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。
{"title":"Six-Month Prognostic Tool for Community-Dwelling People With Dementia","authors":"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","doi":"10.1111/jgs.70183","DOIUrl":"10.1111/jgs.70183","url":null,"abstract":"<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 ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"269-271"},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12695061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357358","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}
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}
Hannah J. Wong, Hsien Seow, Anastasia Gayowsky, Robert C. Wu, Hilda Lim, Rinku Sutradhar
Background
Goals of care (GOC) discussions between the clinical team and nursing home (NH) residents provide the basis for decision-making on advance directives (AD) that include do-not-resuscitate (DNR) and do-not-hospitalize (DNH). Optimal timing and prompts for initiating GOC discussions are unclear. This study investigates recent emergency department (ED) use and clinical and demographic factors associated with subsequent AD changes.
Methods
Nested case–control study within a population-based retrospective cohort using linked administrative health care data of individuals admitted to NHs in Ontario, Canada between 2013 and 2017 and then followed up until 2019. Eligible cases and controls were residents with and without an AD change between 2013 and 2019, respectively. Cases and controls were matched 1:1 by sex, composite AD at NH admission, NH admission date (±90 days), and birthdate (±365 days). The primary outcome was incident AD change, and exposures included recent ED use (either ED visits discharged back to NH or ED visits that resulted in hospitalization) and clinical and demographic variables measured at the time of documented AD change. Conditional logistic regression provided adjusted odds ratios for associations between exposures and incident AD change.
Results
The cases and controls (27,942 residents) had a mean age of 84 years at NH admission and 67.1% were female. 48.3% had a baseline AD of “DNR Only” while the remaining were evenly divided between “Full Code” and “DNR+DNH.” The estimated adjusted odds ratio of AD change was 2.01 (95% CI, 1.83–2.21) in residents with recent hospitalization, 1.89 (95% CI, 1.67–2.13) in those having end-stage disease, and 1.82 (95% CI, 1.56–2.12) in residents who were mostly bedfast.
Conclusions
A recent hospitalization, end-stage disease, or being bedfast are significant predictors of AD change. These important predictors exhibited by NH residents present opportunities to reassess GOC.
{"title":"Predictors of Advance Directive Changes in Ontario Nursing Home Residents: A Case–Control Study","authors":"Hannah J. Wong, Hsien Seow, Anastasia Gayowsky, Robert C. Wu, Hilda Lim, Rinku Sutradhar","doi":"10.1111/jgs.70184","DOIUrl":"10.1111/jgs.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Goals of care (GOC) discussions between the clinical team and nursing home (NH) residents provide the basis for decision-making on advance directives (AD) that include do-not-resuscitate (DNR) and do-not-hospitalize (DNH). Optimal timing and prompts for initiating GOC discussions are unclear. This study investigates recent emergency department (ED) use and clinical and demographic factors associated with subsequent AD changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Nested case–control study within a population-based retrospective cohort using linked administrative health care data of individuals admitted to NHs in Ontario, Canada between 2013 and 2017 and then followed up until 2019. Eligible cases and controls were residents with and without an AD change between 2013 and 2019, respectively. Cases and controls were matched 1:1 by sex, composite AD at NH admission, NH admission date (±90 days), and birthdate (±365 days). The primary outcome was incident AD change, and exposures included recent ED use (either ED visits discharged back to NH or ED visits that resulted in hospitalization) and clinical and demographic variables measured at the time of documented AD change. Conditional logistic regression provided adjusted odds ratios for associations between exposures and incident AD change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cases and controls (27,942 residents) had a mean age of 84 years at NH admission and 67.1% were female. 48.3% had a baseline AD of “DNR Only” while the remaining were evenly divided between “Full Code” and “DNR+DNH.” The estimated adjusted odds ratio of AD change was 2.01 (95% CI, 1.83–2.21) in residents with recent hospitalization, 1.89 (95% CI, 1.67–2.13) in those having end-stage disease, and 1.82 (95% CI, 1.56–2.12) in residents who were mostly bedfast.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A recent hospitalization, end-stage disease, or being bedfast are significant predictors of AD change. These important predictors exhibited by NH residents present opportunities to reassess GOC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"107-118"},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357384","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}
Alanna C. Bridgman, Mohammad Arshad Imrit, Surain B. Roberts, Mina Tadrous, Nathan M. Stall, Michael Fralick, Jennifer Watt, Amol A. Verma, Fahad Razak, Aaron M. Drucker
Background
Small studies have reported associations between first-generation antihistamines and delirium. It is unclear whether first-generation antihistamines cause clinically important delirium among older adult inpatients.
Objective
To estimate the association between inpatient physician prescribing of first-generation antihistamines and delirium among older general medicine inpatients.
Methods
Cross-sectional study using the GEMINI database of inpatient admissions between April 1, 2015, and March 31, 2022, across 17 hospitals in Ontario, Canada, among people aged 65 years and older. The main exposure was the proportion of attending physicians' admissions by quartile that included a first-generation antihistamine prescription. The primary outcome was inpatient delirium identified using a machine learning tool. We estimated the association between attending physicians' first-generation antihistamine prescribing rate and individual inpatients' risk of delirium using multivariable mixed-effects logistic regression.
Results
Among 328,140 inpatient admissions to 755 physicians, 11,507 (3.5%) admissions included a first-generation antihistamine prescription. Physicians in the lowest quartile prescribed a first-generation antihistamine during 2.1% of admissions compared to 5.4% of physicians in the highest quartile. Delirium occurred in 32.3% of admissions to the lowest-prescribing quartile and 36.6% of the highest-prescribing quartile of physicians. In adjusted analyses, every 1% absolute increase in first-generation antihistamine prescribing was associated with 8% increased odds of delirium (aOR: 1.08, 95% CI: 1.05–1.10). Patients admitted to physicians in the highest quartile had 41% increased odds of delirium compared to the lowest quartile (aOR: 1.41, 95% CI: 1.28–1.56).
Conclusions
Older adults admitted to physicians who prescribe first-generation antihistamines more commonly were more likely to experience delirium in the hospital.
{"title":"Association of Inpatient Prescribing of First-Generation Antihistamines With Delirium in Older Adults: A Cross-Sectional Study","authors":"Alanna C. Bridgman, Mohammad Arshad Imrit, Surain B. Roberts, Mina Tadrous, Nathan M. Stall, Michael Fralick, Jennifer Watt, Amol A. Verma, Fahad Razak, Aaron M. Drucker","doi":"10.1111/jgs.70121","DOIUrl":"10.1111/jgs.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Small studies have reported associations between first-generation antihistamines and delirium. It is unclear whether first-generation antihistamines cause clinically important delirium among older adult inpatients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To estimate the association between inpatient physician prescribing of first-generation antihistamines and delirium among older general medicine inpatients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional study using the GEMINI database of inpatient admissions between April 1, 2015, and March 31, 2022, across 17 hospitals in Ontario, Canada, among people aged 65 years and older. The main exposure was the proportion of attending physicians' admissions by quartile that included a first-generation antihistamine prescription. The primary outcome was inpatient delirium identified using a machine learning tool. We estimated the association between attending physicians' first-generation antihistamine prescribing rate and individual inpatients' risk of delirium using multivariable mixed-effects logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 328,140 inpatient admissions to 755 physicians, 11,507 (3.5%) admissions included a first-generation antihistamine prescription. Physicians in the lowest quartile prescribed a first-generation antihistamine during 2.1% of admissions compared to 5.4% of physicians in the highest quartile. Delirium occurred in 32.3% of admissions to the lowest-prescribing quartile and 36.6% of the highest-prescribing quartile of physicians. In adjusted analyses, every 1% absolute increase in first-generation antihistamine prescribing was associated with 8% increased odds of delirium (aOR: 1.08, 95% CI: 1.05–1.10). Patients admitted to physicians in the highest quartile had 41% increased odds of delirium compared to the lowest quartile (aOR: 1.41, 95% CI: 1.28–1.56).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older adults admitted to physicians who prescribe first-generation antihistamines more commonly were more likely to experience delirium in the hospital.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3475-3483"},"PeriodicalIF":4.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350794","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}
Hyungsoek Daniel Oh, Thaer Idrees, Theodore M. Johnson II
<p>In this issue of the <i>Journal of the American Geriatrics Society</i>, Khan et al. [<span>1</span>], offer evidence attesting to the superior ability of continuous glucose monitors (CGMs) to detect hypoglycemia when compared to finger blood glucose (FBG) readings in skilled nursing facility (SNF) residents. Hypoglycemic events have been associated in older adults with falls and fractures, future cognitive impairment, and functional decline, suggesting the need to better detect low blood sugar [<span>2, 3</span>]. We offer in this commentary a brief overview of CGMs, a description of how they might be used differently according to the setting of care, and data showing US older adults' increased use of these devices. Given that technology can either fit or fail when introduced to a SNF, we demonstrate an evaluative framework [<span>4</span>] for looking at devices using two examples (bed alarms for fall prevention; CGMs for hypoglycemia detection and improved glucose control in older adults with Type 2 diabetes mellitus [T2D]).</p><p>CGMs largely perform two core functions. First, CGMs continuously or repeatedly detect if glucose is high (hyperglycemia), low (hypoglycemia), or in the appropriate range. Second, the glucose values and trends from CGMs provide an opportunity to intervene (medications, diet, activity) and then quickly assess the effects. Continuous glucose monitors (CGMs) have the 2025 American Diabetes Association's highest standard of care recommendation (Grade A) for use in people with type 1 diabetes mellitus and for their introduction at the time of diagnosis [<span>5</span>]. The ADA also offers strong endorsements for CGM use in older adults with T2D that receive either insulin therapy or other medications known to lower blood glucose (both Grade B) [<span>5</span>]. How CGMs are used will differ by patient group, setting of care, and purpose of monitoring (Table 1). A 2025 study of payer databases found that, among adults over 65 with T2D on insulin, annual CGM initiation rates rose from 107 to 5249 per 100,000 in Medicare Fee-for-Service (2013–2020) and from 796 to 9195 per 100,000 in the Clinformatics Data Mart Database (2013–2022) [<span>6</span>]. These figures show a 10–40 fold increase in payer-funded CGM starts, yet that would be only about 10% of US older adults with T2D on insulin. These data likely underestimate true CGM use since they are limited to insurance claims only until 2020 or 2022, exclude self-paid CGMs use, and do not capture recommended use in T2D patients not on insulin.</p><p>How CGMs work in other settings may not predict benefit in SNFs. Innovative health technology brought into SNFs can fit or fail. Zhao et al. used a scoping review to identify themes predicting when technology introduced into SNFs is truly “smart technology” [<span>4</span>]. This evidence-informed approach for SNF integration suggests four key factors (FIPPS): technological feasibility (F); easy access to information (I); fit w
在本期的《美国老年病学会杂志》上，Khan等人提供了证据，证明连续血糖监测仪（cgm）在检测低血糖方面比熟练护理机构（SNF）居民的手指血糖（FBG）读数更有优势。低血糖事件与老年人跌倒和骨折、未来认知障碍和功能下降有关，这表明需要更好地检测低血糖[2,3]。我们在这篇评论中提供了cgm的简要概述，描述了如何根据护理设置不同地使用cgm，以及显示美国老年人增加使用这些设备的数据。考虑到技术在引入SNF时可能适合也可能失败，我们展示了一个评估框架[4]，通过两个例子来观察设备（用于预防跌倒的床报警器；用于低血糖检测的CGMs和改善2型糖尿病老年人的血糖控制[T2D]）。cgm主要执行两个核心功能。首先，cgm连续或反复检测葡萄糖是高（高血糖）、低（低血糖）还是在适当的范围内。其次，CGMs的血糖值和趋势为干预（药物、饮食、活动）提供了一个机会，然后快速评估效果。连续血糖监测仪（cgm）具有2025年美国糖尿病协会最高标准的护理推荐（A级），用于1型糖尿病患者，并在诊断时引入。美国糖尿病协会（ADA）也强烈支持在接受胰岛素治疗或其他已知降血糖药物（均为B级）的老年t2dm患者中使用CGM。如何使用cgm将因患者组、护理环境和监测目的而异（表1）。2025年对付款人数据库的研究发现，在接受胰岛素治疗的65岁以上t2dm患者中，医疗服务收费（2013-2020）的年度CGM启动率从每10万人107例上升到5249例，临床信息学数据集市数据库（2013-2022）的年度CGM启动率从每10万人796例上升到9195例。这些数据表明，由支付者资助的CGM启动量增加了10-40倍，但这仅占美国老年糖尿病患者胰岛素治疗的10%左右。这些数据可能低估了CGM的真实使用，因为它们仅限于2020年或2022年之前的保险索赔，不包括自费CGM的使用，也没有包括未使用胰岛素的t2dm患者的推荐使用。cgm在其他情况下的作用可能无法预测snf的获益。引进snf的创新卫生技术可能适合也可能失败。Zhao等人使用范围审查来确定主题，预测何时将技术引入snf是真正的“智能技术”[4]。基于证据的SNF整合方法提出了四个关键因素（FIPPS）：技术可行性(F)；方便获取信息（一）；符合当前临床实践模式（PP）；以及所有利益相关者的可接受性。在这里，我们将首先将这个SNF FIPPS框架应用于过去的技术介绍（床警报），然后应用于CGM。在床上警报器被引入几十年后，研究人员对snf患者预防跌倒的床上警报器进行了系统回顾，发现没有高质量的研究证明其有效性[10]。但当床上警报技术被引入时，许多人表达了希望，而另一些人则认识到，真正的考验将是在护理系统的背景下对该设备进行评判。使用SNF FIPPS框架，床上报警器的可行性标准不足。该设备不会在预定的床位离开之前发出警报，但通常会在患者重新定位运动时发出警报，或者在响应人员发现患者迅速离开床并且已经摔倒的情况下发出“太晚无法帮助”的通知。床上的警报声提供的信息有限，也不符合该单位的实践模式，即工作人员在走廊上走动时提供护理。一名工作人员这样总结警报：“很多时候，你站在大厅中央，试图弄清楚它是从哪里来的。”结果对利益相关者来说是不可接受的(S)：护理和管理人员没有意识到跌倒的减少；助手们被告知要做得更好，监控警报和居民；居民们被要求保持静止，以免触发误报。多年后，研究人员主张，可以通过移除床上警报器来改善SNF的质量。这个SNF FIPPS框架也可以应用于CGM的使用。Kahn等人的研究结果支持cgm在技术上的可行性，以提供更好的低血糖捕获。在本研究中，CGMs被假定为金标准，与常规指测血糖（FBG）比较。他们招募了42名佩戴cgm 14天的人，他们的数据被收集到附近的服务器上。虽然FBG在检测低血糖方面表现出近乎完美的特异性，但FBG的敏感性极低。 换句话说，CGM检测到的每5个低血糖事件中，FBG只检测到1个。在我们之前的SNF随机临床试验[11]中，CGM识别血糖水平低于70 mg/dL的比率明显高于FBG （40.2% vs. 14%, p < 0.001）。在没有确定低血糖的情况下，人们可能不会适当地调整药物。虽然确定低血糖的理由很充分，但cgm改善snf患者总体糖尿病控制的技术可行性尚未得到证实。考虑到Khan研究的目的，他们让SNF的工作人员和提供者对CGM的输出视而不见。在Idrees等人对胰岛素治疗的t2snf患者进行的长达60天的随机试验中，葡萄糖时间范围（70-180 mg/dL）或高于或低于该范围的时间在预定的研究结果中没有显著差异。同样，在所有情况下接受非胰岛素治疗的患者的CGM研究均未一致显示A1C水平有临床显著降低。表2显示了赵通知SNF FIPPS框架的详细阐述，指出了促进因素和障碍（表2）。我们提供一些要点供您参考。首先，我们同意Kahn等人的观点，即cgm在检测snf低血糖方面优于标准FBG。但这也意味着snf正在处理一个以前未被认识到的问题，不像床上警报针对的是一个众所周知的重要问题。SNF决策者可能需要更多的证据才能将其视为首要任务。其次，ADA标准适当地认识到，当糖尿病护理和设备由护理人员管理时，他们的技能和偏好应纳入决策过程[b]。这意味着snf的工作人员需要经过全面的培训才能正确使用CGM并提供准确的结果。第三，目前在snf中进行的试验尚未证明来自CGMs和FBG的信息改善了重要参数，如在范围内（70-180 mg/dL）的时间，并减少了低于或高于范围的时间。为了证明CGM可以改善snf的血糖控制，领导者需要时间来访问和审查数据，调整实践，并评估利益相关者的满意度。CGM有两种形式：实时CGM (rtCGM)，它提供连续读数；间歇扫描CGM (isCGM)，它需要至少每8小时扫描一次。有了这些优点，rtCGM在snf中可能会更实用。最后，虽然snf可能会选择不启动CGM计划，但他们仍然需要解决如何管理已经使用这些设备的新入院居民。这篇文章的三位作者都符合ICMJE的署名条件。Drs。吴亨锡（Hyungsoek Daniel Oh）和西奥多·约翰逊（Theodore M. Johnson II）也做出了同样的贡献。三位作者都对本书的构思做出了重大贡献，参与了对重要知识内容的起草和批判性审查，批准了最终版本的出版，并同意对本书的各个方面负责。没有人赞助这项工作。具体来说，Dexcom的代表不知道这份手稿的准备工作，也没有参与这项工作。ther Idrees， Hyungsoek Daniel Oh和Theodore M. Johnson II是Dexcom （Umpierrez， PI, Dexcom IIS-2020-119）资助的一项先前研究的共同作者（PMID: 38460943），旨在评估实时连续血糖监测（t- cgm）在调整熟练护理机构（snf）胰岛素治疗中的效果。ther Idrees博士是艾伯维（AbbVie, Avanti, ClinicalTrials.gov, ID nct06345339,2024 - 2027）资助的一项埃默里研究的无偿现场pi，用于测试Armor Thyroid。亨锡丹尼尔·吴和西奥多·
{"title":"Aligning Innovation With Care: Continuous Glucose Monitoring in Skilled Nursing Facilities","authors":"Hyungsoek Daniel Oh, Thaer Idrees, Theodore M. Johnson II","doi":"10.1111/jgs.70168","DOIUrl":"10.1111/jgs.70168","url":null,"abstract":"<p>In this issue of the <i>Journal of the American Geriatrics Society</i>, Khan et al. [<span>1</span>], offer evidence attesting to the superior ability of continuous glucose monitors (CGMs) to detect hypoglycemia when compared to finger blood glucose (FBG) readings in skilled nursing facility (SNF) residents. Hypoglycemic events have been associated in older adults with falls and fractures, future cognitive impairment, and functional decline, suggesting the need to better detect low blood sugar [<span>2, 3</span>]. We offer in this commentary a brief overview of CGMs, a description of how they might be used differently according to the setting of care, and data showing US older adults' increased use of these devices. Given that technology can either fit or fail when introduced to a SNF, we demonstrate an evaluative framework [<span>4</span>] for looking at devices using two examples (bed alarms for fall prevention; CGMs for hypoglycemia detection and improved glucose control in older adults with Type 2 diabetes mellitus [T2D]).</p><p>CGMs largely perform two core functions. First, CGMs continuously or repeatedly detect if glucose is high (hyperglycemia), low (hypoglycemia), or in the appropriate range. Second, the glucose values and trends from CGMs provide an opportunity to intervene (medications, diet, activity) and then quickly assess the effects. Continuous glucose monitors (CGMs) have the 2025 American Diabetes Association's highest standard of care recommendation (Grade A) for use in people with type 1 diabetes mellitus and for their introduction at the time of diagnosis [<span>5</span>]. The ADA also offers strong endorsements for CGM use in older adults with T2D that receive either insulin therapy or other medications known to lower blood glucose (both Grade B) [<span>5</span>]. How CGMs are used will differ by patient group, setting of care, and purpose of monitoring (Table 1). A 2025 study of payer databases found that, among adults over 65 with T2D on insulin, annual CGM initiation rates rose from 107 to 5249 per 100,000 in Medicare Fee-for-Service (2013–2020) and from 796 to 9195 per 100,000 in the Clinformatics Data Mart Database (2013–2022) [<span>6</span>]. These figures show a 10–40 fold increase in payer-funded CGM starts, yet that would be only about 10% of US older adults with T2D on insulin. These data likely underestimate true CGM use since they are limited to insurance claims only until 2020 or 2022, exclude self-paid CGMs use, and do not capture recommended use in T2D patients not on insulin.</p><p>How CGMs work in other settings may not predict benefit in SNFs. Innovative health technology brought into SNFs can fit or fail. Zhao et al. used a scoping review to identify themes predicting when technology introduced into SNFs is truly “smart technology” [<span>4</span>]. This evidence-informed approach for SNF integration suggests four key factors (FIPPS): technological feasibility (F); easy access to information (I); fit w","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3314-3317"},"PeriodicalIF":4.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350831","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}
Marie-Josée Sirois, Joannie Blais, Mylène Aubertin-Leheudre, Pierre-Hugues Carmichael, Laurence Fruteau de Laclos, Audrey Desjardins, Raoul Daoust, Debra Eagles, Jacques Lee, Jeffrey J. Perry, Nancy M. Salbach, Marcel Émond
Background
Older adults consulting Emergency Departments (EDs) for minor injuries are at risk for new functional impairments in the 6 months following their injuries.
Objective
To compare the effects of exercise programs versus usual ED practices on functional status and physical performance at 3–6 months in at-risk older adults with minor injuries.
Design and Settings
Stepped-wedge randomized trial in six Canadian EDs from 2017 to 2020. Participants aged ≥ 65 years were screened for low, moderate, or high risk of functional decline and assessed three times: baseline at ED, 3 and 6 months.
Intervention and Measures
Multicomponent (flexibility, balance, strengthening, aerobic) and risk-level adapted exercise programs targeting moderate- and high-risk patients, 3×/week for 12 weeks, at home or in community groups. Control: Usual ED care. Measures: Functional decline was defined as a 2/28-point loss from baseline on the Older Americans Resources and Services (OARS) scale. Basic physical performance (leg strength, balance, walking speed) was measured using the Short Physical Performance Battery (SPPB) test. Generalized linear mixed log-binomial regressions were used to examine the effects of the intervention on outcomes compared to usual ED care, stratified by risk level.
Results
The intervention and control phases included 277 and 205 moderate-risk individuals, and 249 and 128 high-risk individuals, respectively. Among moderate-risk individuals, functional loss in intervention participants at 3 months was half that of controls: 12% [95% CI: 8%–17%] vs. 25% [95% CI: 18%–34%], RR: 0.48 [0.26, 0.90].
Conclusion
12-week multicomponent exercises implemented early after minor injuries are associated with lower proportions of functional decline at 3 months in moderate-risk seniors and may help those at high risk recover some physical performance.
{"title":"Effectiveness of Exercise in Older Adults Discharged From the ER After Minor Injuries: The CEDeComS Stepped-Wedge Trial","authors":"Marie-Josée Sirois, Joannie Blais, Mylène Aubertin-Leheudre, Pierre-Hugues Carmichael, Laurence Fruteau de Laclos, Audrey Desjardins, Raoul Daoust, Debra Eagles, Jacques Lee, Jeffrey J. Perry, Nancy M. Salbach, Marcel Émond","doi":"10.1111/jgs.70166","DOIUrl":"10.1111/jgs.70166","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older adults consulting Emergency Departments (EDs) for minor injuries are at risk for new functional impairments in the 6 months following their injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the effects of exercise programs versus usual ED practices on functional status and physical performance at 3–6 months in at-risk older adults with minor injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Settings</h3>\u0000 \u0000 <p>Stepped-wedge randomized trial in six Canadian EDs from 2017 to 2020. Participants aged ≥ 65 years were screened for low, moderate, or high risk of functional decline and assessed three times: baseline at ED, 3 and 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention and Measures</h3>\u0000 \u0000 <p>Multicomponent (flexibility, balance, strengthening, aerobic) and risk-level adapted exercise programs targeting moderate- and high-risk patients, 3×/week for 12 weeks, at home or in community groups. <i>Control</i>: Usual ED care. <i>Measures</i>: Functional decline was defined as a 2/28-point loss from baseline on the Older Americans Resources and Services (OARS) scale. Basic physical performance (leg strength, balance, walking speed) was measured using the Short Physical Performance Battery (SPPB) test. Generalized linear mixed log-binomial regressions were used to examine the effects of the intervention on outcomes compared to usual ED care, stratified by risk level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The intervention and control phases included 277 and 205 moderate-risk individuals, and 249 and 128 high-risk individuals, respectively. Among moderate-risk individuals, functional loss in intervention participants at 3 months was half that of controls: 12% [95% CI: 8%–17%] vs. 25% [95% CI: 18%–34%], RR: 0.48 [0.26, 0.90].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>12-week multicomponent exercises implemented early after minor injuries are associated with lower proportions of functional decline at 3 months in moderate-risk seniors and may help those at high risk recover some physical performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>\u0000 ClinicalTrials.gov, ID Cedecoms NCT03991598</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"74-84"},"PeriodicalIF":4.5,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338376","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}
Calif A. A. Yousuf, Julie A. Womack, Roger J. Bedimo, Christopher T. Rentsch, Charlotte Warren-Gash
Background
Herpes zoster (HZ) and fragility fractures typically affect older adults and present major burdens to healthcare systems. While HZ is associated with an increased risk of neurological, ocular, skin, and visceral complications, it is unclear whether it affects long-term bone health. Therefore, we aimed to compare the risk of fragility fractures in Veterans with HZ relative to matched Veterans without HZ in the United States.
Methods
We used routinely collected data from the Veterans Aging Cohort Study (VACS-National) from 01/01/2008 to 31/12/2023. Veterans with incident HZ diagnoses aged 40+ were matched on age, sex, race, ethnicity, site of care, and calendar time with up to five Veterans without HZ. The association between HZ and subsequent fragility fractures (defined as hip/femoral, shoulder/upper arm, vertebral, and wrist/forearm fractures) overall and by site was assessed using a Cox model stratified by matched set adjusting for sociodemographic, lifestyle, and clinical confounders. Age, frailty, and receipt of antivirals (AVT) within 7 days of exposure were investigated as potential effect modifiers for the relationship.
Results
We included 229,992 Veterans with HZ matched to 1,134,519 Veterans without HZ. Both groups were comparable in median age (67.8 vs. 67.7 years), percentage males (93.5% vs. 93.7%), and median follow-up time (5.9 vs. 5.4 years). Veterans with HZ had a 15% higher risk of incident fragility fracture (aHR = 1.15, 95% CI: 1.13, 1.18) compared to Veterans without HZ. The increased risk was observed for each fracture site. There was evidence of interaction by age, frailty, and receipt of AVT, as older, frailer, and AVT-treated Veterans had a higher risk of fragility fracture.
Conclusions
Veterans with HZ were at a higher risk of fragility fractures relative to Veterans without HZ, highlighting the need for improved fracture prevention among those diagnosed with HZ. Further research in non-Veteran and female populations will improve generalizability.
{"title":"Association Between Herpes Zoster and Risk of Incident Fragility Fractures in US Veterans: A Matched Cohort Study","authors":"Calif A. A. Yousuf, Julie A. Womack, Roger J. Bedimo, Christopher T. Rentsch, Charlotte Warren-Gash","doi":"10.1111/jgs.70174","DOIUrl":"10.1111/jgs.70174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Herpes zoster (HZ) and fragility fractures typically affect older adults and present major burdens to healthcare systems. While HZ is associated with an increased risk of neurological, ocular, skin, and visceral complications, it is unclear whether it affects long-term bone health. Therefore, we aimed to compare the risk of fragility fractures in Veterans with HZ relative to matched Veterans without HZ in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used routinely collected data from the Veterans Aging Cohort Study (VACS-National) from 01/01/2008 to 31/12/2023. Veterans with incident HZ diagnoses aged 40+ were matched on age, sex, race, ethnicity, site of care, and calendar time with up to five Veterans without HZ. The association between HZ and subsequent fragility fractures (defined as hip/femoral, shoulder/upper arm, vertebral, and wrist/forearm fractures) overall and by site was assessed using a Cox model stratified by matched set adjusting for sociodemographic, lifestyle, and clinical confounders. Age, frailty, and receipt of antivirals (AVT) within 7 days of exposure were investigated as potential effect modifiers for the relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 229,992 Veterans with HZ matched to 1,134,519 Veterans without HZ. Both groups were comparable in median age (67.8 vs. 67.7 years), percentage males (93.5% vs. 93.7%), and median follow-up time (5.9 vs. 5.4 years). Veterans with HZ had a 15% higher risk of incident fragility fracture (aHR = 1.15, 95% CI: 1.13, 1.18) compared to Veterans without HZ. The increased risk was observed for each fracture site. There was evidence of interaction by age, frailty, and receipt of AVT, as older, frailer, and AVT-treated Veterans had a higher risk of fragility fracture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Veterans with HZ were at a higher risk of fragility fractures relative to Veterans without HZ, highlighting the need for improved fracture prevention among those diagnosed with HZ. Further research in non-Veteran and female populations will improve generalizability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3778-3788"},"PeriodicalIF":4.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12748036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310546","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}
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