Journal of the American Geriatrics Society最新文献

{"title":"Exploring geriatric assessment-driven rehabilitation referral patterns and its influence on functional outcomes and survival in older adults with advanced cancer","authors":"Rachelle Brick PhD, MSPH, OTR/L,&nbsp;Marielle Jensen-Battaglia PT, DPT,&nbsp;Brennan P. Streck PhD, RN, MPH,&nbsp;Lindsey Page PhD, MPH,&nbsp;Rachael Tylock MS,&nbsp;Jenna Cacciatore MS,&nbsp;Karen Mustian PhD, MPH,&nbsp;Jamil Khatri MD,&nbsp;Jeff Giguere MD,&nbsp;Elie G. Dib MD, MS,&nbsp;Supriya Mohile MD, MS,&nbsp;Eva Culakova PhD, MS","doi":"10.1111/jgs.19250","DOIUrl":"10.1111/jgs.19250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older adults with advanced cancer experience functional disability that warrants rehabilitation services; however, evidence indicates inconsistencies in referral. The purpose was to (1) identify predictors of geriatric assessment (GA)-driven referrals to rehabilitation services and (2) explore associations between referral and change in function, health-related quality of life (HRQoL), and overall survival among older adults with advanced cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a secondary analysis (NCT020107443, UG1CA189961) of a nationwide GA clinical trial. Patients were older adults with advanced cancer who had at least one GA-defined physical performance or functional status impairment. Primary outcomes were oncologist-initiated discussion about or referral to rehabilitation services after the GA (Aim 1) and decline in activities of daily living (ADL), Instrumental ADL (IADL), and HRQoL within 3 months, and overall survival at 1 year (Exploratory Aims). Analyses included multivariable logistic regression and Cox proportional hazards models. Demographic and clinical factors were controlled for by using 1:1 propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total 265 patients were analyzed. After adjustment, impaired cognition (odds ratio [OR] = 2.25, <i>p</i> = 0.01), Karnofsky score indicating disability (OR = 2.86, <i>p</i> &lt; 0.01), and receipt of monoclonal antibodies (OR = 1.95, <i>p</i> = 0.04) were associated with higher odds of referral. In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, <i>p</i> &lt; 0.01). Referred patients were less likely to decline in ADL (OR 0.30, <i>p</i> = 0.07) and IADL (OR 0.64, <i>p</i> = 0.35), but more likely to decline in HRQoL (OR 1.20, <i>p</i> = 0.67) and have worse survival (HR 1.18, <i>p</i> = 0.62).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. Future studies should evaluate patients' utilization of rehabilitation services post-referral and determine whether dose/timing of rehabilitation services influence clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"136-149"},"PeriodicalIF":4.3,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565408","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":"Association of body indices with mortality in older population: Japan Specific Health Checkups (J-SHC) Study","authors":"Takaaki Kosugi MD, PhD,&nbsp;Masahiro Eriguchi MD, PhD,&nbsp;Hisako Yoshida PhD,&nbsp;Hiroyuki Tamaki MD,&nbsp;Takayuki Uemura MD, PhD,&nbsp;Hikari Tasaki MD, PhD,&nbsp;Riri Furuyama MD,&nbsp;Masatoshi Nishimoto MD, PhD,&nbsp;Masaru Matsui MD, PhD,&nbsp;Ken-ichi Samejima MD, PhD,&nbsp;Kunitoshi Iseki MD, PhD,&nbsp;Shouichi Fujimoto MD, PhD,&nbsp;Tsuneo Konta MD, PhD,&nbsp;Toshiki Moriyama MD, PhD,&nbsp;Kunihiro Yamagata MD, PhD,&nbsp;Ichiei Narita MD, PhD,&nbsp;Masato Kasahara MD, PhD,&nbsp;Yugo Shibagaki MD, PhD,&nbsp;Masahide Kondo MD, PhD,&nbsp;Koichi Asahi MD, PhD,&nbsp;Tsuyoshi Watanabe MD, PhD,&nbsp;Kazuhiko Tsuruya MD, PhD","doi":"10.1111/jgs.19244","DOIUrl":"10.1111/jgs.19244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Obesity indices reflect not only fat mass but also muscle mass and nutritional status in older people. Therefore, they may not accurately reflect prognosis. This study aimed to investigate associations between a body shape index (ABSI), body mass index (BMI), and mortality in the general older population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This nationwide observational longitudinal study included individuals aged between 65 and 74 years who underwent annual health checkups between 2008 and 2014. Exposures of interest were ABSI and BMI, and the primary outcome was all-cause mortality. Association between the ABSI and BMI quartile (Q1–4) and mortality was assessed using Cox regression analysis. A restricted cubic spline was also used to investigate nonlinear associations. The missing values were imputed using multiple imputation by chained equations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 315,215 participants, 5074 died during a median follow-up period of 42.5 (interquartile range: 26.2–59.3) months. Compared with ABSI Q1, ABSI Q3 and Q4 were associated with increased risk of mortality, with the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of 1.13 (1.05–1.22) and 1.23 (1.13–1.35), respectively. Compared with BMI Q3, BMI Q1 and Q2 were associated with an increased risk of mortality, with aHRs and 95% CIs of 1.51 (1.39–1.65) and 1.12 (1.03–1.22), respectively. The impacts of these indices were greater in male than in female. The heatmap of the aHR for mortality by continuous ABSI and BMI showed that higher ABSI was consistently associated with higher mortality risk regardless of BMI, and that the combination of low BMI and high ABSI was strongly associated with increased mortality risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>High ABSI and low BMI are additively associated with the risk of all-cause mortality in the general older population in Japan. Combination of ABSI and BMI is useful for evaluating mortality risk in older people.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"150-161"},"PeriodicalIF":4.3,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565406","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":"Correction to “Attitudes on Participation in Clinical Drug Trials: A Nationally Representative Survey of Older Adults With Multimorbidity”","authors":"","doi":"10.1111/jgs.19233","DOIUrl":"10.1111/jgs.19233","url":null,"abstract":"<p>Schwartz JB, Liu R, Boscardin J, et al. Attitudes on participation in clinical drug trials: A nationally representative survey of older adults with multimorbidity. <i>J Am Geriatr Soc</i>. 2024;72(6):1717–1727. doi: 10.1111/jgs.18857</p><p>The authors have discovered an error in Table 2. In the highlighted row below, total <i>n</i> (%) is incorrect and should be: 632 (47.9%).</p><p><span>Afraid of side effects  632 (47.9)</span>  346 (52.8)  286 (43.1)</p><p>We apologize for this error.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3950"},"PeriodicalIF":4.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19233","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549852","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":"Introduction for the 2024 Chinese Congress on Gerontology and Health Industry (CCGI) Abstracts","authors":"Sean X. Leng MD, PhD,&nbsp;Xiao-Ying Li MD","doi":"10.1111/jgs.19221","DOIUrl":"10.1111/jgs.19221","url":null,"abstract":"&lt;p&gt;It is once again with great pleasure that we introduce the research work to be presented at the 2024 Chinese Congress on Gerontology and Health Industry (CCGI), which is published in abstract form in this issue of the Journal of the American Geriatrics Society (JAGS). The 2024 CCGI conference is the continuation of the annual national geriatrics and gerontology conference co-organized and co-sponsored by a number of major Chinese professional healthcare organizations including the Chinese Medical Association (CMA) Geriatrics Branch and China Health Promotion Foundation. This year's CCGI conference will be held on November 1–3. 2024 in the city of Haikou, China's island province Hainan. We have 115 quality abstracts to be included in this issue.&lt;/p&gt;&lt;p&gt;While COVID-19 pandemic is largely behind us, its impact on world economy and scientific conferences continues to be palpable. The current economic downturn and overseas regional conflicts create additional challenges. Despite these difficulties, the 2024 CCGI conference will be held in person and the research work to be presented at the conference is as robust as that presented at previous years' CCGI conferences. Similar to the previous 11 years, the work to be presented at this year's CCGI conference encompasses many important areas of geriatrics and gerontology, from basic aging research to geriatric syndromes; from clinical observation and large epidemiological studies to clinical trials; and from biological investigations to social and behavioral research. Unique to this year, it emphasizes palliative care, cardiovascular aging and diseases, systems approach for senior health, as well as socioeconomic determinants of aging care. It also includes a broad range of studies of basic and translational aging research, such as investigation into chronic cytomegalovirus (CMV) infection as a potential contributing factor to immunosenescence and age-related chronic inflammation, longitudinal cohort studies, mechanistic studies in animal models, and other types of studies including clinical trials for the prevention and treatment of common geriatric syndromes and age-related diseases. Moreover, almost 20% of the abstracts are submitted by researchers from other countries and regions including the United States, European countries (Germany, UK), South Korea, Macao, etc., demonstrating a robust international representation. The work described here will be presented in the form of oral presentation or poster at the conference. The conference will have similar number of symposia with individual symposium on translational aging research, common geriatric syndromes, prevention, rehabilitation, nutrition, geriatric nursing, traditional Chinese medicine, community geriatrics care, and long-term care, and so on. Publication of such exemplary work in geriatrics and gerontology in this supplement issue of JAGS will further enhance scientific and scholarly exchanges between colleagues in China and geriatrics and g","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 S4","pages":"S3-S5"},"PeriodicalIF":4.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549854","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":"Abstracts for JGS Chinese Supplement","authors":"","doi":"10.1111/jgs.19222","DOIUrl":"10.1111/jgs.19222","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 S4","pages":"S6-S68"},"PeriodicalIF":4.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549855","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":"Vaccinations in older adults: Optimization, strategies, and latest guidelines","authors":"Aileen R. Pangilinan MD,&nbsp;Sharon A. Brangman MD,&nbsp;Stefan Gravenstein MD MPH,&nbsp;Kenneth Schmader MD,&nbsp;George A. Kuchel MD","doi":"10.1111/jgs.19243","DOIUrl":"10.1111/jgs.19243","url":null,"abstract":"<p>This article is a summary of the first AGS Symposium entitled “<i>Update on Vaccination Strategies for Older Adults</i>: <i>Matching the Approach to the Individual and the Care Setting</i>.” Given declines in host defenses and immune function with aging, vaccinations play a pivotal role in fortifying older adults against preventable infections, resulting diseases, disability, and death. Current guidelines generally list recommendations applicable for an average older adult of a given chronological age. However, growing evidence indicates that heterogeneity in terms of factors as varied as biological sex, frailty, functional status, and multimorbidity may impact vaccine responses and clinical outcomes. As a result, clinicians will increasingly need to take these additional factors into consideration as they seek to improve outcomes through improved targeting of such aging-related heterogeneity. Moreover, efforts at protecting older citizens through vaccination must also include strategies to overcome barriers to the adoption of vaccine recommendations in varied settings including long-term care. This 2023 AGS Plenary Symposium sought to commence a broader dialogue across AGS and beyond on optimizing vaccinations for older adults, ensuring not only extended lifespans but also healthier and more active lives. This report is not a systematic review, and thus should not be considered comprehensive.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"20-28"},"PeriodicalIF":4.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523998","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":"Differences in setting of initial dementia diagnosis among fee-for-service Medicare beneficiaries","authors":"Elizabeth M. White APRN, PhD,&nbsp;Thomas Bayer MD,&nbsp;Cyrus M. Kosar PhD,&nbsp;Christopher M. Santostefano RN, MPH,&nbsp;Ulrike Muench RN, PhD,&nbsp;Hyesung Oh MPH, MBA,&nbsp;Emily A. Gadbois PhD,&nbsp;Pedro L. Gozalo PhD,&nbsp;Momotazur Rahman PhD","doi":"10.1111/jgs.19236","DOIUrl":"10.1111/jgs.19236","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Accurate and timely diagnosis of dementia is necessary to allow affected individuals to make informed decisions and access appropriate resources. When dementia goes undetected until a hospitalization or nursing home stay, this could reflect delayed diagnosis or misdiagnosis, and may reflect underlying disparities in healthcare access.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, we used 2012–2020 Medicare claims and other administrative data to examine variation in setting of dementia diagnosis among fee-for-service Medicare beneficiaries with an initial claims-based dementia diagnosis in 2016. We used multinomial logistic regression to evaluate the association of person and geographic factors with diagnosis location, and Cox proportional hazards regression to examine 4-year survival relative to diagnosis location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 754,204 Medicare beneficiaries newly diagnosed with dementia in 2016, 60.3% were diagnosed in the community, 17.2% in hospitals, and 22.5% in nursing homes. Adjusted 4-year survival rates were significantly lower among those diagnosed in hospitals [−16.1 percentage points (95% CI: −17.0, −15.1)] and nursing homes [−16.8 percentage points (95% CI: −17.7, −15.9)], compared to those diagnosed in the community. Community-diagnosed beneficiaries were more often female, younger, Asian or Pacific Islander, Native American or Alaskan Native, Hispanic, had fewer baseline hospitalizations and higher homecare use, and resided in wealthier ZIP codes. Rural beneficiaries were more likely to be diagnosed in hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many older adults are diagnosed with dementia in a hospital or nursing home. These individuals have significantly lower survival than those diagnosed in the community, which may indicate diagnosis during an acute illness or care transition, or at a later disease stage, all of which are suboptimal. These results highlight the need for improved dementia screening in the general population, particularly for individuals in rural areas and communities with higher social deprivation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"39-49"},"PeriodicalIF":4.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484428","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":"Capacity assessment for euthanasia in dementia: A qualitative study of 60 Dutch cases","authors":"Arne van den Bosch BSc,&nbsp;Radboud M. Marijnissen MD, PhD,&nbsp;Denise J. C. Hanssen PhD,&nbsp;Richard C. Oude Voshaar MD, PhD","doi":"10.1111/jgs.19218","DOIUrl":"10.1111/jgs.19218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient–physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"112-122"},"PeriodicalIF":4.3,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484425","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":"Predictors of advance care planning in 11 high-income nations","authors":"Preshit N. Ambade DrPH,&nbsp;Zachary T. Hoffman MS,&nbsp;Kaamya Mehra BS/MD(c),&nbsp;Neil J. MacKinnon PhD","doi":"10.1111/jgs.19226","DOIUrl":"10.1111/jgs.19226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Elderly population is increasing in high-income countries. For instance, by 2050, 21.4% of the United States population is expected to be 65+, thus making advance care planning (ACP) increasingly important. We aim to identify predictors of ACP completion in 11 high-income countries and explore relationships between ACP and utilization factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Using the 2021 International Health Policy (IHP) survey data, we assessed the relationship between sociodemographic factors, healthcare utilization, and ACP. The primary outcome variable was a composite of three ACP activities. A generalized linear mixed model (GLMM) was used to identify predictors of ACP completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analyses included 18,677 older adults who answered at least one ACP question. Only 5126 (27.4%) reported completion of three ACP activities. Germany (64.7%) showed the highest completion rates, while Sweden (5.0%) and France (5.0%) showed the lowest completion rates. Predictors of ACP completion identified in the GLMM were: increasing age (incidence rate ratio [IRR] range between 1.2 and 1.5), completion of high school education or more (IRR: 1.1, 95% CI: 1.1–1.1), higher income (IRR: 1.1, 95% CI: 1.1–1.2), presence of two or more health conditions (IRR: 1.1, 95% CI: 1.0–1.1), hospital stay in the past 2 years (IRR: 1.1, 95% CI: 1.1–1.1), and access to quality primary care (IRR: 1.0, 95% CI: 1.0–1.1). Male gender (IRR: 0.9, 95% CI: 0.8–0.9) had a negative association with ACP activity completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Several patient-specific and health system utilization factors were identified as predictors of ACP activity completion, which clinicians and policymakers could use to enhance ACP completion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3855-3864"},"PeriodicalIF":4.3,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484436","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":"A public health/hospital partnership to improve Emergency Department transitions of care for vulnerable older adults","authors":"Lauren T. Southerland MD, MPH,&nbsp;Carolyn Dixon MSSA, mSAC, LSW,&nbsp;Shameka Turner,&nbsp;Kalih M. West BSW,&nbsp;Tameka Hairston RN,&nbsp;Tony Rosen MD, MPH,&nbsp;Caroline Rankin MPH","doi":"10.1111/jgs.19227","DOIUrl":"10.1111/jgs.19227","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Community-dwelling older adults are at high risk for unmet social service needs. We describe a novel partnership embedding county services case managers in the Emergency Department (ED) to connect older adults to community services alongside their medical care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p><i>Setting</i>: A medium-sized urban ED with 55,000 patient visits a year. <i>Intervention:</i> Case managers from the Franklin County, Ohio Office on Aging (OA) were embedded within the ED. The OA team worked with the ED social work team to identify community-dwelling older patients, perform an in-person intake assessment, and initiate needed community services (including home-delivered meals, emergency response systems, house repairs, and transportation). Program logic model and development are reported in detail.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From June to December 2023, there were 7284 ED visits for adults ≥60 years old. Referrals to the OA case manager ranged from 1 to 13 per day. The OA case managers performed 252 full intake assessments on unique patients. The population was 51% men. Only 11% (<i>n</i> = 28) were currently connected to OA services, and of those already connected 29% (<i>n</i> = 8) needed increased services. Of the remaining unconnected patients (<i>n</i> = 224), 8% (<i>n</i> = 20) were not county residents and the OA team connected them with other county OAs. Half 53% (<i>n</i> = 120) were accepting of services and had services from the OA or other community health programs initiated during the ED visit. The OA team made three new Adult Protective Services referrals and one referral to the long-term care ombudsman. The program did not increase ED length of stay or hospital admission rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Embedding county service enrollment within a community ED is a cost neutral intervention that reached a population without previous services. Future plans include expansion of the program and evaluation of the program's ability to detect elder mistreatment and self-neglect.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"243-252"},"PeriodicalIF":4.3,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484424","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}