Andrea Wershof Schwartz MD, MPH, AGSF, Shannon Munro PhD, APRN, BC, NP, Katharina V. Echt PhD, Anna Mirk MD, Laurence M. Solberg MD, AGSF, Kimberly Wozneak MS
Background
The Age-Friendly Health System (AFHS) initiative seeks to improve care for older adults through assessing and acting on the 4Ms (What Matters, Medication, Mentation, Mobility). The Department of Veterans Affairs (VA) joined the initiative in 2020, and from 2022 to 2023, VA led its first Age-Friendly Action Community, a 7-month online educational series to teach clinicians about implementing the 4Ms across VA care settings.
Methods
The VA Action Community was designed to spread awareness about Age-Friendly care for older Veterans, improve interprofessional team knowledge for providing care guided by the 4Ms, and support AFHS implementation across multiple care settings. The VA Action Community included online synchronous webinars, Community of Practice coaching calls, and office hours. A learner experience questionnaire was administered at the completion of the Action Community.
Results
Totally 186 care teams enrolled in the VA Action Community, representing 78/171 (45.6%) VA medical centers (VAMCs), across 36 US states and 20 types of care settings. Participants reported high rates of satisfaction and confidence in their ability to apply the knowledge and skills learned. Overall, 58 Action Community teams earned Level 1, Participant recognition, and 43 teams also earned Level 2, Committed to Care Excellence recognition from the Institute for Healthcare Improvement.
Conclusions
The VA Action Community facilitated learning about the 4Ms, supported interprofessional teams in earning AFHS recognition, and offers a promising model for spreading AFHS in other large health systems. Further work is underway to evaluate the impact of this educational experience on clinical process and outcomes measures.
{"title":"Scaling and spreading age-friendly care: Early lessons from the VA National Age-Friendly Action Community","authors":"Andrea Wershof Schwartz MD, MPH, AGSF, Shannon Munro PhD, APRN, BC, NP, Katharina V. Echt PhD, Anna Mirk MD, Laurence M. Solberg MD, AGSF, Kimberly Wozneak MS","doi":"10.1111/jgs.19321","DOIUrl":"10.1111/jgs.19321","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Age-Friendly Health System (AFHS) initiative seeks to improve care for older adults through assessing and acting on the 4Ms (What Matters, Medication, Mentation, Mobility). The Department of Veterans Affairs (VA) joined the initiative in 2020, and from 2022 to 2023, VA led its first Age-Friendly Action Community, a 7-month online educational series to teach clinicians about implementing the 4Ms across VA care settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The VA Action Community was designed to spread awareness about Age-Friendly care for older Veterans, improve interprofessional team knowledge for providing care guided by the 4Ms, and support AFHS implementation across multiple care settings. The VA Action Community included online synchronous webinars, Community of Practice coaching calls, and office hours. A learner experience questionnaire was administered at the completion of the Action Community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Totally 186 care teams enrolled in the VA Action Community, representing 78/171 (45.6%) VA medical centers (VAMCs), across 36 US states and 20 types of care settings. Participants reported high rates of satisfaction and confidence in their ability to apply the knowledge and skills learned. Overall, 58 Action Community teams earned Level 1, Participant recognition, and 43 teams also earned Level 2, Committed to Care Excellence recognition from the Institute for Healthcare Improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The VA Action Community facilitated learning about the 4Ms, supported interprofessional teams in earning AFHS recognition, and offers a promising model for spreading AFHS in other large health systems. Further work is underway to evaluate the impact of this educational experience on clinical process and outcomes measures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"583-591"},"PeriodicalIF":4.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960661","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>The past three decades of aging research has rapidly grown with significant federal funding from the National Institutes of Health/National Institutes on Aging, which has been matched by exponential growth in identifying and measuring various risk factors for mild cognitive impairment (MCI) and dementia [<span>1</span>]. While preclinical AD and MCI have received significant interest in screening and early assessment, limited studies have examined the role of social and environmental factors in risk prediction across diverse samples. Structural and social determinants of health (S/SDOH) are social, economic, and political conditions exerting synergistic direct/indirect effects on health outcomes [<span>2</span>]. Micro-to-macro-level factors like greenspace, air pollution, poverty, mobility, crime, and interpersonal biases interact within S/SDOH across the life course to create and intensify disparities for specific groups [<span>3</span>].</p><p>This timely and compelling study [<span>4</span>] by Dr. Mary Ganguli and colleagues leveraged two well-characterized, diverse, population-based cohorts (Monongahela-Youghiogheny Healthy Aging Team [MYHAT], Seniors Project 15104 [SP15104]) to examine the intersections of social and environment-level factors on the risk of MCI among older adults. The study's cross-sectional analysis of over 2800 older adults reveals striking associations between MCI and several community-level factors, including neighborhood disadvantage, schooling, air pollution, limited greenspace, and elevated local violent crime/homicide rates. The results emphasize how systemic inequities and chronic environmental exposures accumulate and compound to increase vulnerabilities in cognitive functioning among participants recruited from under-resourced, post-industrial towns in Pennsylvania. Key findings show that area deprivation and air pollution disproportionately affected participants racialized as Black, demonstrating the interplay of race as a social construct, geographic location, and environmental exposure. These findings resonate with the broader public health literature, which consistently identifies the compounding effects of systemic racism and poverty on health outcomes and dementia risk [<span>5</span>]. The study also highlights the consideration of early-life education, specifically schooling in the southern United States, which was linked to elevated odds of MCI, centralizing the role of historical inequities in education quality and their long-term health implications.</p><p>The study's emphasis on S/SDOH challenges the paradigm that cognitive health can be preserved solely through individual-level interventions, such as lifestyle modifications or obtaining regular clinical care. While encouraging older adults to adopt brain-healthy behaviors remains crucial, these findings emphasize addressing distal upstream factors, such as urban planning, environmental regulations, and community safety. For example, the associati
{"title":"Neighborhoods, Networks, and Neurodegeneration: A Call for Population-Level Policy and Advancing the Exposome","authors":"Ganesh M. Babulal","doi":"10.1111/jgs.19333","DOIUrl":"10.1111/jgs.19333","url":null,"abstract":"<p>The past three decades of aging research has rapidly grown with significant federal funding from the National Institutes of Health/National Institutes on Aging, which has been matched by exponential growth in identifying and measuring various risk factors for mild cognitive impairment (MCI) and dementia [<span>1</span>]. While preclinical AD and MCI have received significant interest in screening and early assessment, limited studies have examined the role of social and environmental factors in risk prediction across diverse samples. Structural and social determinants of health (S/SDOH) are social, economic, and political conditions exerting synergistic direct/indirect effects on health outcomes [<span>2</span>]. Micro-to-macro-level factors like greenspace, air pollution, poverty, mobility, crime, and interpersonal biases interact within S/SDOH across the life course to create and intensify disparities for specific groups [<span>3</span>].</p><p>This timely and compelling study [<span>4</span>] by Dr. Mary Ganguli and colleagues leveraged two well-characterized, diverse, population-based cohorts (Monongahela-Youghiogheny Healthy Aging Team [MYHAT], Seniors Project 15104 [SP15104]) to examine the intersections of social and environment-level factors on the risk of MCI among older adults. The study's cross-sectional analysis of over 2800 older adults reveals striking associations between MCI and several community-level factors, including neighborhood disadvantage, schooling, air pollution, limited greenspace, and elevated local violent crime/homicide rates. The results emphasize how systemic inequities and chronic environmental exposures accumulate and compound to increase vulnerabilities in cognitive functioning among participants recruited from under-resourced, post-industrial towns in Pennsylvania. Key findings show that area deprivation and air pollution disproportionately affected participants racialized as Black, demonstrating the interplay of race as a social construct, geographic location, and environmental exposure. These findings resonate with the broader public health literature, which consistently identifies the compounding effects of systemic racism and poverty on health outcomes and dementia risk [<span>5</span>]. The study also highlights the consideration of early-life education, specifically schooling in the southern United States, which was linked to elevated odds of MCI, centralizing the role of historical inequities in education quality and their long-term health implications.</p><p>The study's emphasis on S/SDOH challenges the paradigm that cognitive health can be preserved solely through individual-level interventions, such as lifestyle modifications or obtaining regular clinical care. While encouraging older adults to adopt brain-healthy behaviors remains crucial, these findings emphasize addressing distal upstream factors, such as urban planning, environmental regulations, and community safety. For example, the associati","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"340-342"},"PeriodicalIF":4.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934192","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}
Ahmed I. Soliman, Jean Wactawski-Wende, Amy E. Millen, Shelly L. Gray, Charles B. Eaton, Kathleen M. Hovey, Chris A. Andrews, Aladdin H. Shadyab, Bernhard Haring, Nazmus Saquib, Karen C. Johnson, Matthew Allison, JoAnn E. Manson, Michael J. LaMonte
Background
Epidemiological studies have been inconsistent regarding an association between proton pump inhibitor (PPI) use and risk of primary cardiovascular disease (CVD) events.
Methods
We studied 85,189 postmenopausal women (mean age 63 years at baseline) without known CVD at enrollment into the Women's Health Initiative Observational Study (1993–1998). PPI use was determined from medication inventories at baseline and Year-3. CVD events were physician adjudicated and defined as a composite of coronary heart disease, stroke, and CVD mortality. Follow up was from baseline to September 2010. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident CVD according to baseline PPI use (no/yes), use duration (non-user, < 1 year, 1–3 years, > 3 years), and time-varying based on updated Year-3 information. Propensity score adjustment was used to control for residual confounding.
Results
At baseline, 1747 (2.1%) women reported using PPIs. During a mean follow-up of 11 years, 5778 (6.8%) cases of primary CVD were identified. PPI users had significantly higher risk of CVD compared with non-users in the fully adjusted model (HR: 1.21, 95% CI: 1.02–1.43), and after propensity score adjustment (HR: 1.27, 95% CI: 1.21–1.32). Longer PPI use duration was associated with incrementally higher CVD risk (HRs: < 1 year: 1.11, 1–3 years: 1.27, > 3 years: 1.33; p for trend = 0.02).
Conclusions
PPI use was associated with higher risk of incident primary CVD in older postmenopausal women. These findings underscore the importance of guideline-directed PPI use to avoid unwanted adverse events.
{"title":"Proton Pump Inhibitor Use and Incident Cardiovascular Disease in Older Postmenopausal Women","authors":"Ahmed I. Soliman, Jean Wactawski-Wende, Amy E. Millen, Shelly L. Gray, Charles B. Eaton, Kathleen M. Hovey, Chris A. Andrews, Aladdin H. Shadyab, Bernhard Haring, Nazmus Saquib, Karen C. Johnson, Matthew Allison, JoAnn E. Manson, Michael J. LaMonte","doi":"10.1111/jgs.19326","DOIUrl":"10.1111/jgs.19326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Epidemiological studies have been inconsistent regarding an association between proton pump inhibitor (PPI) use and risk of primary cardiovascular disease (CVD) events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 85,189 postmenopausal women (mean age 63 years at baseline) without known CVD at enrollment into the Women's Health Initiative Observational Study (1993–1998). PPI use was determined from medication inventories at baseline and Year-3. CVD events were physician adjudicated and defined as a composite of coronary heart disease, stroke, and CVD mortality. Follow up was from baseline to September 2010. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident CVD according to baseline PPI use (no/yes), use duration (non-user, < 1 year, 1–3 years, > 3 years), and time-varying based on updated Year-3 information. Propensity score adjustment was used to control for residual confounding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, 1747 (2.1%) women reported using PPIs. During a mean follow-up of 11 years, 5778 (6.8%) cases of primary CVD were identified. PPI users had significantly higher risk of CVD compared with non-users in the fully adjusted model (HR: 1.21, 95% CI: 1.02–1.43), and after propensity score adjustment (HR: 1.27, 95% CI: 1.21–1.32). Longer PPI use duration was associated with incrementally higher CVD risk (HRs: < 1 year: 1.11, 1–3 years: 1.27, > 3 years: 1.33; <i>p</i> for trend = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PPI use was associated with higher risk of incident primary CVD in older postmenopausal women. These findings underscore the importance of guideline-directed PPI use to avoid unwanted adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"411-421"},"PeriodicalIF":4.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911405","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}
Steven M. Albert, Xiaotong Li, Sandra L. Gill-Kane, Jacob Lombardi, Krishi Akenapalli, Richard D. Boyce
<div> <section> <h3> Importance</h3> <p>The incidence of potentially inappropriate medication (PIM) prescribing among older adults is not as well studied as its prevalence. Estimates of factors associated with PIM incidence, such as patient age, sex, race-ethnicity, medication subsidy support, and comorbidity, are also limited.</p> </section> <section> <h3> Objective</h3> <p>To estimate the incidence of PIM prescribing in older adult outpatients, as well as the incidence and predictors for each PIM class, in a large outpatient electronic health records (EHR) cohort.</p> </section> <section> <h3> Design</h3> <p>Retrospective study of PIM prescribing among outpatients with encounters leading to prescription orders, 2015–2018, excluding prevalent cases.</p> </section> <section> <h3> Setting</h3> <p>Outpatients receiving care from a multi-site health system in western Pennsylvania.</p> </section> <section> <h3> Participants</h3> <p>342,405 patients, contributing 893,754 person-years of follow-up.</p> </section> <section> <h3> Main Outcomes and Measures</h3> <p>The incidence of PIM prescribing based on automated coding of 2019 Beers criteria. A multivariable Poisson regression model was estimated to assess the impact of age, sex, race-ethnicity, comorbidity, and medication subsidy (PACE/PACENET) on PIM risk. For each PIM class, the association between predictors and time to PIM prescribing was evaluated using proportional hazard models.</p> </section> <section> <h3> Results</h3> <p>The incidence rate (IR) for 1 or more PIM was 193.5 per 1000 person-years, led by short- and intermediate-acting benzodiazepines (37.6), first-generation antihistamines (32.8), and skeletal muscle relaxants (22.0). The incidence of PIM prescribing was 15% higher among white patients and 35% lower among males. High comorbidity (Charlson score ≥ 3) was associated with a 59% higher risk. Participation in the PACE/PACENET program, a medication subsidy program, was associated with an 83% increase in incidence. Each additional year of age was associated with a 1.2% reduction in incidence.</p> </section> <section> <h3> Conclusions and Relevance</h3> <p>This study establishes benchma
{"title":"Incidence of Potentially Inappropriate Prescribing: Longitudinal Investigation of Outpatient EHR Prescriptions","authors":"Steven M. Albert, Xiaotong Li, Sandra L. Gill-Kane, Jacob Lombardi, Krishi Akenapalli, Richard D. Boyce","doi":"10.1111/jgs.19340","DOIUrl":"10.1111/jgs.19340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Importance</h3>\u0000 \u0000 <p>The incidence of potentially inappropriate medication (PIM) prescribing among older adults is not as well studied as its prevalence. Estimates of factors associated with PIM incidence, such as patient age, sex, race-ethnicity, medication subsidy support, and comorbidity, are also limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To estimate the incidence of PIM prescribing in older adult outpatients, as well as the incidence and predictors for each PIM class, in a large outpatient electronic health records (EHR) cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective study of PIM prescribing among outpatients with encounters leading to prescription orders, 2015–2018, excluding prevalent cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Outpatients receiving care from a multi-site health system in western Pennsylvania.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>342,405 patients, contributing 893,754 person-years of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes and Measures</h3>\u0000 \u0000 <p>The incidence of PIM prescribing based on automated coding of 2019 Beers criteria. A multivariable Poisson regression model was estimated to assess the impact of age, sex, race-ethnicity, comorbidity, and medication subsidy (PACE/PACENET) on PIM risk. For each PIM class, the association between predictors and time to PIM prescribing was evaluated using proportional hazard models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence rate (IR) for 1 or more PIM was 193.5 per 1000 person-years, led by short- and intermediate-acting benzodiazepines (37.6), first-generation antihistamines (32.8), and skeletal muscle relaxants (22.0). The incidence of PIM prescribing was 15% higher among white patients and 35% lower among males. High comorbidity (Charlson score ≥ 3) was associated with a 59% higher risk. Participation in the PACE/PACENET program, a medication subsidy program, was associated with an 83% increase in incidence. Each additional year of age was associated with a 1.2% reduction in incidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions and Relevance</h3>\u0000 \u0000 <p>This study establishes benchma","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"728-736"},"PeriodicalIF":4.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911399","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":"Clementines and Kinder Surprises","authors":"Antonio Yaghy","doi":"10.1111/jgs.19359","DOIUrl":"10.1111/jgs.19359","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"956-957"},"PeriodicalIF":4.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911382","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":"Bridging the Gap: Virtual Interprofessional Education on the Hospital-to-Skilled Nursing Facility Transition","authors":"Collin Burks, Geraldine Kanne, Cindy Leslie A. Roberson, Rachel Hughes, Colette Allen, Aubrey Jolly Graham, Camila Reyes, Heidi White, Mamata Yanamadala","doi":"10.1111/jgs.19357","DOIUrl":"10.1111/jgs.19357","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"669-671"},"PeriodicalIF":4.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911379","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}
Paula A. Rochon MD, MPH, Joyce Li MSc, Denis O'Mahony MD, DSc, Graziano Onder MD, Mirko Petrovic MD, PhD, Shelley A. Sternberg MD, Jerry H. Gurwitz MD, Rachel D. Savage PhD, Wei Wu MSc, Vasily Giannakeas PhD, Altea Kthupi MPH, Kieran Dalton PhD, Lisa M. McCarthy PharmD, MSc, Robin Mason PhD, Amanda Giancola MSc, Parya Borhani MPH, Antonio Cherubini MD, PhD
<div> <section> <h3> Background</h3> <p>Few studies describe how gender-related factors may contribute to polypharmacy and prescribing cascades. Describing these patterns using cross-national comparisons can improve the robustness of findings and provide lessons on the importance of considering age, sex, and gender in pharmacological research. The aim of the study was to explore the intersection of age, sex, and gender with polypharmacy and co-prescribing suggesting a potential prescribing cascade.</p> </section> <section> <h3> Methods</h3> <p>In this cross-sectional descriptive study, we assessed polypharmacy and calcium channel blocker and diuretic co-prescribing suggesting a prescribing cascade in patients aged ≥65 years from five international secondary databases: population-level community and nursing home (ICES, Maccabi Healthcare Services), clinical trial (SENATOR), and patient registry (Report-AGE, SHELTER). The intersection of age, sex, and gender was explored.</p> </section> <section> <h3> Results</h3> <p>All databases provided age and sex; none included gender-identity data. Gender-related sociocultural factors, socioeconomic status (SES) measured as income and educational attainment, and marital status were not uniformly collected. Compared with males, females had lower income, has less educational attainment, and were more frequently widowed. Polypharmacy was more common in men. Co-prescribing suggesting a prescribing cascade was more frequent in females in four databases and was also more frequent in lower SES and unmarried groups (significant in ICES (community and nursing home) and Maccabi (community), with a nonsignificant trend in Maccabi (nursing home) and three remaining databases). Using two population-level databases, the prevalence of co-prescribing suggesting a prescribing cascade was highest among females 85 years and older who were also in the lower SES group (11.0% ICES and 14.6% Maccabi). Gender disparity was highest in this group (ICES Differential Prevalence = 3.0%, Maccabi Differential Prevalence = 3.8%).</p> </section> <section> <h3> Conclusion</h3> <p>Older adults with lower SES experienced polypharmacy or co-prescribing suggesting a prescribing cascade more frequently than those with higher SES. Within the lower SES groups, females more frequently than males had evidence of co-prescribing suggesting a prescribing cascade. Considering the role of sex and gender-related sociocultural factors may help to better understand some contributors to polypharmacy and prescribing cascades. The research applications are highlig
{"title":"The impact of age, sex, and gender on polypharmacy and potential prescribing cascades: Lessons from five databases","authors":"Paula A. Rochon MD, MPH, Joyce Li MSc, Denis O'Mahony MD, DSc, Graziano Onder MD, Mirko Petrovic MD, PhD, Shelley A. Sternberg MD, Jerry H. Gurwitz MD, Rachel D. Savage PhD, Wei Wu MSc, Vasily Giannakeas PhD, Altea Kthupi MPH, Kieran Dalton PhD, Lisa M. McCarthy PharmD, MSc, Robin Mason PhD, Amanda Giancola MSc, Parya Borhani MPH, Antonio Cherubini MD, PhD","doi":"10.1111/jgs.19282","DOIUrl":"10.1111/jgs.19282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Few studies describe how gender-related factors may contribute to polypharmacy and prescribing cascades. Describing these patterns using cross-national comparisons can improve the robustness of findings and provide lessons on the importance of considering age, sex, and gender in pharmacological research. The aim of the study was to explore the intersection of age, sex, and gender with polypharmacy and co-prescribing suggesting a potential prescribing cascade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional descriptive study, we assessed polypharmacy and calcium channel blocker and diuretic co-prescribing suggesting a prescribing cascade in patients aged ≥65 years from five international secondary databases: population-level community and nursing home (ICES, Maccabi Healthcare Services), clinical trial (SENATOR), and patient registry (Report-AGE, SHELTER). The intersection of age, sex, and gender was explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All databases provided age and sex; none included gender-identity data. Gender-related sociocultural factors, socioeconomic status (SES) measured as income and educational attainment, and marital status were not uniformly collected. Compared with males, females had lower income, has less educational attainment, and were more frequently widowed. Polypharmacy was more common in men. Co-prescribing suggesting a prescribing cascade was more frequent in females in four databases and was also more frequent in lower SES and unmarried groups (significant in ICES (community and nursing home) and Maccabi (community), with a nonsignificant trend in Maccabi (nursing home) and three remaining databases). Using two population-level databases, the prevalence of co-prescribing suggesting a prescribing cascade was highest among females 85 years and older who were also in the lower SES group (11.0% ICES and 14.6% Maccabi). Gender disparity was highest in this group (ICES Differential Prevalence = 3.0%, Maccabi Differential Prevalence = 3.8%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Older adults with lower SES experienced polypharmacy or co-prescribing suggesting a prescribing cascade more frequently than those with higher SES. Within the lower SES groups, females more frequently than males had evidence of co-prescribing suggesting a prescribing cascade. Considering the role of sex and gender-related sociocultural factors may help to better understand some contributors to polypharmacy and prescribing cascades. The research applications are highlig","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"520-532"},"PeriodicalIF":4.3,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857275","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}
Xiao-yi Hu MD, Hua-wei Duan MD, Lei-yuan Wang MD, Quan-fang Liu MD, Hao Yao MD, Da-qing Ma PhD, Dong-xin Wang PhD, Jian-jun Yang PhD, Mu-huo Ji PhD
Background
Poor oral health, prevalent among the older adults, can undermine overall health and contribute to frailty. Older adults experiencing oral frailty and dysbiosis potentially face an elevated risk of postoperative delirium. This study aims to explore the influence of oral frailty and changes in oral microbiota composition on occurrence of postoperative delirium in older adult patients undergoing non-cardiac surgery.
Methods
A total of 303 older adult patients undergoing non-cardiac surgeries were recruited in the Second Affiliated Hospital of Nanjing Medical University from July 2023 to December 2023. Oral swabs for oral microbiota analyses were collected before surgery. Subsequently, after propensity score matching, 21 samples from patients with postoperative delirium and 21 samples from patients without postoperative delirium were analyzed for oral microbiota. Our primary objective was to determine the association between oral frailty, changes in oral microbiota composition, and the occurrence of postoperative delirium.
Results
Oral frailty emerged as an independent risk factor for postoperative delirium [HR = 1.75; 95% CI = (1.04–2.96); p = 0.035]. Additionally, patients with postoperative delirium demonstrated lower oral microbiota diversity, as indicated by a reduced Chao index compared with those without postoperative delirium (p = 0.034). A significant association was also found between the dysbiosis index and postoperative delirium (p < 0.001). ROC analysis revealed a pronounced area under the curve of 0.95 (95% CI: 0.88–1.00) for the dysbiosis index in predicting postoperative delirium. Subsequent Principal Coordinates and Kaplan–Meier analyses affirmed that both beta diversity and the dysbiosis index were significantly correlated with incidence of postoperative delirium, with p-values of 0.002 and <0.001, respectively. Furthermore, the interaction analysis through Cox proportional hazards regression suggested a combined effect of oral frailty and the dysbiosis index on the likelihood of developing postoperative delirium (p = 0.004).
Conclusions
Oral frailty and changes in oral microbiota among older adult patients undergoing non-cardiac surgery may influence the incidence of postoperative delirium.
背景：口腔健康状况不佳，在老年人中普遍存在，会损害整体健康并导致身体虚弱。经历口腔脆弱和生态失调的老年人可能面临术后谵妄的高风险。本研究旨在探讨口腔脆弱及口腔菌群组成变化对老年非心脏手术患者术后谵妄发生的影响。方法：选取南京医科大学第二附属医院于2023年7月至2023年12月行非心脏手术的老年患者303例。术前采集口腔拭子进行口腔菌群分析。随后，经过倾向评分匹配，对21例术后谵妄患者和21例术后非谵妄患者的口腔微生物群进行分析。我们的主要目的是确定口腔脆弱、口腔微生物群组成变化和术后谵妄发生之间的关系。结果：口腔虚弱成为术后谵妄的独立危险因素[HR = 1.75；95% ci = (1.04-2.96)；p = 0.035]。此外，术后谵妄患者口腔微生物群多样性较低，Chao指数较无术后谵妄患者降低（p = 0.034）。结论：接受非心脏手术的老年患者口腔脆弱和口腔微生物群的变化可能影响术后谵妄的发生率。
{"title":"Associations between oral frailty, oral microbiota composition, and postoperative delirium in older adult patients","authors":"Xiao-yi Hu MD, Hua-wei Duan MD, Lei-yuan Wang MD, Quan-fang Liu MD, Hao Yao MD, Da-qing Ma PhD, Dong-xin Wang PhD, Jian-jun Yang PhD, Mu-huo Ji PhD","doi":"10.1111/jgs.19315","DOIUrl":"10.1111/jgs.19315","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Poor oral health, prevalent among the older adults, can undermine overall health and contribute to frailty. Older adults experiencing oral frailty and dysbiosis potentially face an elevated risk of postoperative delirium. This study aims to explore the influence of oral frailty and changes in oral microbiota composition on occurrence of postoperative delirium in older adult patients undergoing non-cardiac surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 303 older adult patients undergoing non-cardiac surgeries were recruited in the Second Affiliated Hospital of Nanjing Medical University from July 2023 to December 2023. Oral swabs for oral microbiota analyses were collected before surgery. Subsequently, after propensity score matching, 21 samples from patients with postoperative delirium and 21 samples from patients without postoperative delirium were analyzed for oral microbiota. Our primary objective was to determine the association between oral frailty, changes in oral microbiota composition, and the occurrence of postoperative delirium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Oral frailty emerged as an independent risk factor for postoperative delirium [HR = 1.75; 95% CI = (1.04–2.96); <i>p</i> = 0.035]. Additionally, patients with postoperative delirium demonstrated lower oral microbiota diversity, as indicated by a reduced Chao index compared with those without postoperative delirium (<i>p</i> = 0.034). A significant association was also found between the dysbiosis index and postoperative delirium (<i>p <</i> 0.001). ROC analysis revealed a pronounced area under the curve of 0.95 (95% CI: 0.88–1.00) for the dysbiosis index in predicting postoperative delirium. Subsequent Principal Coordinates and Kaplan–Meier analyses affirmed that both beta diversity and the dysbiosis index were significantly correlated with incidence of postoperative delirium, with <i>p</i>-values of 0.002 and <0.001, respectively. Furthermore, the interaction analysis through Cox proportional hazards regression suggested a combined effect of oral frailty and the dysbiosis index on the likelihood of developing postoperative delirium (<i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Oral frailty and changes in oral microbiota among older adult patients undergoing non-cardiac surgery may influence the incidence of postoperative delirium.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"812-823"},"PeriodicalIF":4.3,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857440","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}
Giorgi Beridze MD, MMSc, Lu Dai MD, PhD, Juan-Jesús Carrero MPharm, PhD, Alessandra Marengoni MD, PhD, Davide L. Vetrano MD, PhD, Amaia Calderón-Larrañaga MPharm, MPH, PhD
Background
Individual chronic conditions have been linked to kidney function decline; however, the role of multimorbidity (the presence of ≥2 conditions) and multimorbidity patterns remains unclear.
Methods
A total of 3094 individuals from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed for 15 years. Multimorbidity was operationalized as the number of chronic conditions and multimorbidity patterns identified using latent class analysis (LCA). Joint models and Cox regression models were used to explore the associations between multimorbidity, and subsequent absolute and relative (≥25% decline from baseline) changes, respectively, in the estimated glomerular filtration rate (eGFR) calculated using the creatinine-based Berlin Initiative Study equation.
Results
Mean age of the sample was 73.9, and 87% had multimorbidity. There was an independent dose–response relationship between the number of chronic conditions, and absolute (β [95% confidence interval, CI] = −0.05 [−0.07; −0.03]) and relative (hazard ratio, HR [95% CI] = 1.23 [1.17; 1.29]) declines in eGFR. Five patterns of multimorbidity were identified. The Unspecific, low burden pattern had the lowest morbidity burden and was used as the reference category. The Unspecific, high burden, and Cardiometabolic patterns showed accelerated absolute (β [95% CI] = −0.15 [−0.26; −0.05] and −0.77 [−0.98; −0.55], respectively) and relative (HR [95% CI] = 1.45 [1.09; 1.92] and 3.45 [2.27; 5.23], respectively) declines. Additionally, the Cognitive and Sensory pattern showed accelerated relative decline (HR [95% CI] = 1.53 [1.02; 2.31]). No associations were found for the Psychiatric and Respiratory pattern.
Conclusion
Multimorbidity is strongly associated with accelerated kidney function decline in older age. Individuals with cardiometabolic multimorbidity exhibit a particularly increased risk. Increased monitoring and timely interventions may preserve kidney function and reduce cardiovascular risks in individuals presenting with conditions that are characteristic of high-risk multimorbidity patterns.
{"title":"Associations between multimorbidity and kidney function decline in old age: A population-based cohort study","authors":"Giorgi Beridze MD, MMSc, Lu Dai MD, PhD, Juan-Jesús Carrero MPharm, PhD, Alessandra Marengoni MD, PhD, Davide L. Vetrano MD, PhD, Amaia Calderón-Larrañaga MPharm, MPH, PhD","doi":"10.1111/jgs.19298","DOIUrl":"10.1111/jgs.19298","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individual chronic conditions have been linked to kidney function decline; however, the role of multimorbidity (the presence of ≥2 conditions) and multimorbidity patterns remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 3094 individuals from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed for 15 years. Multimorbidity was operationalized as the number of chronic conditions and multimorbidity patterns identified using latent class analysis (LCA). Joint models and Cox regression models were used to explore the associations between multimorbidity, and subsequent absolute and relative (≥25% decline from baseline) changes, respectively, in the estimated glomerular filtration rate (eGFR) calculated using the creatinine-based Berlin Initiative Study equation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean age of the sample was 73.9, and 87% had multimorbidity. There was an independent dose–response relationship between the number of chronic conditions, and absolute (β [95% confidence interval, CI] = −0.05 [−0.07; −0.03]) and relative (hazard ratio, HR [95% CI] = 1.23 [1.17; 1.29]) declines in eGFR. Five patterns of multimorbidity were identified. The <i>Unspecific, low burden</i> pattern had the lowest morbidity burden and was used as the reference category. The <i>Unspecific, high burden</i>, and <i>Cardiometabolic</i> patterns showed accelerated absolute (β [95% CI] = −0.15 [−0.26; −0.05] and −0.77 [−0.98; −0.55], respectively) and relative (HR [95% CI] = 1.45 [1.09; 1.92] and 3.45 [2.27; 5.23], respectively) declines. Additionally, the <i>Cognitive and Sensory</i> pattern showed accelerated relative decline (HR [95% CI] = 1.53 [1.02; 2.31]). No associations were found for the <i>Psychiatric and Respiratory</i> pattern.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Multimorbidity is strongly associated with accelerated kidney function decline in older age. Individuals with cardiometabolic multimorbidity exhibit a particularly increased risk. Increased monitoring and timely interventions may preserve kidney function and reduce cardiovascular risks in individuals presenting with conditions that are characteristic of high-risk multimorbidity patterns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"837-848"},"PeriodicalIF":4.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848726","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}
Rachel A. Prusynski DPT, PhD, Natalie E. Leland PhD, OTR/L, Andrew Humbert PhD, Arati Dahal PhD, Cait Brown MA, CCC-SLP, Harsha Amaravadi MPH, Debra Saliba MD, MPH, Tracy M. Mroz PhD, OTR/L
Background
Shortly after Medicare implemented post-acute care payment reforms, the COVID-19 pandemic began, but little is known about how these reforms and the pandemic impacted admissions to the most common post-acute settings—skilled nursing facilities (SNF) and home health agencies (HHAs)—for the full Medicare fee-for-service population.
Methods
Using 100% of Medicare fee-for-service data, we conducted adjusted interrupted time series analyses of 31,730,994 hospital stays of all adult beneficiaries discharged alive from the hospital between 2018 and 2021 to examine whether payment reforms and the pandemic were associated with differences in admissions to SNFs and HHAs compared to pre-reform and pre-COVID (baseline) trends.
Results
At baseline, an average 18.0% of hospitalized beneficiaries were admitted to SNFs and 14.8% to HHAs. While SNF payment reform in October 2019 was associated with an immediate reduction in SNF admissions, a positive temporal trend reversed this decrease in admissions. HHA payment reform implemented in January 2020 was associated with increased HHA admissions compared to baseline. Post-COVID, admissions to SNF declined to 15.5% of patients being discharged from hospitals and HHA admissions increased to 19.2%.
Conclusions
SNF and HHA payment reforms were associated with small increases in admissions to their respective settings, suggesting that Medicare reforms did not negatively impact access. However, the baseline trends of decreasing admissions to SNF and increasing HHA admissions were greatly accelerated by the COVID-19 pandemic. Results highlight changes in the demand for these settings, which must be recognized in policy efforts and research examining impacts on specific patient populations.
{"title":"Changes in skilled nursing and home health admissions associated with Medicare payment reforms and the COVID-19 pandemic","authors":"Rachel A. Prusynski DPT, PhD, Natalie E. Leland PhD, OTR/L, Andrew Humbert PhD, Arati Dahal PhD, Cait Brown MA, CCC-SLP, Harsha Amaravadi MPH, Debra Saliba MD, MPH, Tracy M. Mroz PhD, OTR/L","doi":"10.1111/jgs.19322","DOIUrl":"10.1111/jgs.19322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Shortly after Medicare implemented post-acute care payment reforms, the COVID-19 pandemic began, but little is known about how these reforms and the pandemic impacted admissions to the most common post-acute settings—skilled nursing facilities (SNF) and home health agencies (HHAs)—for the full Medicare fee-for-service population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using 100% of Medicare fee-for-service data, we conducted adjusted interrupted time series analyses of 31,730,994 hospital stays of all adult beneficiaries discharged alive from the hospital between 2018 and 2021 to examine whether payment reforms and the pandemic were associated with differences in admissions to SNFs and HHAs compared to pre-reform and pre-COVID (baseline) trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, an average 18.0% of hospitalized beneficiaries were admitted to SNFs and 14.8% to HHAs. While SNF payment reform in October 2019 was associated with an immediate reduction in SNF admissions, a positive temporal trend reversed this decrease in admissions. HHA payment reform implemented in January 2020 was associated with increased HHA admissions compared to baseline. Post-COVID, admissions to SNF declined to 15.5% of patients being discharged from hospitals and HHA admissions increased to 19.2%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SNF and HHA payment reforms were associated with small increases in admissions to their respective settings, suggesting that Medicare reforms did not negatively impact access. However, the baseline trends of decreasing admissions to SNF and increasing HHA admissions were greatly accelerated by the COVID-19 pandemic. Results highlight changes in the demand for these settings, which must be recognized in policy efforts and research examining impacts on specific patient populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"592-601"},"PeriodicalIF":4.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831548","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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