcomes in homebound older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"143-152"},"PeriodicalIF":4.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515327","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}
Taylor I. Bucy, Carrie E. Henning-Smith, Donovan T. Maust, Tetyana P. Shippee, Dori A. Cross
Background
Discharge to the home/community following a skilled nursing facility (SNF) stay is a key metric of high-quality care. However, achieving this in this domain remains challenging, especially for distinctly complex patients. Little research to date has examined within-group variation in discharge outcomes for persons with SMI, a population that reflects a growing proportion of SNF consumers in the U.S.
Methods
We leveraged a 4-year (2016–2019) 100% sample of Medicare claims data to examine individual- and organization-level predictors of SNF discharge location for persons with SMI. We first describe within-group differences for persons with SMI at the bivariate level. We then test linear probability models fully adjusted for individual and organization-level covariates, allowing for calculation of post-estimation marginal effects.
Results
We identified 118,325 unique SNF stays for people with SMI; 54% ended in discharge to the home/community. Patients with SMI who were discharged to the home/community (versus not) were significantly younger, more likely to be female, and were less likely to be dual-eligible or to have co-occurring ADRD. SMI patients discharged to the home/community were also significantly more likely to receive care in SNFs that were more integrated, higher quality, and saw a smaller share of SMI patients overall. These findings were reinforced by our fully adjusted regression analyses.
Discussion
This work finds within-group differences in characteristics associated with SNF discharge outcomes among the population of patients with SMI at both the person- and organization-levels. Policymakers should consider how to leverage value-based payment (VBP) programs, including new SNF-VBP requirements, in a way that more realistically accounts for the resources (e.g., time, staffing) required to coordinate care for this population. Similarly, an explicit focus on investments along the continuum should center around services that facilitate community retention (e.g., home- and community-based services).
{"title":"Who Makes It Home: Skilled Nursing Facility to Community Transitions for Medicare Beneficiaries With Serious Mental Illness","authors":"Taylor I. Bucy, Carrie E. Henning-Smith, Donovan T. Maust, Tetyana P. Shippee, Dori A. Cross","doi":"10.1111/jgs.70205","DOIUrl":"10.1111/jgs.70205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Discharge to the home/community following a skilled nursing facility (SNF) stay is a key metric of high-quality care. However, achieving this in this domain remains challenging, especially for distinctly complex patients. Little research to date has examined within-group variation in discharge outcomes for persons with SMI, a population that reflects a growing proportion of SNF consumers in the U.S.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We leveraged a 4-year (2016–2019) 100% sample of Medicare claims data to examine individual- and organization-level predictors of SNF discharge location for persons with SMI. We first describe within-group differences for persons with SMI at the bivariate level. We then test linear probability models fully adjusted for individual and organization-level covariates, allowing for calculation of post-estimation marginal effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 118,325 unique SNF stays for people with SMI; 54% ended in discharge to the home/community. Patients with SMI who were discharged to the home/community (versus not) were significantly younger, more likely to be female, and were less likely to be dual-eligible or to have co-occurring ADRD. SMI patients discharged to the home/community were also significantly more likely to receive care in SNFs that were more integrated, higher quality, and saw a smaller share of SMI patients overall. These findings were reinforced by our fully adjusted regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This work finds <i>within-group</i> differences in characteristics associated with SNF discharge outcomes among the population of patients with SMI at both the person- and organization-levels. Policymakers should consider how to leverage value-based payment (VBP) programs, including new SNF-VBP requirements, in a way that more realistically accounts for the resources (e.g., time, staffing) required to coordinate care for this population. Similarly, an explicit focus on investments along the continuum should center around services that facilitate community retention (e.g., home- and community-based services).</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"210-219"},"PeriodicalIF":4.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508641","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}
Benjamin W. Frush, Farr A. Curlin, Daniel P. Sulmasy
The conventional approach to caring for patients pursuing voluntarily stopping of eating and drinking (VSED) allows physicians to disagree with the patient's decisions to pursue VSED, but it assumes clinicians should accept the patient's choice and provide all aspects of supportive care after the patient has autonomously elected to pursue VSED. We argue this conventional approach problematically ignores the problem of complicity with what some physicians take to be an unethical action. We propose an alternative approach that makes space for clinicians opposed to VSED to advise against this course of action, and to provide palliative medicine while resisting interventions that facilitate VSED.
{"title":"The Role of the Physician in Caring for Patients Pursuing VSED: Challenging the Conventional Approach","authors":"Benjamin W. Frush, Farr A. Curlin, Daniel P. Sulmasy","doi":"10.1111/jgs.70195","DOIUrl":"10.1111/jgs.70195","url":null,"abstract":"<p>The conventional approach to caring for patients pursuing voluntarily stopping of eating and drinking (VSED) allows physicians to disagree with the patient's decisions to pursue VSED, but it assumes clinicians should accept the patient's choice and provide all aspects of supportive care after the patient has autonomously elected to pursue VSED. We argue this conventional approach problematically ignores the problem of complicity with what some physicians take to be an unethical action. We propose an alternative approach that makes space for clinicians opposed to VSED to advise against this course of action, and to provide palliative medicine while resisting interventions that facilitate VSED.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3844-3848"},"PeriodicalIF":4.5,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12748032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446820","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}
Kristin Lees Haggerty, David B. Reuben, Rebecca Stoeckle, David Bass, Malaz Boustani, Carolyn Clevenger, Ian Kremer, David R. Lee, Madelyn Johnson, Morgan J. Minyo, Katherine L. Possin, Quincy M. Samus, Lynn Spragens, Lee A. Jennings, Gary Epstein-Lubow
The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach. The National Dementia Care Collaborative (NDCC), a coalition of scientific and clinical leaders in evidence-based dementia care, works to promote comprehensive dementia care. Drawing from the experiences of six previously tested programs—Aging Brain Care, Alzheimer's and Dementia Care, BRI Care Consultation, Care Ecosystem, Integrated Memory Care, and MIND at Home—we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. Our guidance also emphasizes leveraging existing community assets, aligning efforts with organizational priorities, and using both storytelling and data to make the case for change. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.
{"title":"GUIDE and Beyond: Strategies for Comprehensive Dementia Care Integration","authors":"Kristin Lees Haggerty, David B. Reuben, Rebecca Stoeckle, David Bass, Malaz Boustani, Carolyn Clevenger, Ian Kremer, David R. Lee, Madelyn Johnson, Morgan J. Minyo, Katherine L. Possin, Quincy M. Samus, Lynn Spragens, Lee A. Jennings, Gary Epstein-Lubow","doi":"10.1111/jgs.70107","DOIUrl":"10.1111/jgs.70107","url":null,"abstract":"<p>The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach. The National Dementia Care Collaborative (NDCC), a coalition of scientific and clinical leaders in evidence-based dementia care, works to promote comprehensive dementia care. Drawing from the experiences of six previously tested programs—Aging Brain Care, Alzheimer's and Dementia Care, BRI Care Consultation, Care Ecosystem, Integrated Memory Care, and MIND at Home—we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. Our guidance also emphasizes leveraging existing community assets, aligning efforts with organizational priorities, and using both storytelling and data to make the case for change. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3548-3554"},"PeriodicalIF":4.5,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423632","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}
Nicholas S. Reed, Sarah Y. Bessen, Pablo Martinez-Amezcua, Jennifer A. Deal, Danielle Powell, Julie Hoover Fong, Edgar R. Miller III, Frank R. Lin, Megan A. Morris, Esther S. Oh
Background
Hearing loss affects nearly two-thirds of adults over the age of 70 years, and is associated with lower satisfaction with health care, which may be mediated by patient-provider communication barriers. Accompaniment, the presence and support of a companion during health care interactions, may modify the association between hearing and satisfaction with care by providing an intermediary to assist with communication.
Methods
Cross-sectional study of 9698 Medicare beneficiaries from the 2016 Medicare Current Beneficiaries Survey. We used regression models to estimate the association between self-reported trouble hearing and satisfaction with care, which was measured through reported satisfaction with overall quality of care, satisfaction with information provided, and satisfaction with provider's concern. Interaction terms and stratification by being accompanied to healthcare visits were used to assess if accompaniment modified the association between hearing loss and satisfaction with care.
Results
Nearly 45% of Medicare beneficiaries reported at least a little trouble hearing. Adults with a little trouble hearing (Odds Ratio [OR] = 1.168; 95% Confidence Interval [CI] = 1.047–1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043–1.603) had higher odds of being dissatisfied with the quality of their health care over the previous year compared to those with no trouble hearing. Among accompanied participants, no association was found between level of hearing trouble and dissatisfaction with care. Among unaccompanied adults, trouble with hearing was associated with higher odds of dissatisfaction. The associations were consistent across the three dissatisfaction outcomes.
Conclusions
Medicare beneficiaries with hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Stratified models suggest that accompaniment may modify the association between hearing and dissatisfaction with care. Future research should consider interventions to support unaccompanied adults with hearing loss during health care interactions.
{"title":"Modification of the Association Between Hearing Trouble and Satisfaction With Care by Accompaniment to Health Care Visits","authors":"Nicholas S. Reed, Sarah Y. Bessen, Pablo Martinez-Amezcua, Jennifer A. Deal, Danielle Powell, Julie Hoover Fong, Edgar R. Miller III, Frank R. Lin, Megan A. Morris, Esther S. Oh","doi":"10.1111/jgs.70176","DOIUrl":"10.1111/jgs.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hearing loss affects nearly two-thirds of adults over the age of 70 years, and is associated with lower satisfaction with health care, which may be mediated by patient-provider communication barriers. Accompaniment, the presence and support of a companion during health care interactions, may modify the association between hearing and satisfaction with care by providing an intermediary to assist with communication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional study of 9698 Medicare beneficiaries from the 2016 Medicare Current Beneficiaries Survey. We used regression models to estimate the association between self-reported trouble hearing and satisfaction with care, which was measured through reported satisfaction with overall quality of care, satisfaction with information provided, and satisfaction with provider's concern. Interaction terms and stratification by being accompanied to healthcare visits were used to assess if accompaniment modified the association between hearing loss and satisfaction with care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nearly 45% of Medicare beneficiaries reported at least a little trouble hearing. Adults with a little trouble hearing (Odds Ratio [OR] = 1.168; 95% Confidence Interval [CI] = 1.047–1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043–1.603) had higher odds of being dissatisfied with the quality of their health care over the previous year compared to those with no trouble hearing. Among accompanied participants, no association was found between level of hearing trouble and dissatisfaction with care. Among unaccompanied adults, trouble with hearing was associated with higher odds of dissatisfaction. The associations were consistent across the three dissatisfaction outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Medicare beneficiaries with hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Stratified models suggest that accompaniment may modify the association between hearing and dissatisfaction with care. Future research should consider interventions to support unaccompanied adults with hearing loss during health care interactions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"85-95"},"PeriodicalIF":4.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380549","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}
Austin Murphy, Zihao Liu, Heidi G. De Souza, Erica Leigh Chilson, Robyn Moucka, Pete Kardel, Caitlin Sheetz, Reiko Sato
Cover caption: Cumulative RSV Vaccination Uptake Rate by State. See the related article by Murphy et al., pages 3196–3202.
封面标题：各州累计RSV疫苗接种率。参见墨菲等人的相关文章，第3196-3202页。
{"title":"Cover","authors":"Austin Murphy, Zihao Liu, Heidi G. De Souza, Erica Leigh Chilson, Robyn Moucka, Pete Kardel, Caitlin Sheetz, Reiko Sato","doi":"10.1111/jgs.70162","DOIUrl":"https://doi.org/10.1111/jgs.70162","url":null,"abstract":"<p><b>Cover caption</b>: Cumulative RSV Vaccination Uptake Rate by State. See the related article by Murphy et al., pages 3196–3202.\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":"73 10","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369990","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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