Geoff Kerr, Allie Chown, Mathew Mercuri, Natasha Clayton, Éric Mercier, Judy Morris, Rebecca Jeanmonod, Debra Eagles, Catherine Varner, David Barbic, Sameer Parpia, Ian M. Buchanan, Mariyam Ali, Yoan K. Kagoma, Ashkan Shoamanesh, Paul Engels, Sunjay Sharma, Andrew Worster, Shelley McLeod, Marcel Émond, Ian Stiell, Alexandra Papaioannou, Kerstin de Wit
Background
The Canadian CT Head Rule (CCTHR) is validated in adults who hit their head and experience loss of consciousness, amnesia, or disorientation. There is less evidence to guide brain imaging when the fall history is unclear.
Methods
This is a secondary analysis of a prospective study on adults aged ≥ 65 who presented to 11 emergency departments across Canada and the United States after a ground level fall. We reported the prevalence of adjudicated clinically important intracranial bleeding within 42 days of the emergency department visit among (a) patients who hit their head and met the application criteria for the CCTHR (experienced loss of consciousness, amnesia, or disorientation), (b) patients who hit their head and did not meet the CCTHR application criteria, (c) patients with an unclear history of the CCTHR application criteria, (d) patients with an unclear head injury history, and (e) patients with no head injury.
Results
4303 participants were analyzed. The prevalence of clinically important intracranial bleeding in the subgroups was (a) patients who fulfilled the CCTHR application criteria, 7.7% (54/703, 95% confidence interval [CI]: 5.9%–9.9%), (b) patients who hit their head but did not meet CCTHR application criteria, 2.5% (30/1204, 95% CI: 1.8%–3.5%), (c) patients with head injury but an unclear history of the CCTHR application criteria, 7.6% (19/251, 95% CI: 4.9%–12.0%), (d) patients with an unclear history of head injury, 4.6% (23/502, 95% CI: 3.2%–6.8%), and (e) patients who did not hit their head, 0.8% (13/1643, 95% CI: 0.5%–1.3%).
Conclusions
Older adults presenting after a fall with an unclear history of head injury, or an unclear history of head injury-associated loss of consciousness, amnesia, or disorientation have an elevated risk for clinically important intracranial bleeding that merits emergency brain imaging.
{"title":"Applying the Canadian Head CT Criteria to Older Adults Seen in the Emergency Department After a Fall","authors":"Geoff Kerr, Allie Chown, Mathew Mercuri, Natasha Clayton, Éric Mercier, Judy Morris, Rebecca Jeanmonod, Debra Eagles, Catherine Varner, David Barbic, Sameer Parpia, Ian M. Buchanan, Mariyam Ali, Yoan K. Kagoma, Ashkan Shoamanesh, Paul Engels, Sunjay Sharma, Andrew Worster, Shelley McLeod, Marcel Émond, Ian Stiell, Alexandra Papaioannou, Kerstin de Wit","doi":"10.1111/jgs.70191","DOIUrl":"10.1111/jgs.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Canadian CT Head Rule (CCTHR) is validated in adults who hit their head and experience loss of consciousness, amnesia, or disorientation. There is less evidence to guide brain imaging when the fall history is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a secondary analysis of a prospective study on adults aged ≥ 65 who presented to 11 emergency departments across Canada and the United States after a ground level fall. We reported the prevalence of adjudicated clinically important intracranial bleeding within 42 days of the emergency department visit among (a) patients who hit their head and met the application criteria for the CCTHR (experienced loss of consciousness, amnesia, or disorientation), (b) patients who hit their head and did not meet the CCTHR application criteria, (c) patients with an unclear history of the CCTHR application criteria, (d) patients with an unclear head injury history, and (e) patients with no head injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>4303 participants were analyzed. The prevalence of clinically important intracranial bleeding in the subgroups was (a) patients who fulfilled the CCTHR application criteria, 7.7% (54/703, 95% confidence interval [CI]: 5.9%–9.9%), (b) patients who hit their head but did not meet CCTHR application criteria, 2.5% (30/1204, 95% CI: 1.8%–3.5%), (c) patients with head injury but an unclear history of the CCTHR application criteria, 7.6% (19/251, 95% CI: 4.9%–12.0%), (d) patients with an unclear history of head injury, 4.6% (23/502, 95% CI: 3.2%–6.8%), and (e) patients who did not hit their head, 0.8% (13/1643, 95% CI: 0.5%–1.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older adults presenting after a fall with an unclear history of head injury, or an unclear history of head injury-associated loss of consciousness, amnesia, or disorientation have an elevated risk for clinically important intracranial bleeding that merits emergency brain imaging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"509-515"},"PeriodicalIF":4.5,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristin Lees Haggerty, David B. Reuben, Rebecca Stoeckle, David Bass, Malaz Boustani, Carolyn Clevenger, Ian Kremer, David R. Lee, Madelyn Johnson, Morgan J. Minyo, Katherine L. Possin, Quincy M. Samus, Lynn Spragens, Lee A. Jennings, Gary Epstein-Lubow
The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach. The National Dementia Care Collaborative (NDCC), a coalition of scientific and clinical leaders in evidence-based dementia care, works to promote comprehensive dementia care. Drawing from the experiences of six previously tested programs—Aging Brain Care, Alzheimer's and Dementia Care, BRI Care Consultation, Care Ecosystem, Integrated Memory Care, and MIND at Home—we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. Our guidance also emphasizes leveraging existing community assets, aligning efforts with organizational priorities, and using both storytelling and data to make the case for change. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.
{"title":"GUIDE and Beyond: Strategies for Comprehensive Dementia Care Integration","authors":"Kristin Lees Haggerty, David B. Reuben, Rebecca Stoeckle, David Bass, Malaz Boustani, Carolyn Clevenger, Ian Kremer, David R. Lee, Madelyn Johnson, Morgan J. Minyo, Katherine L. Possin, Quincy M. Samus, Lynn Spragens, Lee A. Jennings, Gary Epstein-Lubow","doi":"10.1111/jgs.70107","DOIUrl":"10.1111/jgs.70107","url":null,"abstract":"<p>The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach. The National Dementia Care Collaborative (NDCC), a coalition of scientific and clinical leaders in evidence-based dementia care, works to promote comprehensive dementia care. Drawing from the experiences of six previously tested programs—Aging Brain Care, Alzheimer's and Dementia Care, BRI Care Consultation, Care Ecosystem, Integrated Memory Care, and MIND at Home—we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. Our guidance also emphasizes leveraging existing community assets, aligning efforts with organizational priorities, and using both storytelling and data to make the case for change. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3548-3554"},"PeriodicalIF":4.5,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariana P. Socal, Jenny Markell, Pineal I. Bareamichael, Ge Bai, Jeromie Ballreich
<p>Medicare Part D is the primary source of prescription drug coverage for Americans with Alzheimer's disease and related dementias (ADRD). Cognitive and functional limitations may hinder beneficiaries' pharmacy access. Mail-order pharmacies can offer convenience [<span>1</span>], although their use among beneficiaries with ADRD and implications on drug utilization and spending remain unknown. This study examined utilization and spending patterns among ADRD Medicare Part D beneficiaries using mail-order and retail pharmacies.</p><p>Pharmaceutical claims data were obtained for beneficiaries with ADRD using 2021 Medicare Prescription Drug Events (PDE) files from a 20% national random sample of Medicare beneficiaries enrolled in traditional fee-for-service Medicare (see Supporting Information) [<span>2</span>]. We identified beneficiaries with ADRD using Medicare-defined diagnosis codes from Medicare's 2020 Master Beneficiary Summary File (MBSF) Chronic Conditions segment [<span>3</span>] and 2021 MBSF Base segment [<span>4</span>]. We restricted the sample to beneficiaries continuously enrolled in Medicare, living at home, and alive through 2021. We excluded beneficiaries without any Part D prescription fills and those with claims from pharmacy types other than retail or mail-order pharmacies in 2021. Beneficiary characteristics were compared between primarily mail-order users (> 50% of prescriptions dispensed in mail-order) and primarily retail pharmacy users (≥ 50% of prescriptions from retail pharmacies).</p><p>Drugs were defined as the combination of active ingredient, dosage form, and strength [<span>5</span>]. Acute-use drugs were excluded. For each beneficiary-drug pair, the proportion of days covered (PDC), the beneficiary out-of-pocket cost, plan spending, and total spending (plan plus beneficiary plus any third-party payments) were calculated per 30-day supply. Comparisons were implemented at the beneficiary-drug level between beneficiary-drug pairs with 100% of the claims in mail-order versus beneficiary-drug pairs with 100% in retail pharmacies. Because low-income subsidies can lower beneficiary out-of-pocket costs, spending metrics were also examined separately for beneficiaries not receiving subsidies. Statistical significance was set at two-tailed <i>p</i> < 0.05. Two-tailed independent-samples <i>T</i> tests and Chi-square tests were used for the comparisons; all analyses used STATA Version 16 (Stata Corp, College Station, TX). The study was approved by the Internal Review Board and followed STROBE reporting guidelines for observational studies.</p><p>The sample totaled 121,754 Medicare Part D beneficiaries with ADRD, with 13,393 (11%) primarily mail-order and 108,361 (89%) primarily retail pharmacy users (Table 1). Mail-order users were slightly older (mean (SD) age: 81.5 (7.8) vs. 80.3 (9.6) years, <i>p</i> < 0.001); less often female (56% vs. 62%, <i>p</i> < 0.001); and more frequently white (87% vs. 70%, <i>p</i> <
医疗保险D部分是美国阿尔茨海默病和相关痴呆（ADRD）患者处方药覆盖的主要来源。认知和功能限制可能会阻碍受益人获得药房。邮购药店可以提供便利，尽管它们在患有ADRD的受益人中的使用情况及其对药物使用和支出的影响尚不清楚。本研究考察了ADRD医疗保险D部分受益人使用邮购和零售药房的使用和支出模式。药物索赔数据是使用2021年医疗保险处方药事件（PDE）文件获得的，这些文件来自20%的全国随机样本，这些样本参加了传统的按服务收费的医疗保险（见支持信息）bbb。我们使用医疗保险定义的诊断代码从医疗保险2020年主要受益人摘要文件（MBSF）慢性病部分[3]和2021年MBSF基础部分[4]确定患有ADRD的受益人。我们将样本限制为连续参加医疗保险，住在家里并且活到2021年的受益人。我们排除了2021年没有任何D部分处方的受益人，以及在零售或邮购药店以外的药房类型索赔的受益人。比较主要是邮购用户（邮购处方占50%）和主要是零售药房用户（零售药房处方占50%以上）的受益人特征。药物定义为有效成分、剂型和强度[5]的组合。排除急性用药。对于每个受益人-药物对，计算每30天供应的覆盖天数比例（PDC）、受益人自付费用、计划支出和总支出（计划+受益人+任何第三方支付）。在受益药物水平上对邮购中100%索赔的受益药物对与零售药店中100%索赔的受益药物对进行了比较。由于低收入补贴可以降低受益人的自付费用，因此对未获得补贴的受益人的支出指标也进行了单独检查。双尾p <； 0.05具有统计学意义。比较采用双尾独立样本T检验和卡方检验；所有分析使用STATA Version 16 （STATA Corp, College Station， TX）。该研究获得了内部审查委员会的批准，并遵循了STROBE观察性研究报告指南。样本共121,754名患有ADRD的医疗保险D部分受益人，其中13,393（11%）主要是邮购，108,361（89%）主要是零售药房用户（表1）。邮购用户年龄稍大（平均（SD）年龄：81.5（7.8）岁vs 80.3（9.6）岁，p < 0.001）；女性较少（56% vs. 62%, p < 0.001）；更常见的是白人（87%对70%，p < 0.001）。较少的MO用户获得低收入补贴（7%对36%，p < 0.001），较少的人有双重资格获得医疗补助（6%对34%，p < 0.001）。通过PDC测量，邮购受益人-药物对的药物持有率更高(平均（SD） PDC: 1.0 （0.1) vs 0.9 (0.2), p < 0.001）。总体而言，邮购受益人-药物对每30天供应的计划成本较低（平均（SD）： 17.6美元（56.0美元）对19.1美元（72.2美元），p < 0.001）；较低的总成本(平均(SD): 34.8美元(102美元)和37.8美元(116美元),p & lt; 0.001);与零售药房相比，受益人自付费用占总费用的百分比更低（平均（SD）： 31.6%（37.5%）对39.4% (39.3%),p < 0.001）（图1）。在未接受低收入补贴的受益人中，邮购受益人-药物组合的自付费用较低（平均（SD）： 6.3美元（17.5美元）对9.6美元（22.9美元），p < 0.001），受益人自付费用占总成本的百分比较低（平均（SD）： 33.1%（38.0%）对58.2% (37.5%),p < 0.001）。研究结果表明，邮购药店可以通过更高的药物持有率和减少自付费用，为患有ADRD的医疗保险D部分受益人提供好处，特别是对那些没有接受低收入补贴的人。然而，邮购药店为低收入受益人服务的可能性明显低于零售药店。医疗保险D部分计划应要求计划为所有受益人提供邮购药房信息，特别是低收入补贴接受者和有双重资格享受医疗补助的人。研究的局限性包括没有控制混杂因素，如认知障碍程度、护理人员支持、药物偏好、健康状况和药物治疗方案复杂性。PDC可能实际上并不反映药物摄入，虽然药物持有的差异具有统计学意义，但其临床意义仍不确定。研究结果可能不能推广到所有患有ADRD的医疗保险受益人，包括新诊断的病例和医疗保险优势受益人。 未来的研究应探讨患者和护理者的偏好、用药特征和药房类型如何相互作用，影响药物利用、临床和财务结果。为了为政策干预提供信息，研究应该评估具体的策略，这些策略可以帮助D部分计划增加患有ADRD的医疗保险人群的药物获取和利用。Mariana P. Socal：概念化，方法论，写作-审查和编辑，监督，项目管理，资金获取。Jenny Markell：方法论，数据管理，形式分析，调查，可视化，写作-原始草案准备，写作-审查和编辑。Pineal I. bareammichael：数据管理，形式分析，调查，可视化，写作-原稿准备，写作-审查和编辑。葛白：构思、方法论、编审、监督。Jeromie Ballreich：概念，方法论，写作-审查和编辑，监督。资金来源在研究的设计和实施中没有任何作用；收集、管理、分析和解释数据；对文章的准备、审查或批准；并决定将文章提交发表。Mariana P. Socal和Jeromie Ballreich可以完全访问研究中的所有数据，并对数据的完整性和数据分析的准确性负责。其他作者声明没有利益冲突。
{"title":"Mail-Order and Retail Pharmacy Use Among Medicare Beneficiaries With Alzheimer's Disease and Related Dementias","authors":"Mariana P. Socal, Jenny Markell, Pineal I. Bareamichael, Ge Bai, Jeromie Ballreich","doi":"10.1111/jgs.70188","DOIUrl":"10.1111/jgs.70188","url":null,"abstract":"<p>Medicare Part D is the primary source of prescription drug coverage for Americans with Alzheimer's disease and related dementias (ADRD). Cognitive and functional limitations may hinder beneficiaries' pharmacy access. Mail-order pharmacies can offer convenience [<span>1</span>], although their use among beneficiaries with ADRD and implications on drug utilization and spending remain unknown. This study examined utilization and spending patterns among ADRD Medicare Part D beneficiaries using mail-order and retail pharmacies.</p><p>Pharmaceutical claims data were obtained for beneficiaries with ADRD using 2021 Medicare Prescription Drug Events (PDE) files from a 20% national random sample of Medicare beneficiaries enrolled in traditional fee-for-service Medicare (see Supporting Information) [<span>2</span>]. We identified beneficiaries with ADRD using Medicare-defined diagnosis codes from Medicare's 2020 Master Beneficiary Summary File (MBSF) Chronic Conditions segment [<span>3</span>] and 2021 MBSF Base segment [<span>4</span>]. We restricted the sample to beneficiaries continuously enrolled in Medicare, living at home, and alive through 2021. We excluded beneficiaries without any Part D prescription fills and those with claims from pharmacy types other than retail or mail-order pharmacies in 2021. Beneficiary characteristics were compared between primarily mail-order users (> 50% of prescriptions dispensed in mail-order) and primarily retail pharmacy users (≥ 50% of prescriptions from retail pharmacies).</p><p>Drugs were defined as the combination of active ingredient, dosage form, and strength [<span>5</span>]. Acute-use drugs were excluded. For each beneficiary-drug pair, the proportion of days covered (PDC), the beneficiary out-of-pocket cost, plan spending, and total spending (plan plus beneficiary plus any third-party payments) were calculated per 30-day supply. Comparisons were implemented at the beneficiary-drug level between beneficiary-drug pairs with 100% of the claims in mail-order versus beneficiary-drug pairs with 100% in retail pharmacies. Because low-income subsidies can lower beneficiary out-of-pocket costs, spending metrics were also examined separately for beneficiaries not receiving subsidies. Statistical significance was set at two-tailed <i>p</i> < 0.05. Two-tailed independent-samples <i>T</i> tests and Chi-square tests were used for the comparisons; all analyses used STATA Version 16 (Stata Corp, College Station, TX). The study was approved by the Internal Review Board and followed STROBE reporting guidelines for observational studies.</p><p>The sample totaled 121,754 Medicare Part D beneficiaries with ADRD, with 13,393 (11%) primarily mail-order and 108,361 (89%) primarily retail pharmacy users (Table 1). Mail-order users were slightly older (mean (SD) age: 81.5 (7.8) vs. 80.3 (9.6) years, <i>p</i> < 0.001); less often female (56% vs. 62%, <i>p</i> < 0.001); and more frequently white (87% vs. 70%, <i>p</i> <","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"585-588"},"PeriodicalIF":4.5,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12833993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas S. Reed, Sarah Y. Bessen, Pablo Martinez-Amezcua, Jennifer A. Deal, Danielle Powell, Julie Hoover Fong, Edgar R. Miller III, Frank R. Lin, Megan A. Morris, Esther S. Oh
Background
Hearing loss affects nearly two-thirds of adults over the age of 70 years, and is associated with lower satisfaction with health care, which may be mediated by patient-provider communication barriers. Accompaniment, the presence and support of a companion during health care interactions, may modify the association between hearing and satisfaction with care by providing an intermediary to assist with communication.
Methods
Cross-sectional study of 9698 Medicare beneficiaries from the 2016 Medicare Current Beneficiaries Survey. We used regression models to estimate the association between self-reported trouble hearing and satisfaction with care, which was measured through reported satisfaction with overall quality of care, satisfaction with information provided, and satisfaction with provider's concern. Interaction terms and stratification by being accompanied to healthcare visits were used to assess if accompaniment modified the association between hearing loss and satisfaction with care.
Results
Nearly 45% of Medicare beneficiaries reported at least a little trouble hearing. Adults with a little trouble hearing (Odds Ratio [OR] = 1.168; 95% Confidence Interval [CI] = 1.047–1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043–1.603) had higher odds of being dissatisfied with the quality of their health care over the previous year compared to those with no trouble hearing. Among accompanied participants, no association was found between level of hearing trouble and dissatisfaction with care. Among unaccompanied adults, trouble with hearing was associated with higher odds of dissatisfaction. The associations were consistent across the three dissatisfaction outcomes.
Conclusions
Medicare beneficiaries with hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Stratified models suggest that accompaniment may modify the association between hearing and dissatisfaction with care. Future research should consider interventions to support unaccompanied adults with hearing loss during health care interactions.
{"title":"Modification of the Association Between Hearing Trouble and Satisfaction With Care by Accompaniment to Health Care Visits","authors":"Nicholas S. Reed, Sarah Y. Bessen, Pablo Martinez-Amezcua, Jennifer A. Deal, Danielle Powell, Julie Hoover Fong, Edgar R. Miller III, Frank R. Lin, Megan A. Morris, Esther S. Oh","doi":"10.1111/jgs.70176","DOIUrl":"10.1111/jgs.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hearing loss affects nearly two-thirds of adults over the age of 70 years, and is associated with lower satisfaction with health care, which may be mediated by patient-provider communication barriers. Accompaniment, the presence and support of a companion during health care interactions, may modify the association between hearing and satisfaction with care by providing an intermediary to assist with communication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional study of 9698 Medicare beneficiaries from the 2016 Medicare Current Beneficiaries Survey. We used regression models to estimate the association between self-reported trouble hearing and satisfaction with care, which was measured through reported satisfaction with overall quality of care, satisfaction with information provided, and satisfaction with provider's concern. Interaction terms and stratification by being accompanied to healthcare visits were used to assess if accompaniment modified the association between hearing loss and satisfaction with care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nearly 45% of Medicare beneficiaries reported at least a little trouble hearing. Adults with a little trouble hearing (Odds Ratio [OR] = 1.168; 95% Confidence Interval [CI] = 1.047–1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043–1.603) had higher odds of being dissatisfied with the quality of their health care over the previous year compared to those with no trouble hearing. Among accompanied participants, no association was found between level of hearing trouble and dissatisfaction with care. Among unaccompanied adults, trouble with hearing was associated with higher odds of dissatisfaction. The associations were consistent across the three dissatisfaction outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Medicare beneficiaries with hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Stratified models suggest that accompaniment may modify the association between hearing and dissatisfaction with care. Future research should consider interventions to support unaccompanied adults with hearing loss during health care interactions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"85-95"},"PeriodicalIF":4.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Austin Murphy, Zihao Liu, Heidi G. De Souza, Erica Leigh Chilson, Robyn Moucka, Pete Kardel, Caitlin Sheetz, Reiko Sato
Cover caption: Cumulative RSV Vaccination Uptake Rate by State. See the related article by Murphy et al., pages 3196–3202.
封面标题：各州累计RSV疫苗接种率。参见墨菲等人的相关文章，第3196-3202页。
{"title":"Cover","authors":"Austin Murphy, Zihao Liu, Heidi G. De Souza, Erica Leigh Chilson, Robyn Moucka, Pete Kardel, Caitlin Sheetz, Reiko Sato","doi":"10.1111/jgs.70162","DOIUrl":"https://doi.org/10.1111/jgs.70162","url":null,"abstract":"<p><b>Cover caption</b>: Cumulative RSV Vaccination Uptake Rate by State. See the related article by Murphy et al., pages 3196–3202.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 10","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential in improving glycemic control and reducing adverse outcomes in patients with Type 2 diabetes mellitus (T2DM); however, their efficacy in individuals aged 80 years and older remains understudied. To evaluate the efficacy of GLP-1 RAs compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in patients aged ≥ 80 years with T2DM.
Participant and Setting
De-identified records from the TriNetX United States database identified 284,417 patients aged ≥ 80 years with T2DM, including 12,032 new GLP-1 RA users and 28,230 new DPP4i users, analyzed from January 2018 to December 2022.
Methods
This retrospective cohort study utilized a new-user and active comparator design to evaluate clinical outcomes between GLP-1 RA and DPP4i users during a follow-up period of up to 5 years. Propensity score matching, incorporating all the baseline covariates, was used to minimize baseline differences. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs) for clinical outcomes. Sensitivity analyses were performed to validate the findings.
Results
After 1:1 propensity score matching, 11,464 patients were included in each group. Both cohorts had a mean age of 81.6 years; 47.7% were female, and 67% were White. GLP-1 RA users had significantly lower risks of major adverse cardiovascular events (HR: 0.86, 95% CI: 0.81–0.91), major adverse kidney events (HR: 0.86, 95% CI: 0.82–0.91), all-cause hospitalization (HR: 0.91, 95% CI: 0.84–0.97), and all-cause mortality (HR: 0.82, 95% CI: 0.77–0.88) compared with DPP4i users. No significant differences were observed between the groups in the rate of heart failure or bone fractures.
Conclusions
GLP-1 RAs may offer substantial cardiorenal and survival benefits in patients aged 80 years and older with T2DM. These findings support the use of GLP-1 RAs as a therapeutic option in this high-risk, older population.
{"title":"GLP-1 Receptor Agonist Therapy and Cardiorenal Outcomes in Patients ≥ 80 Years Old With Type 2 Diabetes","authors":"Jui-Cheng Chen, Yu-Wei Fang, Ya-Fang Liu, Mon-Ting Chen, Ming-Hsien Tsai","doi":"10.1111/jgs.70187","DOIUrl":"10.1111/jgs.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential in improving glycemic control and reducing adverse outcomes in patients with Type 2 diabetes mellitus (T2DM); however, their efficacy in individuals aged 80 years and older remains understudied. To evaluate the efficacy of GLP-1 RAs compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in patients aged ≥ 80 years with T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participant and Setting</h3>\u0000 \u0000 <p>De-identified records from the TriNetX United States database identified 284,417 patients aged ≥ 80 years with T2DM, including 12,032 new GLP-1 RA users and 28,230 new DPP4i users, analyzed from January 2018 to December 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study utilized a new-user and active comparator design to evaluate clinical outcomes between GLP-1 RA and DPP4i users during a follow-up period of up to 5 years. Propensity score matching, incorporating all the baseline covariates, was used to minimize baseline differences. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs) for clinical outcomes. Sensitivity analyses were performed to validate the findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After 1:1 propensity score matching, 11,464 patients were included in each group. Both cohorts had a mean age of 81.6 years; 47.7% were female, and 67% were White. GLP-1 RA users had significantly lower risks of major adverse cardiovascular events (HR: 0.86, 95% CI: 0.81–0.91), major adverse kidney events (HR: 0.86, 95% CI: 0.82–0.91), all-cause hospitalization (HR: 0.91, 95% CI: 0.84–0.97), and all-cause mortality (HR: 0.82, 95% CI: 0.77–0.88) compared with DPP4i users. No significant differences were observed between the groups in the rate of heart failure or bone fractures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GLP-1 RAs may offer substantial cardiorenal and survival benefits in patients aged 80 years and older with T2DM. These findings support the use of GLP-1 RAs as a therapeutic option in this high-risk, older population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"96-106"},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357374","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}
Sunny C. Lin, Shekinah Fashaw-Walters, Gmerice Hammond, Ganesh M. Babulal, Ellesse-Roselee Akré, Bailey A. Martin Giacalone, R. J. Waken, Karen Joynt Maddox
Background
Racial segregation is believed to play a critical role in enforcing racial disparities in nursing home quality. In this study, we test whether segregation exacerbates racial disparities in nursing home quality.
Methods
We used data from the 2023 Minimum Data Set (MDS) and 2025 public use files on nursing home quality from the Center for Medicare and Medicaid Services to compare the quality of nursing homes with a high versus low proportion of Black residents and assess whether that relationship varied depending on the level of racial segregation among nursing homes in the county. Racial segregation was measured based on how Black and non-Hispanic White nursing home residents were distributed across nursing homes in a county. Nursing home quality measures included: star ratings, nursing turnover rates, adjusted staffing hours, and inspection deficiency scores.
Results
Racial disparities existed at all levels of segregation. Nursing home segregation was associated with widening disparities in inspection deficiency scores; no statistically significant association was found between segregation and racial disparities in star rating, nursing turnover rates, or adjusted staffing hours.
Conclusions
Racial disparities in nursing home quality are stark, with disparities in inspection deficiency scores exacerbated in counties with more segregated nursing home markets. These findings highlight the need for targeted policies to mitigate the impact of systemic disinvestment on nursing homes that serve a high proportion of Black residents.
{"title":"Nursing Home Segregation and Quality of Care","authors":"Sunny C. Lin, Shekinah Fashaw-Walters, Gmerice Hammond, Ganesh M. Babulal, Ellesse-Roselee Akré, Bailey A. Martin Giacalone, R. J. Waken, Karen Joynt Maddox","doi":"10.1111/jgs.70165","DOIUrl":"10.1111/jgs.70165","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Racial segregation is believed to play a critical role in enforcing racial disparities in nursing home quality. In this study, we test whether segregation exacerbates racial disparities in nursing home quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the 2023 Minimum Data Set (MDS) and 2025 public use files on nursing home quality from the Center for Medicare and Medicaid Services to compare the quality of nursing homes with a high versus low proportion of Black residents and assess whether that relationship varied depending on the level of racial segregation among nursing homes in the county. Racial segregation was measured based on how Black and non-Hispanic White nursing home residents were distributed across nursing homes in a county. Nursing home quality measures included: star ratings, nursing turnover rates, adjusted staffing hours, and inspection deficiency scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Racial disparities existed at all levels of segregation. Nursing home segregation was associated with widening disparities in inspection deficiency scores; no statistically significant association was found between segregation and racial disparities in star rating, nursing turnover rates, or adjusted staffing hours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Racial disparities in nursing home quality are stark, with disparities in inspection deficiency scores exacerbated in counties with more segregated nursing home markets. These findings highlight the need for targeted policies to mitigate the impact of systemic disinvestment on nursing homes that serve a high proportion of Black residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3757-3765"},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357334","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}
Derek Lake, Soryan Kumar, Fangli Geng, Pedro Gozalo
Background
Prior research suggests discharge to inpatient rehabilitation facilities (IRF) leads to improved outcomes for stroke and hip fracture patients relative to skilled nursing facilities (SNF), while incurring greater costs. However, these estimates are likely biased by non-random patient selection.
Methods
We used a quasi-experimental design to compare post-acute care outcomes among Medicare beneficiaries hospitalized for stroke or hip fracture in 55 US hospitals that closed their IRF units between 2009 and 2017. Primary and secondary outcomes were 30-, 90-, and 180-day readmission and mortality, and successful community discharge.
Results
Among 10,761 stroke and 13,963 hip fracture hospitalizations, IRF discharge declined sharply, offset by increases to SNF and home health. Relative to IRF, SNF discharge was associated with no significant differences in readmissions but an increase in 90-day mortality for stroke (+6.5%, 95% CI 1.5%–11.4%) and hip fracture (+5.8%, 95% CI 2.5%–9.0%). Successful community discharge did not differ for patients redirected to SNF, but stroke patients redirected to home health had significantly higher rates of successful discharge (DID estimate: +6.8%; 95% CI 0.1%–13.5%). The protective effect of IRF was concentrated within 20 days post-discharge.
Conclusions
Following hospitalization for stroke and hip fracture, discharge to an IRF was associated with lower mortality relative to SNF. However, given the potential for unmeasured confounding, this association should be interpreted with caution. Careful post-acute care referral protocols are critical to ensure good patient outcomes.
背景：先前的研究表明，相对于熟练护理设施（SNF），住院康复设施（IRF）可以改善中风和髋部骨折患者的预后，但会产生更高的费用。然而，这些估计可能因非随机患者选择而有偏差。方法：我们采用准实验设计，比较2009年至2017年期间关闭IRF单位的55家美国医院因中风或髋部骨折住院的医疗保险受益人的急性后护理结果。主要和次要结局是30、90和180天的再入院和死亡率，以及成功的社区出院。结果：在10,761例卒中和13,963例髋部骨折住院患者中，IRF出院率急剧下降，被SNF和家庭健康的增加所抵消。相对于IRF， SNF出院与再入院无显著差异，但卒中（+6.5%,95% CI 1.5%-11.4%）和髋部骨折（+5.8%,95% CI 2.5%-9.0%）的90天死亡率增加。转到SNF的患者成功出院的社区没有差异，但转到家庭健康的卒中患者成功出院的比例显著更高（did估计：+6.8%;95% CI 0.1%-13.5%）。IRF的保护作用在出院后20天内集中。结论：卒中和髋部骨折住院后，与SNF相比，IRF出院的死亡率较低。然而，考虑到潜在的无法测量的混杂，这种关联应该谨慎解释。仔细的急性后护理转诊协议对于确保良好的患者预后至关重要。
{"title":"Comparative Effectiveness of Inpatient Rehabilitation Versus Skilled Nursing Facilities for Stroke and Hip Fracture Patients","authors":"Derek Lake, Soryan Kumar, Fangli Geng, Pedro Gozalo","doi":"10.1111/jgs.70164","DOIUrl":"10.1111/jgs.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Prior research suggests discharge to inpatient rehabilitation facilities (IRF) leads to improved outcomes for stroke and hip fracture patients relative to skilled nursing facilities (SNF), while incurring greater costs. However, these estimates are likely biased by non-random patient selection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a quasi-experimental design to compare post-acute care outcomes among Medicare beneficiaries hospitalized for stroke or hip fracture in 55 US hospitals that closed their IRF units between 2009 and 2017. Primary and secondary outcomes were 30-, 90-, and 180-day readmission and mortality, and successful community discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 10,761 stroke and 13,963 hip fracture hospitalizations, IRF discharge declined sharply, offset by increases to SNF and home health. Relative to IRF, SNF discharge was associated with no significant differences in readmissions but an increase in 90-day mortality for stroke (+6.5%, 95% CI 1.5%–11.4%) and hip fracture (+5.8%, 95% CI 2.5%–9.0%). Successful community discharge did not differ for patients redirected to SNF, but stroke patients redirected to home health had significantly higher rates of successful discharge (DID estimate: +6.8%; 95% CI 0.1%–13.5%). The protective effect of IRF was concentrated within 20 days post-discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Following hospitalization for stroke and hip fracture, discharge to an IRF was associated with lower mortality relative to SNF. However, given the potential for unmeasured confounding, this association should be interpreted with caution. Careful post-acute care referral protocols are critical to ensure good patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"64-73"},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357336","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}
Krista L. Harrison, Sun Y. Jeon, W. James Deardorff, Alexandra K. Lee, Lauren J. Hunt, Claire Ankuda, Melissa D. Aldridge, Kenneth E. Covinsky, Irena Cenzer, W. John Boscardin, Sei J. Lee, Alexander K. Smith
<p>People with dementia (PWD) with less than a 6-month prognosis stand to benefit from discussions about goals of care, medications, and deprescribing, and hospice [<span>1</span>]. Hospice eligibility requires a 6-month prognosis, but existing 6-month prognostic models are not accurate [<span>2</span>] nor easily replicable [<span>3</span>] for community-dwelling PWD. The “Deardorff 1–10 year Mortality in Dementia Index” has been shown to be effective at assessing mortality at 1, 2, 5, and 10 years among community-dwelling PWD [<span>4</span>]. As indicators of its use in clinical practice, the original manuscript has been cited 36 times between 2022 and 2025; in addition, monthly use of the Index in ePrognosis (https://eprognosis.ucsf.edu/dementia.php) ranges from 8000 and 11,000 people in 2025. We tested its performance for a 6-month prognosis.</p><p>As previously reported, we used the Health and Retirement Study (HRS) 1998–2016 (internal validation) and the National Health and Aging Trends Study (NHATS) 2011–2019 (external validation). We also replicated the analyses with newer data: HRS 2018–2022 and NHATS 2020–2023 (temporal validation).</p><p>Participants were age 65+, community-dwelling, with a 50%+ probability of dementia per the Wu-Glymour algorithm [<span>5</span>]. Predictors were assessed at the time of dementia identification: age, sex, body mass index, smoking status, count of activities of daily living dependencies (1–5), count of instrumental activities of daily living difficulties (1–5), difficulty walking several blocks, participation in vigorous physical activity, and presence of cancer, heart disease, diabetes, or lung disease. The primary outcome was death within 6 months. Missing variables were multiply imputed (<i>m</i> = 20).</p><p>We assessed model performance for 6-month prognosis by applying the previously developed Deardorff index to obtain predicted risks and evaluated discrimination (time-specific area under the receiver operating characteristic curve [AUC]), accounting for survey weights, calibration (plots of predicted and observed mortality), and calculation of sensitivity, specificity, positive and negative predictive value for various 6-month mortality risk thresholds. We re-estimated coefficients and tested the model in a subpopulation with greater disability, but performance was not superior. Our reporting was guided by the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) guidelines [<span>6</span>]. The study was approved by the UCSF Human Research Protection Program.</p><p>Of 4267 PWD in HRS (internal validation), the mean (SD) age was 82.2 (7.6) years, 2930 (69.4%) were female, and 785 (survey-weighted 12.1%) identified as Black. Median (IQR) follow-up time was 3.9 (2.0–6.8) years. Of these, 239 died within 6 months (survey-weighted 5.3%). The time-specific AUC at 6 months was 0.76 (95% confidence interval [CI], 0.74–0.77).</p><p>Of 2404 PWD in NHATS
预后少于6个月的痴呆症（PWD）患者可以从关于护理目标、药物、处方和临终关怀bb10的讨论中获益。安宁疗护资格需要6个月的预后，但现有的6个月预后模型对于社区居住的残疾人士并不准确，也不容易复制。“Deardorff 1 - 10年痴呆死亡率指数”已被证明在评估社区居住的残疾儿童1、2、5和10年死亡率方面是有效的。作为临床应用的指标，2022 - 2025年间原稿被引36次；此外，到2025年，每月使用ePrognosis （https://eprognosis.ucsf.edu/dementia.php）指数的人数将在8000至11000人之间。我们测试了它六个月的预后。如前所述，我们使用了1998-2016年健康与退休研究（HRS）（内部验证）和2011-2019年国家健康与老龄化趋势研究（NHATS）（外部验证）。我们还使用更新的数据重复了分析：HRS 2018-2022和NHATS 2020-2023（时间验证）。参与者年龄在65岁以上，居住在社区，根据Wu-Glymour算法[5]，痴呆症的概率为50%以上。在痴呆识别时评估预测因素：年龄、性别、体重指数、吸烟状况、日常生活依赖活动计数（1-5）、日常生活困难的工具活动计数（1-5）、步行几个街区的困难、参与剧烈体育活动以及癌症、心脏病、糖尿病或肺部疾病的存在。主要结局为6个月内死亡。对缺失变量进行多重估算（m = 20）。我们通过应用先前开发的Deardorff指数来评估模型6个月预后的性能，以获得预测风险和评估歧视（受试者工作特征曲线下的时间特异性面积[AUC]），考虑调查权重，校准（预测和观察死亡率图），以及计算各种6个月死亡率风险阈值的敏感性，特异性，阳性和阴性预测值。我们重新估计了系数，并在残疾程度更高的亚群中测试了模型，但效果并不好。我们的报告是在透明报告个体预后或诊断多变量预测模型（TRIPOD）指南[6]的指导下进行的。这项研究得到了加州大学旧金山分校人类研究保护计划的批准。在HRS（内部验证）的4267名PWD中，平均（SD）年龄为82.2（7.6）岁，2930（69.4%）为女性，785（调查加权12.1%）为黑人。中位（IQR）随访时间为3.9（2.0 ~ 6.8）年。其中239人在6个月内死亡（调查加权5.3%）。6个月时的时间特异性AUC为0.76（95%可信区间[CI]， 0.74-0.77）。在NHATS的2404例PWD（外部验证）中，176例在6个月内死亡（调查加权7.1%）；25%的人在43天内死亡，75%的人在138天内死亡。6个月时的时间特异性AUC为0.71 （95% CI, 0.67-0.75）。校准图显示，在预测风险的十分位数上，观察到的风险和预测的风险之间存在很强的一致性（图1）。在5%风险阈值以上，特异性和阴性预测值较高，敏感性和阳性预测值较低（表1）。更新数据的时间验证发现HRS中新增n = 498例新诊断的PWD，其中31例在6个月内死亡；NHATS中新诊断的PWD患者n = 412例，其中17例在6个月内死亡。时间特异性auc相似(HRS为0.70 (95% CI, 0.61-0.79)；NHATS为0.77 （95% CI, 0.64-0.89）。通过模型性能的传统测量，Deardorff 1-10年痴呆死亡率指数在6个月的结果中表现良好，与1年Deardorff指数相似（AUC统计量0.73）。然而，在该社区居住的PWD样本中，6个月死亡率罕见（~5%），因此，该指数具有高特异性，低敏感性和低阳性预测值。局限性包括尽管使用了经过验证的算法，但仍可能对痴呆症进行错误分类，缺乏有关痴呆症病因或严重程度的信息，以及6个月时的低死亡率（这影响了阳性和阴性预测值的估计，但不影响敏感性或特异性）。在临床实践或卫生系统中，该指数可作为一种筛查工具，用于识别社区居住的痴呆症成人，以进行高可能受益和低伤害风险的姑息性干预，包括关于目标、开处方的机会和未来护理计划的对话。Sun Y. Jeon对研究中的所有数据有完全的访问权，并对数据的完整性和数据分析的准确性负责。研究概念与设计：Krista L. Harrison， W. James Deardorff, Kenneth E. Covinsky, Alexander K. Smith, Sei J. Lee。数据获取：Alexander K. Smith, Sei J。
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Brent R. Schell, Jesse R. Katz, Megan Carr, Maryam Hasan
{"title":"Combating Ageism and Improving Attitudes Towards Aging Among Medicine Residents","authors":"Brent R. Schell, Jesse R. Katz, Megan Carr, Maryam Hasan","doi":"10.1111/jgs.70179","DOIUrl":"10.1111/jgs.70179","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3947-3949"},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357418","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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