Journal of the American Geriatrics Society最新文献

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Editor's Note on Barriers and Facilitators to the Fidelity of Delirium Screening in the Emergency Department: An Ethnographic Approach 编者注：障碍和促进在急诊科谵妄筛查的保真度：民族志方法

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-12-04 DOI: 10.1111/jgs.70236

Edward R. Marcantonio

引用次数: 0

Contextual Analysis and Implementation Strategies for an Age-Friendly Emergency Department Uptake: The FRED Study Protocol 对老年人友好的急诊科吸收的背景分析和实施策略：FRED研究方案。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-12-02 DOI: 10.1111/jgs.70230

Alisa Cantarero Fernandez, Christian H. Nickel, Thomas Dreher-Hummel, Florian Grossmann, Luca Ünlü, Christopher R. Carpenter, Pieter Heeren, Robert A. C. Ruiter, Michael Simon, Franziska Zúñiga

Background

Older adults frequently present to the Emergency Department (ED). In response, a Swiss university hospital introduced age-friendly interventions and achieved Geriatric Emergency Department Accreditation (GEDA) by the American College of Emergency Physicians (ACEP). However, the impact of previously introduced interventions and the reasons behind emergency clinicians' varying uptake or lack of continued use remain unclear. To further improve patient outcomes, conducting a contextual analysis to identify implementation barriers and facilitators is crucial, followed by the development of tailored implementation strategies supporting the sustainable uptake of all age-friendly program elements. The project's overall aim is to systematically promote the uptake and sustainable re-implementation of the existing age-friendly ED program. The first study phase outlined in this protocol (“Phase A”) focuses on 2 key objectives: (1) to assess current age-friendly interventions in the ED and identify barriers and facilitators affecting their reach, adoption, implementation, and maintenance; (2) to develop tailored implementation strategies for re-implementing program elements.

Methods

This project uses a modified implementation mapping in 5 Steps across 2 Phases. Phase A includes Steps 1–4: (1) conducting a contextual analysis using a mixed-methods design combining observations, interviews, patient chart reviews, E-survey and a Gemba walk; (2) identifying expected intervention and implementation outcomes, performance objectives; (3) adapting, extending, or developing tailored implementation strategies based on the Expert Recommendations for Implementing Change taxonomy; and (4) co-designing an implementation protocol to guide re-implementation. The follow-up Phase B will involve the re-implementation of the intervention elements and co-designing the evaluation protocol (Step 5) for the implementation process.

Conclusion

Age-friendly EDs are essential for person-centered emergency care, enhancing safety and quality of care for older adults. This study will provide insights into adaptable, evidence-informed implementation strategies that support behavioral change among emergency clinicians to increase patient reach and sustainability of age-friendly interventions for complex ED settings.

背景：老年人经常出现在急诊科（ED）。作为回应，一家瑞士大学医院引入了对老年人友好的干预措施，并获得了美国急诊医师学会（ACEP）的老年急诊科认证（GEDA）。然而，以前引入的干预措施的影响和急诊临床医生不同的接受或缺乏继续使用背后的原因尚不清楚。为了进一步改善患者的治疗效果，开展背景分析以确定实施障碍和促进因素至关重要，其次是制定量身定制的实施战略，支持所有老年人友好型项目要素的可持续吸收。该项目的总体目标是系统地促进现有的老年人友好型ED计划的吸收和可持续地重新实施。本方案概述的第一阶段研究（“A阶段”）侧重于两个关键目标：(1)评估当前ED中对老年人友好的干预措施，并确定影响其范围、采用、实施和维护的障碍和促进因素；(2)为重新实施项目要素制定量身定制的实施策略。方法：这个项目使用了一个经过修改的实现映射，分为跨2个阶段的5个步骤。A期包括步骤1-4:(1)使用混合方法设计进行上下文分析，结合观察、访谈、患者图表回顾、电子调查和玄叶漫步；(2)确定预期的干预措施和实施结果、绩效目标；(3)根据实施变革的专家建议分类法调整、扩展或开发量身定制的实施战略；(4)共同设计实现协议，指导再实现。后续B阶段将涉及重新实施干预要素和共同设计实施过程的评估方案（步骤5）。结论：老年人友好型急诊科对以人为本的急诊护理至关重要，可提高老年人护理的安全性和质量。本研究将为适应性强、证据充分的实施策略提供见解，这些策略支持急诊临床医生的行为改变，以增加复杂急诊科环境中老年人友好干预措施的患者覆盖面和可持续性。

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引用次数: 0

Predictors of a Gabapentinoid–Loop-Diuretic Prescribing Cascade in U.S. Nursing Home Residents 美国养老院居民加巴喷丁-利尿剂处方级联的预测因素。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-11-28 DOI: 10.1111/jgs.70219

Kaleen N. Hayes, Emmanuelle Belanger, Arman Oganisian, Richa Joshi, Xiao (Joyce) Wang, Lexie R. Grove, Kelsey L. Corcoran, Andrew R. Zullo

Background

Gabapentinoid-related peripheral edema may prompt loop diuretic prescribing. Nursing home (NH) residents may be especially prone to this prescribing cascade. We estimated the incidence and identified predictors of the gabapentinoid-loop diuretic prescribing cascade in NHs.

Methods

We conducted a retrospective cohort study using 2016–2022 Medicare claims linked with Minimum Data Set assessments. We identified residents aged ≥ 66 years who initiated gabapentinoids in NHs and who had no evidence of loop diuretic use, heart failure, or renal insufficiency during the prior 6 months. The outcome was loop diuretic initiation within 90 days of gabapentinoid initiation. Using multivariable Poisson regression models, we estimated adjusted risk ratios (aRR) with 95% robust confidence intervals to identify predictors. We used pooled logistic regression models to examine the relationship between time-varying gabapentinoid dose and loop diuretic initiation risk.

Results

Among 23,544 residents, 994 (4.2%) experienced a prescribing cascade at a median of 36 days (IQR 15–61) after gabapentinoid initiation. Risk was higher with age 86–90 years (aRR = 1.60) or ≥ 91 years (aRR = 1.38); a diagnosis of chronic pain or fibromyalgia (aRR = 1.16), or diabetes (aRR = 1.23); and receipt of potassium-sparing diuretics (aRR = 1.53), thiazide diuretics (aRR = 1.27), or 15 or more unique medications (aRR = 1.18). Higher (versus lower) weekly gabapentin dose during follow-up was associated with a 1.45 times higher prescribing cascade risk over 13 weeks. Those with Alzheimer's Disease and Related Dementias (aRR = 0.79), or moderate (aRR = 0.72) to severe cognitive impairment (aRR = 0.59) had a lower risk versus those with intact cognition.

Conclusions

Approximately 1 in 20 NH residents who initiate gabapentinoids receives a loop diuretic within 3 months. Potentially modifiable predictors included existing polypharmacy and titrating gabapentinoid doses. NH clinicians should monitor for edema soon after gabapentinoid initiation and consider dose reductions or discontinuation before adding a loop diuretic.

背景：加巴喷丁类药物相关的外周水肿可能促使循环利尿剂处方。养老院（NH）的居民可能特别容易出现这种处方级联。我们估计了NHs中加巴喷丁类环状利尿剂处方级联的发生率并确定了预测因素。方法：我们进行了一项回顾性队列研究，使用2016-2022年与最小数据集评估相关的医疗保险索赔。我们确定了年龄≥66岁的居民，他们在NHs中开始使用加巴喷丁类药物，并且在过去6个月内没有循环利尿剂使用、心力衰竭或肾功能不全的证据。结果是在加巴喷丁类药物开始90天内开始循环利尿剂。使用多变量泊松回归模型，我们以95%的稳健置信区间估计调整风险比（aRR），以确定预测因子。我们使用混合逻辑回归模型来检验时变加巴喷丁类剂量与利尿剂起始循环风险之间的关系。结果：在23,544名居民中，994名（4.2%）在加巴喷丁类药物开始治疗后的中位36天（IQR 15-61）经历了处方级联。年龄86 ~ 90岁（aRR = 1.60）或≥91岁（aRR = 1.38）时风险更高；诊断为慢性疼痛或纤维肌痛（aRR = 1.16）或糖尿病（aRR = 1.23）；并接受保钾利尿剂（aRR = 1.53）、噻嗪类利尿剂（aRR = 1.27）或15种或更多独特药物（aRR = 1.18）。随访期间每周加巴喷丁剂量较高（相对较低）与13周内处方级联风险增加1.45倍相关。阿尔茨海默病和相关痴呆（aRR = 0.79）或中度（aRR = 0.72）至重度认知障碍（aRR = 0.59）患者的风险低于认知功能完整的患者。结论：大约1 / 20的NH患者在3个月内开始使用加巴喷丁类利尿剂。潜在的可修改的预测因素包括现有的多药和加巴喷丁类药物的滴定剂量。NH临床医生应在加巴喷丁类药物开始使用后立即监测水肿，并在添加利尿剂之前考虑减少剂量或停药。

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引用次数: 0

Sarcopenic Obesity, Not Sarcopenia or Obesity Alone, Is Independently Associated With Urinary Incontinence in Older Women 老年妇女尿失禁独立与肌肉减少性肥胖有关，而不是单纯的肌肉减少或肥胖。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-11-27 DOI: 10.1111/jgs.70226

Neslihan Hazel Önür, Tuğba Erdoğan, Denizler Sezer, Cihan Kılıç, Serdar Özkök, Gülistan Bahat, Mehmet Akif Karan

Background

Sarcopenic obesity is a condition characterized by decreased muscle mass and strength along with an increased body fat percentage. While previous studies have separately examined the relationship between sarcopenia and obesity with urinary incontinence (UI), this study aimed to evaluate the combined impact of sarcopenic obesity on UI.

Methods

This study included 1147 female patients aged ≥ 60 years who attended a geriatrics outpatient clinic between November 2012 and June 2024. Body composition was assessed using bioimpedance analysis (BIA), and muscle strength was measured by handgrip strength. The skeletal muscle mass index (SMMI) was adjusted for body weight. Sarcopenic obesity was defined using population-specific threshold values, incorporating low muscle strength, low muscle mass, and high fat percentage. Patients were classified into four groups: non-sarcopenic non-obese, sarcopenic non-obese, sarcopenic obese, and non-sarcopenic obese. The prevalence of UI and its association with these phenotypes was analyzed using multivariable logistic regression.

Results

The mean age was 74 ± 7 years. The prevalence of sarcopenic obesity was 20%, while the prevalence of UI was 49%. UI was observed in 57% of the 230 patients with sarcopenic obesity. A significant difference in UI prevalence was found among phenotypic groups (p < 0.001). In multivariable regression analysis, sarcopenic obesity was independently associated with UI (OR: 1.82, 95% CI: 1.16–2.85, p = 0.009). Other phenotypes were not significantly associated.

Conclusions

Sarcopenic obesity is more strongly associated with UI than sarcopenia or obesity alone. Early identification and targeted interventions may play a crucial role in mitigating the effects of UI or reducing its incidence.

背景：肌少性肥胖是一种以肌肉质量和力量减少以及体脂百分比增加为特征的疾病。虽然以往的研究分别探讨了肌肉减少症和肥胖与尿失禁（UI）之间的关系，但本研究旨在评估肌肉减少性肥胖对尿失禁的综合影响。方法：本研究纳入2012年11月至2024年6月在老年科门诊就诊的1147例年龄≥60岁的女性患者。采用生物阻抗分析（BIA）评估身体成分，通过握力测量肌肉力量。根据体重调整骨骼肌质量指数（SMMI）。肌少性肥胖的定义采用人群特异性阈值，包括低肌肉力量、低肌肉质量和高脂肪百分比。患者分为四组：非肌肉减少的非肥胖、肌肉减少的非肥胖、肌肉减少的肥胖和非肌肉减少的肥胖。使用多变量逻辑回归分析UI患病率及其与这些表型的关系。结果：患者平均年龄74±7岁。肌少性肥胖的患病率为20%，而尿失禁的患病率为49%。230例肌肉减少型肥胖患者中有57%出现尿失禁。不同表型组间尿失禁患病率存在显著差异(p)。结论：肌肉减少型肥胖与尿失禁的相关性强于肌肉减少症或单纯肥胖。早期识别和有针对性的干预可能在减轻尿失禁的影响或减少其发病率方面发挥关键作用。

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引用次数: 0

Fool Me Once: A Case of Recurrent Delirium in the Setting of Buprenorphine Use 愚弄我一次：丁丙诺啡使用后复发性谵妄1例。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-11-27 DOI: 10.1111/jgs.70227

Yasmeen Abdo, Camila S. Badell, Abeer Qasim, Eloy F. Ruiz

引用次数: 0

Learning How Preoperative Communication Relates to Postoperative Experiences for Older Veterans Having Inguinal Hernia Surgery 学习术前沟通与老年退伍军人腹股沟疝手术术后经验的关系。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-11-26 DOI: 10.1111/jgs.70216

Melissa A. Thornton, Elisa L. Marten, Nicole Lunardi, Don Mai, Cameron Macdonald, Jocelyn G. Baker, Ava Hitzeman, Celette Sugg Skinner, Cynthia J. Brown, Miles Berger, Simon Craddock Lee, C. Munro Cullum, Konstantinos I. Makris, Thai H. Pham, Aanand Naik, Victoria Tang, Courtney J. Balentine

Background

For older adults to decide whether inguinal hernia repair will meaningfully improve their lives, it is critical to (1) understand how the operation affects them and whether it enhances outcomes that matter to them, and (2) identify ways to improve how surgeons discuss the benefits of surgery and how they prepare older adults for postoperative recovery.

Methods

We conducted semi-structured interviews with 40 Veterans ≥ 65 years old who had inguinal hernia repair at two high-volume Veterans Affairs hospitals.

Results

Participants were all men; their mean age was 73 years, 65% were White, and 33% were Black. Older adults felt that the surgical team provided excellent reassurance regarding the safety and efficacy of surgery but expressed a desire for improved listening during preoperative counseling and for clearer communication regarding the reality of postoperative recovery. Veterans reported a return to baseline physical and cognitive function between 2 days and 6 weeks after surgery, though two Veterans experienced significant short-term cognitive dysfunction. Those who reported dissatisfaction with preoperative communication were more likely to be surprised or concerned about postoperative symptoms.

Conclusions

Our study provides critical information on how hernia repair affects the lives of older adults, and this can be used to better prepare the patients for surgery and to help them decide whether surgery will meaningfully enhance their quality of life.

背景：对于老年人来说，决定腹股沟疝修补是否会有意义地改善他们的生活，至关重要的是：(1)了解手术如何影响他们，是否能提高对他们重要的结果，以及(2)确定如何改进外科医生讨论手术益处的方法，以及他们如何为老年人术后恢复做好准备。方法：我们对40名≥65岁在两家大容量退伍军人医院行腹股沟疝修补术的退伍军人进行半结构化访谈。结果：参与者均为男性；平均年龄73岁，白人占65%，黑人占33%。老年人认为手术团队对手术的安全性和有效性提供了很好的保证，但他们表示希望在术前咨询时更好地倾听，并就术后恢复的现实进行更清晰的沟通。据报道，退伍军人在手术后2天至6周内恢复了基本的身体和认知功能，尽管有两名退伍军人出现了明显的短期认知功能障碍。那些对术前沟通不满意的患者更可能对术后症状感到惊讶或担忧。结论：我们的研究提供了关于疝修补如何影响老年人生活的重要信息，这可以用来更好地为患者做手术准备，并帮助他们决定手术是否会有意义地提高他们的生活质量。

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引用次数: 0

Identifying Barriers and Motivators to Increase Surgical Clinical Trial Participation for Older Veterans 识别障碍和动机，以增加老年退伍军人外科临床试验的参与。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-11-26 DOI: 10.1111/jgs.70218

Benjamin A. Y. Cher, Nicole Lunardi, Melissa Thornton, Ava Hitzeman, Jocelyn Baker, Cameron Macdonald, Celette Sugg Skinner, Cynthia J. Brown, Don Mai, Elisa L. Marten, Konstantinos Makris, Maria Luisa Machado Heredia, Miles Berger, C. Munro Cullum, Simon C. Lee, Thai H. Pham, Courtney J. Balentine

Background

Patients aged 65+ are underrepresented in surgical clinical trials, and few studies have explored the unique barriers that limit participation of older adults in surgical trials. We aimed to identify barriers and facilitators to participation in surgical randomized trials among adults aged 65+.

Participants and Setting

Patients aged 65+ years having hernia surgery at two high-volume Veterans' Affairs hospitals.

Methods

We conducted semi-structured interviews to identify barriers and facilitators to participation in clinical trials. Interviews were analyzed with directed content analysis.

Results

We interviewed 40 Veterans aged 65+ years. The most frequently cited barriers to participation were logistical (e.g., needing to visit the hospital more frequently) and emotional (e.g., medical mistrust, fear of hospitals, and fear of bodily harm). COVID-19 pandemic-related misinformation was commonly cited by these participants as a justification for medical mistrust. The most frequently cited motivators to participate in trials were altruism, access to novel treatments, increased time with clinicians, and advancing scientific knowledge. Patients uncertain about participation were potentially persuadable by referencing the impact of the trial on their friends and family, or by increasing transparency around trial purpose and design. Notably, using virtual visits to minimize travel to the hospital was not regarded as a viable way to address logistical barriers.

Conclusions

Increasing the participation of older adults in surgical clinical trials will require a multi-factorial strategy that emphasizes communication of benefits to more than just the patient and includes deliberate planning to combat misperceptions and misinformation.

背景：65岁以上的患者在外科临床试验中的代表性不足，并且很少有研究探讨限制老年人参与外科试验的独特障碍。我们的目的是确定65岁以上成人参与外科随机试验的障碍和促进因素。参与者和环境：在两家大容量退伍军人事务医院接受疝气手术的65岁以上患者。方法：我们进行了半结构化访谈，以确定参与临床试验的障碍和促进因素。访谈采用定向内容分析进行分析。结果：我们采访了40名65岁以上的退伍军人。最常提到的参与障碍是后勤（例如，需要更频繁地去医院）和情感（例如，对医疗的不信任、对医院的恐惧和对身体伤害的恐惧）。这些参与者通常将与COVID-19大流行相关的错误信息作为医疗不信任的理由。参与试验最常见的动机是利他主义、获得新疗法、与临床医生相处时间的增加以及科学知识的进步。通过参考试验对其朋友和家人的影响，或通过增加试验目的和设计的透明度，可以潜在地说服不确定参与试验的患者。值得注意的是，利用虚拟访问来尽量减少到医院的旅行被认为不是解决后勤障碍的可行方法。结论：增加老年人参与外科临床试验将需要一个多因素的策略，强调益处的沟通，而不仅仅是患者，包括深思熟虑的计划，以消除误解和错误信息。

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引用次数: 0

Cover 封面

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-11-25 DOI: 10.1111/jgs.70194

Samir K. Shah, Lingwei Xiang, Rachel R. Adler, Clancy J. Clark, Zara Cooper, Emily Finlayson, Susan L. Mitchell, Dae Hyun Kim, Kueiyu Joshua Lin, Stuart R. Lipsitz, Joel S. Weissman

Cover caption: Outcomes of high-risk surgery in patients living with ADRD compared to those without. See the related article by Shah et al., pages 3434–3443.

封面说明：与没有ADRD的患者相比，患有ADRD的高危手术的结果。参见Shah等人的相关文章，第3434-3443页。

引用次数: 0

Playlist Prescriptions 播放列表的处方。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-11-25 DOI: 10.1111/jgs.70214

Sophia J. Ruser, Jody Sharninghausen

引用次数: 0

Kevin's Comb and Becky's Braids: A Model for Clinical Reasoning in Geriatric Medicine 凯文的梳子和贝基的辫子：老年医学的临床推理模型。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-11-22 DOI: 10.1111/jgs.70208

Rebecca J. Stetzer, Kevin Costello

引用次数: 0

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