{"title":"Playlist Prescriptions","authors":"Sophia J. Ruser, Jody Sharninghausen","doi":"10.1111/jgs.70214","DOIUrl":"10.1111/jgs.70214","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"249-251"},"PeriodicalIF":4.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145608031","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}
Chih-Ying Li, Yong-Fang Kuo, Md Ibrahim Tahashilder, Samantha S. M. Drover, Fangyun Wu, Bruce Landon, Bheeshma Ravi, Peter Cram
Background
Recent payment reforms in the United States have been credited with reducing the use of institutional post-acute care (PAC) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). This dual-country study of Canada and the United States compares longitudinal trends in discharge to institutional PAC after primary TKA or THA.
Methods
We conducted serial cross-sectional analyses to compare discharge to institutional PAC trends among adults aged ≥ 66 years undergoing primary TKA or THA in the United States and Canada from 2013 to 2019. Patient-level data were obtained from population-based Medicare claims in the United States and analogous datasets in Ontario. Discharge trends were assessed using standardized differences and linear regression models to evaluate relative changes over time.
Results
Patients receiving TKA (2,308,001) and THA (1,234,149) in the United States and Ontario (106,721 and 53,371, respectively) were similar in age (73–74 years) and sex (~60% female). The absolute reduction in institutional PAC discharge over time for TKA was greater in the United States (slope = −3.59) than in Canada (slope = −0.53) (p < 0.0001), but relative reductions (slope = −8.78 in the United States, slope = −6.99 in Canada) were statistically similar (p = 0.08). THA showed a similar trend of absolute reductions; however, the relative reduction trend in the United States (slope = −9.98) was steeper than in Canada (slope = −6.46) (p = 0.0009).
Conclusions
The US payment reforms from 2013 to 2019 were associated with a greater impact on reducing institutional PAC utilization for THA than for TKA.
{"title":"Trends in Discharge to Institutional Post-Acute Care After Total Joint Arthroplasty in the United States and Canada","authors":"Chih-Ying Li, Yong-Fang Kuo, Md Ibrahim Tahashilder, Samantha S. M. Drover, Fangyun Wu, Bruce Landon, Bheeshma Ravi, Peter Cram","doi":"10.1111/jgs.70210","DOIUrl":"10.1111/jgs.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent payment reforms in the United States have been credited with reducing the use of institutional post-acute care (PAC) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). This dual-country study of Canada and the United States compares longitudinal trends in discharge to institutional PAC after primary TKA or THA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted serial cross-sectional analyses to compare discharge to institutional PAC trends among adults aged ≥ 66 years undergoing primary TKA or THA in the United States and Canada from 2013 to 2019. Patient-level data were obtained from population-based Medicare claims in the United States and analogous datasets in Ontario. Discharge trends were assessed using standardized differences and linear regression models to evaluate relative changes over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients receiving TKA (2,308,001) and THA (1,234,149) in the United States and Ontario (106,721 and 53,371, respectively) were similar in age (73–74 years) and sex (~60% female). The absolute reduction in institutional PAC discharge over time for TKA was greater in the United States (slope = −3.59) than in Canada (slope = −0.53) (<i>p</i> < 0.0001), but relative reductions (slope = −8.78 in the United States, slope = −6.99 in Canada) were statistically similar (<i>p</i> = 0.08). THA showed a similar trend of absolute reductions; however, the relative reduction trend in the United States (slope = −9.98) was steeper than in Canada (slope = −6.46) (<i>p</i> = 0.0009).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The US payment reforms from 2013 to 2019 were associated with a greater impact on reducing institutional PAC utilization for THA than for TKA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"532-539"},"PeriodicalIF":4.5,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Kevin's Comb and Becky's Braids: A Model for Clinical Reasoning in Geriatric Medicine","authors":"Rebecca J. Stetzer, Kevin Costello","doi":"10.1111/jgs.70208","DOIUrl":"10.1111/jgs.70208","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"619-622"},"PeriodicalIF":4.5,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582859","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}
Kathryn G. Burford, Kathryn M. Neckerman, James W. Quinn, Michael D. M. Bader, Gina S. Lovasi, Stephen J. Mooney, Nicole G. Itzkowitz, Dirk Kinsey, Andrew G. Rundle
Background
Population-level interventions are needed to address the overrepresentation of older pedestrians in deaths from traffic crashes. Data are absent on whether specific publicly licensed or public establishments are associated with increased risk to older pedestrians, despite their attractiveness as partners for government efforts. We conducted a nationwide location-based case–control study to examine the associations between publicly licensed or public establishments of daily living for older adults and the location of pedestrian fatalities in motor vehicle crashes. We also assessed etiological heterogeneity by pedestrian age and time of day.
Methods
Between 2017 and 2018, there were 10,529 locations where a pedestrian was killed (case location) across the 380 Metropolitan Statistical Areas of the conterminous United States. For each case location two matched control locations were selected. The density of residential living facilities and walkable destinations for older adults was measured within a 1-km radial buffer of each location. Data were analyzed using conditional logistic regression models, adjusting for matching factors, neighborhood composition and walkability metrics.
Results
There was a dose–response relationship between the density of older adult walkable destinations (hospitals, health care delivery venues, health services, pharmacies, senior centers, libraries, community centers) and location case–control status by age group of the fatally struck pedestrian. The strongest pattern was observed for the 65+ age group: Adjusted Odds Ratio (AOR) = 1.61 (95% CI: 1.26–2.06) for Q2; AOR = 2.58 for Q3 (95% CI: 1.99–3.34); and AOR = 3.44 for Q4 (95% CI = 2.61–4.52). Only among the age 50–64 and 65+ age groups was the highest category of density of residential facilities (assisted living facilities, skilled nursing facilities, continuing care retirement communities) associated with fatality location case–control status.
Conclusions
Future research might explore whether prioritizing traffic safety programs near destinations where older adults commonly frequent, such as medical centers, prevents older adult pedestrian fatalities.
{"title":"Where Do Older Pedestrians Experience a Risk of Being Killed in a Motor Vehicle Crash?","authors":"Kathryn G. Burford, Kathryn M. Neckerman, James W. Quinn, Michael D. M. Bader, Gina S. Lovasi, Stephen J. Mooney, Nicole G. Itzkowitz, Dirk Kinsey, Andrew G. Rundle","doi":"10.1111/jgs.70198","DOIUrl":"10.1111/jgs.70198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Population-level interventions are needed to address the overrepresentation of older pedestrians in deaths from traffic crashes. Data are absent on whether specific publicly licensed or public establishments are associated with increased risk to older pedestrians, despite their attractiveness as partners for government efforts. We conducted a nationwide location-based case–control study to examine the associations between publicly licensed or public establishments of daily living for older adults and the location of pedestrian fatalities in motor vehicle crashes. We also assessed etiological heterogeneity by pedestrian age and time of day.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2017 and 2018, there were 10,529 locations where a pedestrian was killed (case location) across the 380 Metropolitan Statistical Areas of the conterminous United States. For each case location two matched control locations were selected. The density of residential living facilities and walkable destinations for older adults was measured within a 1-km radial buffer of each location. Data were analyzed using conditional logistic regression models, adjusting for matching factors, neighborhood composition and walkability metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a dose–response relationship between the density of older adult walkable destinations (hospitals, health care delivery venues, health services, pharmacies, senior centers, libraries, community centers) and location case–control status by age group of the fatally struck pedestrian. The strongest pattern was observed for the 65+ age group: Adjusted Odds Ratio (AOR) = 1.61 (95% CI: 1.26–2.06) for Q2; AOR = 2.58 for Q3 (95% CI: 1.99–3.34); and AOR = 3.44 for Q4 (95% CI = 2.61–4.52). Only among the age 50–64 and 65+ age groups was the highest category of density of residential facilities (assisted living facilities, skilled nursing facilities, continuing care retirement communities) associated with fatality location case–control status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Future research might explore whether prioritizing traffic safety programs near destinations where older adults commonly frequent, such as medical centers, prevents older adult pedestrian fatalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"132-142"},"PeriodicalIF":4.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566838","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}
Amresh D. Hanchate, Mia Yang, Stephanie K. Nothelle, Lindsey Abdelfattah, Michael P. Bancks, Emilie D. Duchesneau, Zhang Zhang, Bruce Kinosian
Background
As more older adults become homebound, home-based medical care (HBMC) has increased, but little is known about the HBMC workforce. This study analyzes national data on the size and structural features of HBMC providers from 2016 to 2022.
Methods
We analyzed annual primary care data for all traditional Medicare enrollees, classifying visits as HBMC (private residence or assisted living facility [ALF]) or non-HBMC (office or telemedicine). We evaluated trends in HBMC providers and visits by HBMC practice exclusivity (only-HBMC or both HBMC and non-HBMC), care setting (private residence, ALF), provider type (physician, nurse practitioner [NP], physician assistant [PA]), and visit volume. We assessed geographic variation in HBMC's share of primary care and payment differences between HBMC and non-HBMC services.
Results
In 2022, 16,125 of 304,326 (5%) primary care clinicians delivered 5.6 million HBMC visits, with most visits (66%) in ALFs. From 2016 to 2022, HBMC providers increased by 40% and visits by 29%. The proportion of only-HBMC providers rose from 50.2% to 61.7%, whereas providers with volume > 1000 visits/year fell from 46.8% to 38.9%. The increase in providers was higher in private residences (49%) than ALFs (33%), though average provider volume decreased in private residences (−24%) and rose in ALFs (7%). NPs among HBMC providers increased from 42.2% to 63.0%, PAs from 6.6% to 8.2%, and physicians dropped from 51.3% to 28.9%. HBMC's share of all visits increased from 3.9% to 5.4%, driven more by ALF visits. Non-HBMC service payments grew faster than those for HBMC services.
Conclusions
Against the backdrop of an expanding HBMC workforce and rising visit volumes from 2016 to 2022, our findings highlight significant shifts in the structural composition of providers. These shifts emphasize the need for ongoing research to address their implications for access, quality, and outcomes in homebound older adults.
{"title":"The Changing Landscape of the Providers of Home-Based Medical Care in Traditional Medicare","authors":"Amresh D. Hanchate, Mia Yang, Stephanie K. Nothelle, Lindsey Abdelfattah, Michael P. Bancks, Emilie D. Duchesneau, Zhang Zhang, Bruce Kinosian","doi":"10.1111/jgs.70203","DOIUrl":"10.1111/jgs.70203","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As more older adults become homebound, home-based medical care (HBMC) has increased, but little is known about the HBMC workforce. This study analyzes national data on the size and structural features of HBMC providers from 2016 to 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed annual primary care data for all traditional Medicare enrollees, classifying visits as HBMC (private residence or assisted living facility [ALF]) or non-HBMC (office or telemedicine). We evaluated trends in HBMC providers and visits by HBMC practice exclusivity (only-HBMC or both HBMC and non-HBMC), care setting (private residence, ALF), provider type (physician, nurse practitioner [NP], physician assistant [PA]), and visit volume. We assessed geographic variation in HBMC's share of primary care and payment differences between HBMC and non-HBMC services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2022, 16,125 of 304,326 (5%) primary care clinicians delivered 5.6 million HBMC visits, with most visits (66%) in ALFs. From 2016 to 2022, HBMC providers increased by 40% and visits by 29%. The proportion of only-HBMC providers rose from 50.2% to 61.7%, whereas providers with volume > 1000 visits/year fell from 46.8% to 38.9%. The increase in providers was higher in private residences (49%) than ALFs (33%), though average provider volume decreased in private residences (−24%) and rose in ALFs (7%). NPs among HBMC providers increased from 42.2% to 63.0%, PAs from 6.6% to 8.2%, and physicians dropped from 51.3% to 28.9%. HBMC's share of all visits increased from 3.9% to 5.4%, driven more by ALF visits. Non-HBMC service payments grew faster than those for HBMC services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Against the backdrop of an expanding HBMC workforce and rising visit volumes from 2016 to 2022, our findings highlight significant shifts in the structural composition of providers. These shifts emphasize the need for ongoing research to address their implications for access, quality, and outcomes in homebound older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"143-152"},"PeriodicalIF":4.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515327","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}
Hyunkyung Yun, Momotazur Rahman, David J. Meyers, Brian E. McGarry, Vincent Mor, Hye-Young Jung, Cyrus Kosar
Background
Medicare Advantage (MA) plans now cover 54% of all Medicare beneficiaries. However, MA is understudied in the nursing home population. We analyzed MA enrollment trends and resident and facility characteristics from 2010 through 2023.
Methods
We calculated the point prevalence of MA enrollment for long-stay nursing home residents, short-stay residents, and all other Medicare beneficiaries from 2010 to 2023, and compared variation in MA growth at the state level between long-stay residents and the general Medicare population. We analyzed how the composition of Traditional Medicare- and MA-enrolled long-stay residents changed over time, changes in special needs plan (SNP) enrollment, and nursing home quality for MA enrollees. We also tracked monthly MA enrollment rates among nursing home residents before and after they became long-stay.
Results
MA enrollment among long-stay residents increased from 12.9% in 2010 to 36.5% in 2023, a 183% increase, outpacing the growth rate among the overall Medicare population. There was substantial geographic variation in MA growth between long-stay residents and others across states. Enrollment in Institutional SNPs grew substantially, accounting for about 35% of MA enrollment among long-stay residents. Dual-Eligible SNP enrollment also accounted for a substantial proportion among MA long-stay residents, ranging between 12% and 20% across years. Long-stay residents covered by Traditional Medicare and MA showed comparable clinical characteristics and had similar shares residing in high-quality nursing homes. Disenrollment from MA sharply increased as beneficiaries entered nursing homes for long-term care.
Conclusions
The substantial growth in MA enrollment among long-stay nursing home residents, coupled with the notable geographic variation and disenrollment, underscores the importance of recognizing that not all beneficiary groups experience MA in the same way. Targeted monitoring is needed to ensure that MA plans adequately address the care needs of this high-risk population.
{"title":"Medicare Advantage Enrollment in Nursing Homes: 2010–2023","authors":"Hyunkyung Yun, Momotazur Rahman, David J. Meyers, Brian E. McGarry, Vincent Mor, Hye-Young Jung, Cyrus Kosar","doi":"10.1111/jgs.70206","DOIUrl":"10.1111/jgs.70206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medicare Advantage (MA) plans now cover 54% of all Medicare beneficiaries. However, MA is understudied in the nursing home population. We analyzed MA enrollment trends and resident and facility characteristics from 2010 through 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We calculated the point prevalence of MA enrollment for long-stay nursing home residents, short-stay residents, and all other Medicare beneficiaries from 2010 to 2023, and compared variation in MA growth at the state level between long-stay residents and the general Medicare population. We analyzed how the composition of Traditional Medicare- and MA-enrolled long-stay residents changed over time, changes in special needs plan (SNP) enrollment, and nursing home quality for MA enrollees. We also tracked monthly MA enrollment rates among nursing home residents before and after they became long-stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MA enrollment among long-stay residents increased from 12.9% in 2010 to 36.5% in 2023, a 183% increase, outpacing the growth rate among the overall Medicare population. There was substantial geographic variation in MA growth between long-stay residents and others across states. Enrollment in Institutional SNPs grew substantially, accounting for about 35% of MA enrollment among long-stay residents. Dual-Eligible SNP enrollment also accounted for a substantial proportion among MA long-stay residents, ranging between 12% and 20% across years. Long-stay residents covered by Traditional Medicare and MA showed comparable clinical characteristics and had similar shares residing in high-quality nursing homes. Disenrollment from MA sharply increased as beneficiaries entered nursing homes for long-term care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The substantial growth in MA enrollment among long-stay nursing home residents, coupled with the notable geographic variation and disenrollment, underscores the importance of recognizing that not all beneficiary groups experience MA in the same way. Targeted monitoring is needed to ensure that MA plans adequately address the care needs of this high-risk population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"516-521"},"PeriodicalIF":4.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515366","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}
Taylor I. Bucy, Carrie E. Henning-Smith, Donovan T. Maust, Tetyana P. Shippee, Dori A. Cross
Background
Discharge to the home/community following a skilled nursing facility (SNF) stay is a key metric of high-quality care. However, achieving this in this domain remains challenging, especially for distinctly complex patients. Little research to date has examined within-group variation in discharge outcomes for persons with SMI, a population that reflects a growing proportion of SNF consumers in the U.S.
Methods
We leveraged a 4-year (2016–2019) 100% sample of Medicare claims data to examine individual- and organization-level predictors of SNF discharge location for persons with SMI. We first describe within-group differences for persons with SMI at the bivariate level. We then test linear probability models fully adjusted for individual and organization-level covariates, allowing for calculation of post-estimation marginal effects.
Results
We identified 118,325 unique SNF stays for people with SMI; 54% ended in discharge to the home/community. Patients with SMI who were discharged to the home/community (versus not) were significantly younger, more likely to be female, and were less likely to be dual-eligible or to have co-occurring ADRD. SMI patients discharged to the home/community were also significantly more likely to receive care in SNFs that were more integrated, higher quality, and saw a smaller share of SMI patients overall. These findings were reinforced by our fully adjusted regression analyses.
Discussion
This work finds within-group differences in characteristics associated with SNF discharge outcomes among the population of patients with SMI at both the person- and organization-levels. Policymakers should consider how to leverage value-based payment (VBP) programs, including new SNF-VBP requirements, in a way that more realistically accounts for the resources (e.g., time, staffing) required to coordinate care for this population. Similarly, an explicit focus on investments along the continuum should center around services that facilitate community retention (e.g., home- and community-based services).
{"title":"Who Makes It Home: Skilled Nursing Facility to Community Transitions for Medicare Beneficiaries With Serious Mental Illness","authors":"Taylor I. Bucy, Carrie E. Henning-Smith, Donovan T. Maust, Tetyana P. Shippee, Dori A. Cross","doi":"10.1111/jgs.70205","DOIUrl":"10.1111/jgs.70205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Discharge to the home/community following a skilled nursing facility (SNF) stay is a key metric of high-quality care. However, achieving this in this domain remains challenging, especially for distinctly complex patients. Little research to date has examined within-group variation in discharge outcomes for persons with SMI, a population that reflects a growing proportion of SNF consumers in the U.S.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We leveraged a 4-year (2016–2019) 100% sample of Medicare claims data to examine individual- and organization-level predictors of SNF discharge location for persons with SMI. We first describe within-group differences for persons with SMI at the bivariate level. We then test linear probability models fully adjusted for individual and organization-level covariates, allowing for calculation of post-estimation marginal effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 118,325 unique SNF stays for people with SMI; 54% ended in discharge to the home/community. Patients with SMI who were discharged to the home/community (versus not) were significantly younger, more likely to be female, and were less likely to be dual-eligible or to have co-occurring ADRD. SMI patients discharged to the home/community were also significantly more likely to receive care in SNFs that were more integrated, higher quality, and saw a smaller share of SMI patients overall. These findings were reinforced by our fully adjusted regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This work finds <i>within-group</i> differences in characteristics associated with SNF discharge outcomes among the population of patients with SMI at both the person- and organization-levels. Policymakers should consider how to leverage value-based payment (VBP) programs, including new SNF-VBP requirements, in a way that more realistically accounts for the resources (e.g., time, staffing) required to coordinate care for this population. Similarly, an explicit focus on investments along the continuum should center around services that facilitate community retention (e.g., home- and community-based services).</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"210-219"},"PeriodicalIF":4.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"EMR-Accessible Advance Care Plan Documentation Among Hospitalized Older Adults","authors":"Cecily McIntyre, Nancy Kim","doi":"10.1111/jgs.70196","DOIUrl":"10.1111/jgs.70196","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"593-595"},"PeriodicalIF":4.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498150","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}
Meaghan A. Kennedy, Martina Azar, Alicia J. Cohen, Catherine M. P. Dawson, Naila Edwards, Victoria Ngo, Tatiana Rugeles Suarez, Sydney C. Ruggles, Lauren E. Russell, Andrea Wershof Schwartz, Maria D. Venegas, Ramona L. Rhodes
Social drivers of health (SDOH) impact health outcomes across the lifespan, with distinct effects on the health and well-being of older adults. SDOH contribute to outcomes of particular importance to older adults, including physical and cognitive functioning and aging in place, highlighting the critical importance of addressing SDOH as part of comprehensive, patient-centered geriatrics care. Yet, there is limited guidance on best practices for the integration of SDOH into healthcare, particularly in subspecialty clinical settings such as geriatrics. Existing geriatrics frameworks, including Age-Friendly Health Systems and the Geriatrics 5Ms, provide an opportunity to incorporate SDOH concepts, as they are naturally aligned with models of social and medical care integration. Building on existing frameworks, we propose a novel conceptual model that integrates SDOH across the geriatrics care continuum, including practical guidance for geriatrics healthcare professionals to proactively incorporate SDOH into Age-Friendly care.
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<p>We appreciate the thoughtful comments of Jin et al. [<span>1</span>] on our prospective longitudinal study of potentially inappropriate prescribing (PIP) and all-cause mortality in community-dwelling older adults [<span>2</span>].</p><p>Regarding their concern of under-representation of low socioeconomic status (SES) individuals in our cohort, the Israel Study of Glucose Intolerance, Obesity and Hypertension (GOH Study) is a nationwide cohort drawn from the Central Population Registry, comprising Jewish individuals born between 1912 and 1941. The sample was designed to equally represent sex, ethnic origin, and length of residence [<span>3</span>], as most participants immigrated to Israel in its early days of formation during the 1940s–50s. The diversity of this cohort, comprised of individuals from all SES levels, was maintained over follow-up. In our study sample (third follow-up), 40.1% had fewer than 9 years of education and 43.8% were blue-collar workers (manual and skilled trade occupations, such as agriculture, fishing, craft, manufacturing, repair, construction, transport, cleaning, and packaging). Our findings result from multivariable models that accounted for all sociodemographic variables (e.g., education, occupation, ethnic origin).</p><p>As noted in our paper [<span>2</span>], the cohort included relatively few cognitively impaired individuals, and we state that our findings apply primarily to relatively healthy older adults living in the community. Frailty was not directly measured, though one of Fried's frailty criteria is low physical activity [<span>4</span>], and 51.6% of our participants reported no leisure-time physical activity. In addition, 24.4% of participants rated their health as “poor” or “very poor”. Importantly, associations between PIP and mortality remained statistically significant even after adjusting for both subjective and objective health measures at baseline, including polypharmacy and chronic conditions. Nonetheless, given our finding of stronger associations between potentially inappropriate medication (PIM) use and mortality among those with better self-rated health at baseline, our argument that PIP should also be monitored in relatively healthy older adults remains valid. From a public health perspective, we believe that PIP criteria should be implemented in primary care as well, not just in hospitals or long-term care facilities. Early identification and correction of inappropriate prescribing could prevent adverse drug events and subsequent complications, supporting older adults in maintaining their independent lifestyle in the community.</p><p>We agree with Jin et al. [<span>1</span>] that implicit clinician judgment should complement explicit PIP criteria. For example, the OPERAM (Optimizing thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial [<span>5</span>] showed that more than half of the clinical decision support system (CDSS) alerts for overuse, underuse, or mi
{"title":"Reply to: Inappropriate Prescribing and Medication Safety in Older Adults","authors":"Liat Orenstein, Angela Chetrit, Keren Laufer, Rachel Dankner","doi":"10.1111/jgs.70160","DOIUrl":"10.1111/jgs.70160","url":null,"abstract":"<p>We appreciate the thoughtful comments of Jin et al. [<span>1</span>] on our prospective longitudinal study of potentially inappropriate prescribing (PIP) and all-cause mortality in community-dwelling older adults [<span>2</span>].</p><p>Regarding their concern of under-representation of low socioeconomic status (SES) individuals in our cohort, the Israel Study of Glucose Intolerance, Obesity and Hypertension (GOH Study) is a nationwide cohort drawn from the Central Population Registry, comprising Jewish individuals born between 1912 and 1941. The sample was designed to equally represent sex, ethnic origin, and length of residence [<span>3</span>], as most participants immigrated to Israel in its early days of formation during the 1940s–50s. The diversity of this cohort, comprised of individuals from all SES levels, was maintained over follow-up. In our study sample (third follow-up), 40.1% had fewer than 9 years of education and 43.8% were blue-collar workers (manual and skilled trade occupations, such as agriculture, fishing, craft, manufacturing, repair, construction, transport, cleaning, and packaging). Our findings result from multivariable models that accounted for all sociodemographic variables (e.g., education, occupation, ethnic origin).</p><p>As noted in our paper [<span>2</span>], the cohort included relatively few cognitively impaired individuals, and we state that our findings apply primarily to relatively healthy older adults living in the community. Frailty was not directly measured, though one of Fried's frailty criteria is low physical activity [<span>4</span>], and 51.6% of our participants reported no leisure-time physical activity. In addition, 24.4% of participants rated their health as “poor” or “very poor”. Importantly, associations between PIP and mortality remained statistically significant even after adjusting for both subjective and objective health measures at baseline, including polypharmacy and chronic conditions. Nonetheless, given our finding of stronger associations between potentially inappropriate medication (PIM) use and mortality among those with better self-rated health at baseline, our argument that PIP should also be monitored in relatively healthy older adults remains valid. From a public health perspective, we believe that PIP criteria should be implemented in primary care as well, not just in hospitals or long-term care facilities. Early identification and correction of inappropriate prescribing could prevent adverse drug events and subsequent complications, supporting older adults in maintaining their independent lifestyle in the community.</p><p>We agree with Jin et al. [<span>1</span>] that implicit clinician judgment should complement explicit PIP criteria. For example, the OPERAM (Optimizing thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial [<span>5</span>] showed that more than half of the clinical decision support system (CDSS) alerts for overuse, underuse, or mi","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"605-606"},"PeriodicalIF":4.5,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472555","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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