Kerry M. Sheets, Allyson M. Kats, Howard A. Fink, Lisa Langsetmo, Kristine Yaffe, Kristine E. Ensrud
BackgroundLife‐space mobility captures the daily, enacted mobility of older adults. We determined cross‐sectional associations between life‐space mobility and cognitive impairment (CI) among community‐dwelling women in the 9th and 10th decades of life.MethodsA total of 1375 (mean age 88 years; 88% White) community‐dwelling women enrolled in a prospective cohort of older women. Life‐space score was calculated with range 0 (daily restriction to one's bedroom) to 120 (daily trips leaving town without assistance) and categorized (0–20, 21–40, 41–60, 61–80, 81–120). The primary outcome was adjudicated CI defined as mild cognitive impairment or dementia; scores on a 6‐test cognitive battery were secondary outcomes.ResultsCompared to women with life‐space scores of 81–120 and after adjustment for demographics and depressive symptoms, the odds of CI was 1.4‐fold (OR 1.36, 95% CI 0.91–2.03) higher for women with life‐space scores of 61–80, twofold (OR 1.98, 95% CI 1.33–2.94) higher for women with life‐space scores of 41–60, 2.6‐fold (OR 2.62, 95% CI 1.71–4.01) higher for women with life‐space scores of 21–40, and 2.7‐fold (OR 2.71, 95% CI 1.27–5.79) higher for women with life‐space scores of 0–20. The association of life‐space scores with adjudicated CI was primarily due to higher odds of dementia; the odds of dementia versus normal cognition was eightfold (OR 8.63, 95% CI 3.20–23.26) higher among women with life‐space scores of 0–20 compared to women with life‐space scores of 81–120. Lower life‐space scores were associated in a graded manner with lower mean scores on tests of delayed recall (California Verbal Learning Test‐II delayed recall) and language and executive function (phonemic fluency, category fluency, and Trails B). Life‐space score was not associated with scores on tests of attention and working memory (forward and backward digit span).ConclusionsLower life‐space mobility is associated in a graded manner with CI among community‐dwelling White women in the 9th and 10th decades of life.
背景生活空间的流动性反映了老年人的日常活动能力。我们测定了社区居住的九十岁和十十岁女性的生活空间流动性与认知障碍(CI)之间的横断面关联。方法共有 1375 名(平均年龄 88 岁;88% 白人)社区居住的女性加入了老年女性前瞻性队列。生活空间得分的计算范围为 0(每天仅限于自己的卧室)至 120(每天出城旅行无需他人协助),并分为 0-20、21-40、41-60、61-80、81-120 分。结果与生活空间评分为 81-120 分的女性相比,在对人口统计学和抑郁症状进行调整后,生活空间评分为 81-120 分的女性患 CI 的几率是生活空间评分为 81-120 分女性的 1.4 倍(OR 1.36,95% CI 0.91-2.03)。生命空间分数为 61-80 分的女性的几率要高出 1.4 倍(OR 1.36,95% CI 0.91-2.03),生命空间分数为 41-60 分的女性的几率要高出 2 倍(OR 1.98,95% CI 1.33-2.94),生命空间分数为 21-40 分的女性的几率要高出 2.6 倍(OR 2.62,95% CI 1.71-4.01),生命空间分数为 0-20 分的女性的几率要高出 2.7 倍(OR 2.71,95% CI 1.27-5.79)。生命空间得分与判定的 CI 的关系主要是由于痴呆的几率更高;与生命空间得分 81-120 分的女性相比,生命空间得分 0-20 分的女性痴呆的几率是正常认知的 8 倍(OR 8.63,95% CI 3.20-23.26)。生命空间分数较低与延迟回忆测试(加利福尼亚言语学习测试-II延迟回忆)以及语言和执行功能测试(语音流畅性、类别流畅性和Trails B)的平均分数较低呈分级关系。结论在社区居住的白人妇女中,生命期第 9 和第 10 个十年的生命空间活动度较低与 CI 呈分级关系。
{"title":"Life‐space mobility and cognition in community‐dwelling late‐life women: A cross‐sectional analysis","authors":"Kerry M. Sheets, Allyson M. Kats, Howard A. Fink, Lisa Langsetmo, Kristine Yaffe, Kristine E. Ensrud","doi":"10.1111/jgs.19190","DOIUrl":"https://doi.org/10.1111/jgs.19190","url":null,"abstract":"BackgroundLife‐space mobility captures the daily, enacted mobility of older adults. We determined cross‐sectional associations between life‐space mobility and cognitive impairment (CI) among community‐dwelling women in the 9th and 10th decades of life.MethodsA total of 1375 (mean age 88 years; 88% White) community‐dwelling women enrolled in a prospective cohort of older women. Life‐space score was calculated with range 0 (daily restriction to one's bedroom) to 120 (daily trips leaving town without assistance) and categorized (0–20, 21–40, 41–60, 61–80, 81–120). The primary outcome was adjudicated CI defined as mild cognitive impairment or dementia; scores on a 6‐test cognitive battery were secondary outcomes.ResultsCompared to women with life‐space scores of 81–120 and after adjustment for demographics and depressive symptoms, the odds of CI was 1.4‐fold (OR 1.36, 95% CI 0.91–2.03) higher for women with life‐space scores of 61–80, twofold (OR 1.98, 95% CI 1.33–2.94) higher for women with life‐space scores of 41–60, 2.6‐fold (OR 2.62, 95% CI 1.71–4.01) higher for women with life‐space scores of 21–40, and 2.7‐fold (OR 2.71, 95% CI 1.27–5.79) higher for women with life‐space scores of 0–20. The association of life‐space scores with adjudicated CI was primarily due to higher odds of dementia; the odds of dementia versus normal cognition was eightfold (OR 8.63, 95% CI 3.20–23.26) higher among women with life‐space scores of 0–20 compared to women with life‐space scores of 81–120. Lower life‐space scores were associated in a graded manner with lower mean scores on tests of delayed recall (California Verbal Learning Test‐II delayed recall) and language and executive function (phonemic fluency, category fluency, and Trails B). Life‐space score was not associated with scores on tests of attention and working memory (forward and backward digit span).ConclusionsLower life‐space mobility is associated in a graded manner with CI among community‐dwelling White women in the 9th and 10th decades of life.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"6 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251627","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}
Daokun Sun, Romil R. Parikh, Wendy Wang, Anne Eaton, Pamela L. Lutsey, B. Gwen Windham, Riccardo M. Inciardi, Scott D. Solomon, Christie M. Ballantyne, Amil M. Shah, Lin Yee Chen
BackgroundFrailty is common in people with cardiovascular disease. Worse left atrial (LA) function is an independent risk factor for cardiovascular disease. However, whether worse LA function is associated with frailty is unclear.MethodsWe included 3292 older adults from the Atherosclerosis Risk in Communities study who were non‐frail at baseline (visit 5, 2011–2013) and had LA function (reservoir, conduit, and contractile strain) measured from two‐dimensional speckle‐tracking echocardiography. LA stiffness index was calculated as a ratio of E/e′ to LA reservoir strain. Frailty was defined using the validated Fried frailty phenotype. Incident frailty was assessed between 2016 and 2019 during two follow‐up visits. LA function was analyzed as quintiles. Multivariable logistic regression examined odds of incident frailty.ResultsMedian (interquartile range [IQR]) age was 74 (71–77) years, 58% were female, and 214 (7%) participants developed frailty during a median (IQR) follow‐up of 6.3 (5.6–6.8) years. After adjusting for baseline confounders and incident cardiovascular events during follow‐up, the odds of developing frailty was 2.42 (1.26–4.66) times greater among participants in the lowest (vs highest) quintile of LA reservoir strain and 2.41 (1.11–5.22) times greater among those in the highest (vs lowest) quintile of LA stiffness index. Worse LA function was significantly associated with the development of exhaustion, but not the other components of the Fried frailty phenotype.ConclusionsWorse LA function is associated with higher incidence of frailty and exhaustion component independent of LA size and left ventricular function. Future studies are needed to elucidate the underlying mechanisms that drive the observed association.
背景心血管疾病患者普遍存在心力衰竭问题。左心房(LA)功能较差是心血管疾病的一个独立风险因素。方法我们纳入了社区动脉粥样硬化风险研究(Atherosclerosis Risk in Communities)中的 3292 名老年人,他们在基线(2011-2013 年第 5 次就诊)时并不虚弱,并通过二维斑点追踪超声心动图测量了 LA 功能(储血室、导管和收缩应变)。LA僵化指数按E/e′与LA储层应变的比值计算。虚弱的定义采用经过验证的弗里德虚弱表型。在2016年至2019年期间的两次随访中对发生的虚弱情况进行了评估。LA功能以五分位数进行分析。结果中位数(四分位数间距 [IQR])年龄为 74(71-77)岁,58% 为女性,214(7%)名参与者在中位数(IQR)为 6.3(5.6-6.8)年的随访期间出现虚弱。在对基线混杂因素和随访期间发生的心血管事件进行调整后,LA储层应变最低(与最高)五分位数的参与者发生虚弱的几率是前者的2.42(1.26-4.66)倍,LA僵硬度指数最高(与最低)五分位数的参与者发生虚弱的几率是前者的2.41(1.11-5.22)倍。结论 LA功能较差与虚弱和衰竭的发生率较高有关,与LA大小和左心室功能无关。未来的研究还需要阐明导致这种关联的潜在机制。
{"title":"Association of left atrial function with frailty: The Atherosclerosis Risk in Communities (ARIC) study","authors":"Daokun Sun, Romil R. Parikh, Wendy Wang, Anne Eaton, Pamela L. Lutsey, B. Gwen Windham, Riccardo M. Inciardi, Scott D. Solomon, Christie M. Ballantyne, Amil M. Shah, Lin Yee Chen","doi":"10.1111/jgs.19187","DOIUrl":"https://doi.org/10.1111/jgs.19187","url":null,"abstract":"BackgroundFrailty is common in people with cardiovascular disease. Worse left atrial (LA) function is an independent risk factor for cardiovascular disease. However, whether worse LA function is associated with frailty is unclear.MethodsWe included 3292 older adults from the Atherosclerosis Risk in Communities study who were non‐frail at baseline (visit 5, 2011–2013) and had LA function (reservoir, conduit, and contractile strain) measured from two‐dimensional speckle‐tracking echocardiography. LA stiffness index was calculated as a ratio of E/e′ to LA reservoir strain. Frailty was defined using the validated Fried frailty phenotype. Incident frailty was assessed between 2016 and 2019 during two follow‐up visits. LA function was analyzed as quintiles. Multivariable logistic regression examined odds of incident frailty.ResultsMedian (interquartile range [IQR]) age was 74 (71–77) years, 58% were female, and 214 (7%) participants developed frailty during a median (IQR) follow‐up of 6.3 (5.6–6.8) years. After adjusting for baseline confounders and incident cardiovascular events during follow‐up, the odds of developing frailty was 2.42 (1.26–4.66) times greater among participants in the lowest (vs highest) quintile of LA reservoir strain and 2.41 (1.11–5.22) times greater among those in the highest (vs lowest) quintile of LA stiffness index. Worse LA function was significantly associated with the development of exhaustion, but not the other components of the Fried frailty phenotype.ConclusionsWorse LA function is associated with higher incidence of frailty and exhaustion component independent of LA size and left ventricular function. Future studies are needed to elucidate the underlying mechanisms that drive the observed association.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"15 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251629","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}
Anita N. Chary, Annika R. Bhananker, Elise Brickhouse, Beatrice Torres, Ilianna Santangelo, Kyler M. Godwin, Aanand D. Naik, Christopher R. Carpenter, Shan W. Liu, Maura Kennedy
IntroductionDelirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one‐third of cases. Evidence‐based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake. Early adopters of ED delirium screening can offer valuable lessons about successful implementation.MethodsWe conducted semi‐structured interviews with clinician‐administrators leading ED delirium screening initiatives from 20 EDs in the United States and Canada. Interviews focused on experiences of planning and implementing ED delirium screening. Interviews lasted 15 to 50 minutes and were digitally recorded and transcribed. To identify factors that commonly impacted implementation of ED delirium screening, we used constructs from the Consolidated Framework for Implementation Research (CFIR), an Implementation Science framework widely used to evaluate healthcare improvement initiatives.ResultsOverall, notable facilitators of successful implementation were having institutional and ED leadership support and designated clinical champions to longitudinally engage and educate frontline staff. We found specific examples of factors affecting implementation drawn from the following seven CFIR constructs: (1) intervention complexity, (2) intervention adaptability, (3) external policies and incentives, (4) peer pressure from other institutions, (5) the implementation climate of the ED, (6) staff knowledge and beliefs, and (7) engaging deliverers of intervention, that is, frontline ED staff.ConclusionImplementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion.
{"title":"Implementation of delirium screening in the emergency department: A qualitative study with early adopters","authors":"Anita N. Chary, Annika R. Bhananker, Elise Brickhouse, Beatrice Torres, Ilianna Santangelo, Kyler M. Godwin, Aanand D. Naik, Christopher R. Carpenter, Shan W. Liu, Maura Kennedy","doi":"10.1111/jgs.19188","DOIUrl":"https://doi.org/10.1111/jgs.19188","url":null,"abstract":"IntroductionDelirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one‐third of cases. Evidence‐based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake. Early adopters of ED delirium screening can offer valuable lessons about successful implementation.MethodsWe conducted semi‐structured interviews with clinician‐administrators leading ED delirium screening initiatives from 20 EDs in the United States and Canada. Interviews focused on experiences of planning and implementing ED delirium screening. Interviews lasted 15 to 50 minutes and were digitally recorded and transcribed. To identify factors that commonly impacted implementation of ED delirium screening, we used constructs from the Consolidated Framework for Implementation Research (CFIR), an Implementation Science framework widely used to evaluate healthcare improvement initiatives.ResultsOverall, notable facilitators of successful implementation were having institutional and ED leadership support and designated clinical champions to longitudinally engage and educate frontline staff. We found specific examples of factors affecting implementation drawn from the following seven CFIR constructs: (1) intervention complexity, (2) intervention adaptability, (3) external policies and incentives, (4) peer pressure from other institutions, (5) the implementation climate of the ED, (6) staff knowledge and beliefs, and (7) engaging deliverers of intervention, that is, frontline ED staff.ConclusionImplementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"7 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184909","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}
Victoria A Sanchez,Michelle L Arnold,Emmanuel E Garcia Morales,Nicholas S Reed,Sarah Faucette,Sheila Burgard,Haley N Calloway,Josef Coresh,Jennifer A Deal,Adele M Goman,Lisa Gravens-Mueller,Kathleen M Hayden,Alison R Huang,Christine M Mitchell,Thomas H Mosley,James S Pankow,James R Pike,Jennifer A Schrack,Laura Sherry,Jacqueline M Weycker,Frank R Lin,Theresa H Chisolm,
BACKGROUNDThe Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.METHODSThe ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70-84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory-Elderly Screening version (HHIE-S, range 0-40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.RESULTSHHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of -8.9 (95% CI: -10.4, -7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, -9.3 (95% CI: -10.8, -7.9) to Year 1, -8.4 (95% CI: -9.8, -6.9) to Year 2, and - 9.5 (95% CI: -11.0, -8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.CONCLUSIONSHearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.
{"title":"Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial.","authors":"Victoria A Sanchez,Michelle L Arnold,Emmanuel E Garcia Morales,Nicholas S Reed,Sarah Faucette,Sheila Burgard,Haley N Calloway,Josef Coresh,Jennifer A Deal,Adele M Goman,Lisa Gravens-Mueller,Kathleen M Hayden,Alison R Huang,Christine M Mitchell,Thomas H Mosley,James S Pankow,James R Pike,Jennifer A Schrack,Laura Sherry,Jacqueline M Weycker,Frank R Lin,Theresa H Chisolm,","doi":"10.1111/jgs.19185","DOIUrl":"https://doi.org/10.1111/jgs.19185","url":null,"abstract":"BACKGROUNDThe Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.METHODSThe ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70-84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory-Elderly Screening version (HHIE-S, range 0-40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.RESULTSHHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of -8.9 (95% CI: -10.4, -7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, -9.3 (95% CI: -10.8, -7.9) to Year 1, -8.4 (95% CI: -9.8, -6.9) to Year 2, and - 9.5 (95% CI: -11.0, -8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.CONCLUSIONSHearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"9 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252189","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}
Kaleen N. Hayes, Meghan A. Cupp, Richa Joshi, Melissa R. Riester, Francesca L. Beaudoin, Andrew R. Zullo
BackgroundAppropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.MethodsWe conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post‐acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g‐formula to standardize for age and sex.ResultsWe identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).ConclusionRacial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short‐ and long‐term health outcomes.
{"title":"Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care","authors":"Kaleen N. Hayes, Meghan A. Cupp, Richa Joshi, Melissa R. Riester, Francesca L. Beaudoin, Andrew R. Zullo","doi":"10.1111/jgs.19160","DOIUrl":"https://doi.org/10.1111/jgs.19160","url":null,"abstract":"BackgroundAppropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.MethodsWe conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post‐acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g‐formula to standardize for age and sex.ResultsWe identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).ConclusionRacial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short‐ and long‐term health outcomes.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"111 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184910","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}