Kevin T. Pritchard OT, PhD, OTR, Chun-Ting Yang PhD, Qiaoxi Chen PhD, Yichi Zhang MS, James M. Wilkins MD, DPhil, Dae Hyun Kim MD, MPH, ScD, Kueiyu Joshua Lin MD, MPH, ScD
Background
Adults with Alzheimer's disease and Alzheimer's disease related dementias (ADRD) or frailty are susceptible to fractures. Opioid analgesics are frequently prescribed after fractures. Documenting post-fracture opioid discontinuation rates and predictors of discontinuation among adults with ADRD or frailty can inform clinical practice, identify potential disparities, and improve pain management guidelines. The objective of this paper was to investigate opioid discontinuation in opioid-naïve older adults who used opioids after an acute fracture.
Methods
This retrospective cohort study included opioid-naïve Medicare fee-for-service beneficiaries (N = 33,027) ≥65 years of age who filled an opioid prescription within 30 days of a vertebral, lower extremity, or upper extremity fracture from 2013 to 2018. Beneficiaries were classified according to ADRD (yes/no) and frailty (yes/no) status using validated claims-based algorithms. The primary outcome was opioid discontinuation, defined as a 30-day supply gap. We estimated discontinuation rates with the Kaplan–Meier method and identified predictors of opioid discontinuation using Cox proportional hazards regression.
Results
The 30-day opioid discontinuation rate was similar among non-frail beneficiaries without ADRD (81% [95% CI, 80%–81%]) and those who were non-frail with ADRD (83% [81%–84%]). Comparatively, 30-day discontinuation rates were lower among those with frailty and ADRD (76% [75%–77%]) and those with frailty alone (77% [75%–78%]). After adjusting for sociodemographic characteristics, health status, healthcare utilization, and calendar year, beneficiaries with both ADRD and frailty (HR, 0.90 [0.87–0.93]) and those with frailty alone (HR, 0.85 [0.82–0.89]), but not those with ADRD alone (HR, 1.06 [1.01–1.10]), were less likely to discontinue opioids compared with those without ADRD or frailty.
Conclusions and Relevance
Our findings suggest that frailty, but not ADRD, was associated with a lower likelihood of opioid discontinuation among older adults who initiated opioids after an acute fracture. Further research is needed to understand how opioid deprescribing practices depend on patient and provider preferences.
{"title":"Rates and predictors of opioid deprescribing after fracture: A retrospective study of Medicare fee-for-service claims","authors":"Kevin T. Pritchard OT, PhD, OTR, Chun-Ting Yang PhD, Qiaoxi Chen PhD, Yichi Zhang MS, James M. Wilkins MD, DPhil, Dae Hyun Kim MD, MPH, ScD, Kueiyu Joshua Lin MD, MPH, ScD","doi":"10.1111/jgs.19290","DOIUrl":"10.1111/jgs.19290","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adults with Alzheimer's disease and Alzheimer's disease related dementias (ADRD) or frailty are susceptible to fractures. Opioid analgesics are frequently prescribed after fractures. Documenting post-fracture opioid discontinuation rates and predictors of discontinuation among adults with ADRD or frailty can inform clinical practice, identify potential disparities, and improve pain management guidelines. The objective of this paper was to investigate opioid discontinuation in opioid-naïve older adults who used opioids after an acute fracture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included opioid-naïve Medicare fee-for-service beneficiaries (<i>N</i> = 33,027) ≥65 years of age who filled an opioid prescription within 30 days of a vertebral, lower extremity, or upper extremity fracture from 2013 to 2018. Beneficiaries were classified according to ADRD (yes/no) and frailty (yes/no) status using validated claims-based algorithms. The primary outcome was opioid discontinuation, defined as a 30-day supply gap. We estimated discontinuation rates with the Kaplan–Meier method and identified predictors of opioid discontinuation using Cox proportional hazards regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 30-day opioid discontinuation rate was similar among non-frail beneficiaries without ADRD (81% [95% CI, 80%–81%]) and those who were non-frail with ADRD (83% [81%–84%]). Comparatively, 30-day discontinuation rates were lower among those with frailty and ADRD (76% [75%–77%]) and those with frailty alone (77% [75%–78%]). After adjusting for sociodemographic characteristics, health status, healthcare utilization, and calendar year, beneficiaries with both ADRD and frailty (HR, 0.90 [0.87–0.93]) and those with frailty alone (HR, 0.85 [0.82–0.89]), but not those with ADRD alone (HR, 1.06 [1.01–1.10]), were less likely to discontinue opioids compared with those without ADRD or frailty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions and Relevance</h3>\u0000 \u0000 <p>Our findings suggest that frailty, but not ADRD, was associated with a lower likelihood of opioid discontinuation among older adults who initiated opioids after an acute fracture. Further research is needed to understand how opioid deprescribing practices depend on patient and provider preferences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"737-749"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775953","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}
Rachel D. Savage PhD, Tai Huynh MDes, MBA, Shoshana Hahn-Goldberg PhD, Lavina Matai PharmD, MScPH, Alexa Boblitz MPH, Azmina Altaf MSc, Susan E. Bronskill PhD, Kevin A. Brown PhD, Patrick Feng PhD, Samantha E. Lewis-Fung MHSc, Maya S. Sheth BMSc, Christina Yu BScH, Jen Recknagel MDes, Paula A. Rochon MD, MPH
Background
Naturally occurring retirement communities (NORCs) are geographical areas that have naturally become home to a large concentration of older adults. This density means that NORCs have the potential to become a pillar for aging in place strategies, but at present, there is limited data on residents and their health needs. Our objective was to describe and compare the health and healthcare use of older adults living in high-rise NORC buildings to those in all other housing types in the community.
Methods
We conducted a population-based descriptive study of community-dwelling older adults aged ≥65 years by linking a provincial NORC registry in Ontario, Canada with health administrative records. Individuals were classified as NORC residents if their residential postal code on January 1, 2020 matched the NORC registry. Sociodemographic, clinical, and healthcare use characteristics were compared by NORC status using standardized differences (STD) and stratified by rurality, and further by age and sex in urban settings.
Results
Overall, 219,995 (7.7%) of 2,869,706 older adults were NORC residents. Compared to community-dwelling older adults, NORC residents were older (mean 77.4 vs 74.6 years; STD 0.34), and more were female (61.8% vs 52.2%; STD 0.19) and had low income (16.0% vs 9.3%; STD 0.11). NORC residents also had more active chronic conditions (mean 1.9 vs 1.5; STD 0.27), medications (mean 3.4 vs 2.8; STD 0.21), home care use (15.3% vs 9.8%; STD 0.17), and primary care visits (mean 9.7 vs 7.6 visits in prior 2 years; STD 0.22). Findings were robust across rurality, age, and sex.
Conclusions
Our findings suggest that NORC residents have greater health needs than other older adults living in the community and underscore NORCs as important targets for equity-focused strategies to support aging in place.
背景：自然发生的退休社区（norc）是自然成为大量老年人集中的地理区域。这种密度意味着农村中心有潜力成为就地老龄化战略的支柱，但目前，关于居民及其健康需求的数据有限。我们的目标是描述和比较居住在高层NORC建筑中的老年人与社区中所有其他住房类型的老年人的健康和医疗保健使用情况。方法：我们通过将加拿大安大略省的省级NORC登记处与卫生管理记录联系起来，对社区居住的≥65岁老年人进行了一项基于人群的描述性研究。如果2020年1月1日的居住邮政编码与NORC登记相匹配，则个人被归类为NORC居民。社会人口学、临床和医疗保健使用特征通过标准化差异（STD）的NORC状态进行比较，并按农村分层，在城市环境中进一步按年龄和性别分层。结果：总体而言，2,869,706名老年人中有219,995人（7.7%）是NORC居民。与社区居住的老年人相比，NORC居民年龄更大(平均77.4岁vs 74.6岁；性病0.34)，女性多于男性(61.8% vs 52.2%；性病0.19)，收入较低(16.0% vs 9.3%；性病0.11)。NORC居民也有更多的活动性慢性疾病(平均1.9 vs 1.5；STD 0.27)，药物(平均3.4 vs 2.8；性病0.21)，家庭护理使用(15.3% vs 9.8%；性病0.17)和初级保健就诊(前2年平均9.7次vs 7.6次；性病0.22)。调查结果在农村、年龄和性别方面都很明显。结论：我们的研究结果表明，NORC居民比生活在社区中的其他老年人有更大的健康需求，并强调NORC是公平关注策略的重要目标，以支持适当的老龄化。
{"title":"A portrait of older adults in naturally occurring retirement communities in Ontario, Canada: A population-based study","authors":"Rachel D. Savage PhD, Tai Huynh MDes, MBA, Shoshana Hahn-Goldberg PhD, Lavina Matai PharmD, MScPH, Alexa Boblitz MPH, Azmina Altaf MSc, Susan E. Bronskill PhD, Kevin A. Brown PhD, Patrick Feng PhD, Samantha E. Lewis-Fung MHSc, Maya S. Sheth BMSc, Christina Yu BScH, Jen Recknagel MDes, Paula A. Rochon MD, MPH","doi":"10.1111/jgs.19278","DOIUrl":"10.1111/jgs.19278","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Naturally occurring retirement communities (NORCs) are geographical areas that have naturally become home to a large concentration of older adults. This density means that NORCs have the potential to become a pillar for aging in place strategies, but at present, there is limited data on residents and their health needs. Our objective was to describe and compare the health and healthcare use of older adults living in high-rise NORC buildings to those in all other housing types in the community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a population-based descriptive study of community-dwelling older adults aged ≥65 years by linking a provincial NORC registry in Ontario, Canada with health administrative records. Individuals were classified as NORC residents if their residential postal code on January 1, 2020 matched the NORC registry. Sociodemographic, clinical, and healthcare use characteristics were compared by NORC status using standardized differences (STD) and stratified by rurality, and further by age and sex in urban settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 219,995 (7.7%) of 2,869,706 older adults were NORC residents. Compared to community-dwelling older adults, NORC residents were older (mean 77.4 vs 74.6 years; STD 0.34), and more were female (61.8% vs 52.2%; STD 0.19) and had low income (16.0% vs 9.3%; STD 0.11). NORC residents also had more active chronic conditions (mean 1.9 vs 1.5; STD 0.27), medications (mean 3.4 vs 2.8; STD 0.21), home care use (15.3% vs 9.8%; STD 0.17), and primary care visits (mean 9.7 vs 7.6 visits in prior 2 years; STD 0.22). Findings were robust across rurality, age, and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that NORC residents have greater health needs than other older adults living in the community and underscore NORCs as important targets for equity-focused strategies to support aging in place.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"74-87"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristin Lees Haggerty PhD, Rebecca Jackson Stoeckle BA, Randi Campetti BA, Ruthann Froberg MPA, Olanike Ojelabi MS, MPP, M. T. Connolly JD, Gary Epstein-Lubow MD, Laura Mosqueda MD, Kathy Greenlee JD, Laini Tuboku-Metzger BS, Junyue Liao MPH, Terry Fulmer PhD
Policy measures designed to address elder abuse, neglect, and exploitation date back to decades, including the Older Americans Act of 1965. Over the years, various legislative actions have aimed to address elder mistreatment, culminating in the Elder Justice Act of 2010. Despite these efforts, policy changes lag behind need, and government funding appropriation is woefully inadequate. On November 29, 2023, the National Collaboratory to Address Elder Mistreatment convened 76 experts from research, clinical practice, policymaking, federal and state agencies, and national organizations to develop strategies for accelerating policy action to address elder mistreatment. Key themes from the convening included the need for a unified and stronger infrastructure and messaging, the importance of data-driven policy and evidence-informed prevention and intervention practices, and expanding strategic engagements. Participants emphasized the need for a holistic and long-term approach, leveraging data to demonstrate outcomes, and building coalitions across related fields to address elder mistreatment. Action steps were identified for both national and state/local levels, focused on enhancing data-informed elder mistreatment prevention, intervention, and response programs. The broad cross-sector participation in the convening and the findings underscored the urgency of and potential for advancing elder justice policy. By leveraging existing initiatives, utilizing data emerging particularly in the past 5 years, building on decades of advocacy, and fostering new collaborations, there is a significant opportunity to improve prevention, intervention, and response to elder mistreatment.
{"title":"Accelerating the pace of elder justice policy to meet the needs of a growing aging population","authors":"Kristin Lees Haggerty PhD, Rebecca Jackson Stoeckle BA, Randi Campetti BA, Ruthann Froberg MPA, Olanike Ojelabi MS, MPP, M. T. Connolly JD, Gary Epstein-Lubow MD, Laura Mosqueda MD, Kathy Greenlee JD, Laini Tuboku-Metzger BS, Junyue Liao MPH, Terry Fulmer PhD","doi":"10.1111/jgs.19257","DOIUrl":"10.1111/jgs.19257","url":null,"abstract":"<p>Policy measures designed to address elder abuse, neglect, and exploitation date back to decades, including the Older Americans Act of 1965. Over the years, various legislative actions have aimed to address elder mistreatment, culminating in the Elder Justice Act of 2010. Despite these efforts, policy changes lag behind need, and government funding appropriation is woefully inadequate. On November 29, 2023, the National Collaboratory to Address Elder Mistreatment convened 76 experts from research, clinical practice, policymaking, federal and state agencies, and national organizations to develop strategies for accelerating policy action to address elder mistreatment. Key themes from the convening included the need for a unified and stronger infrastructure and messaging, the importance of data-driven policy and evidence-informed prevention and intervention practices, and expanding strategic engagements. Participants emphasized the need for a holistic and long-term approach, leveraging data to demonstrate outcomes, and building coalitions across related fields to address elder mistreatment. Action steps were identified for both national and state/local levels, focused on enhancing data-informed elder mistreatment prevention, intervention, and response programs. The broad cross-sector participation in the convening and the findings underscored the urgency of and potential for advancing elder justice policy. By leveraging existing initiatives, utilizing data emerging particularly in the past 5 years, building on decades of advocacy, and fostering new collaborations, there is a significant opportunity to improve prevention, intervention, and response to elder mistreatment.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"223-231"},"PeriodicalIF":4.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740862","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}
Agathe Mouheb MSB, Hélène Levassort MD, Ziad A. Massy MD, PhD, Christian Jacquelinet MD, PhD, Maurice Laville MD, PhD, Natalia Alencar de Pinho PhD, Marion Pépin MD, PhD, Solène M. Laville PharmD, PhD, Sophie Liabeuf PharmD, PhD, the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) Study Group
Background
People with chronic kidney disease (CKD) have an elevated risk of cognitive impairment (CI). Medications with anticholinergic activity are recognized for their adverse reactions on central nervous system. The putative association between the anticholinergic burden and CI has not previously been evaluated in patients with CKD. The study aimed to (i) describe prescriptions of medications with anticholinergic activity, (ii) analyze factors associated with these prescriptions, and (iii) evaluate the anticholinergic burden's association with cognitive performance.
Methods
CKD-REIN, a prospective cohort study, enrolled nephrology outpatients with a confirmed diagnosis of CKD (eGFR <60 mL/min/1.73m2). Drug prescriptions were recorded prospectively during the 5-year follow-up. Mini Mental State Examination (MMSE) was assessed at baseline and CI was defined as an MMSE score <24/30. For each patient, the anticholinergic burden was determined by summing the Anticholinergic Cognitive Burden (ACB) scores of all prescription drugs at baseline. Multinomial logistic regression was used to analyze factors associated with the ACB score. Logistic regression was used to evaluate the association between the cognitive impairment and the anticholinergic burden at baseline.
Results
At baseline, 3007 patients (median age [IQR], 69[60–76]; 65% men) had MMSE data and were included. 1549 (52%) of these patients were taking at least one drug with anticholinergic properties. Most (1092; 70%) had a low anticholinergic burden, 294 (19%) had a moderate anticholinergic burden, and 163 (11%) had a high anticholinergic burden. A history of neurological/psychiatric disorders and a higher number of daily drugs were associated with a greater probability of having a high anticholinergic burden (odds ratio (OR) [95% confidence interval (95% CI)] = 1.88[1.29;2.74] and 1.53[1.45;1.61], respectively). Patients with a high anticholinergic burden had a significantly higher probability of presenting cognitive impairment, compared with patients without an anticholinergic burden (OR[95% CI] = 1.76[1.12;2.75]) after adjustment for sociodemographic factors, comorbidities, laboratory data, and the number of medications taken daily.
Conclusions
The results of our study emphasize the need for caution in the prescription of drugs with anticholinergic properties to patients with CKD.
{"title":"The anticholinergic burden in patients with chronic kidney disease: Patterns, risk factors, and the link with cognitive impairment","authors":"Agathe Mouheb MSB, Hélène Levassort MD, Ziad A. Massy MD, PhD, Christian Jacquelinet MD, PhD, Maurice Laville MD, PhD, Natalia Alencar de Pinho PhD, Marion Pépin MD, PhD, Solène M. Laville PharmD, PhD, Sophie Liabeuf PharmD, PhD, the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) Study Group","doi":"10.1111/jgs.19283","DOIUrl":"10.1111/jgs.19283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People with chronic kidney disease (CKD) have an elevated risk of cognitive impairment (CI). Medications with anticholinergic activity are recognized for their adverse reactions on central nervous system. The putative association between the anticholinergic burden and CI has not previously been evaluated in patients with CKD. The study aimed to (i) describe prescriptions of medications with anticholinergic activity, (ii) analyze factors associated with these prescriptions, and (iii) evaluate the anticholinergic burden's association with cognitive performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CKD-REIN, a prospective cohort study, enrolled nephrology outpatients with a confirmed diagnosis of CKD (eGFR <60 mL/min/1.73m<sup>2</sup>). Drug prescriptions were recorded prospectively during the 5-year follow-up. Mini Mental State Examination (MMSE) was assessed at baseline and CI was defined as an MMSE score <24/30. For each patient, the anticholinergic burden was determined by summing the Anticholinergic Cognitive Burden (ACB) scores of all prescription drugs at baseline. Multinomial logistic regression was used to analyze factors associated with the ACB score. Logistic regression was used to evaluate the association between the cognitive impairment and the anticholinergic burden at baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, 3007 patients (median age [IQR], 69[60–76]; 65% men) had MMSE data and were included. 1549 (52%) of these patients were taking at least one drug with anticholinergic properties. Most (1092; 70%) had a low anticholinergic burden, 294 (19%) had a moderate anticholinergic burden, and 163 (11%) had a high anticholinergic burden. A history of neurological/psychiatric disorders and a higher number of daily drugs were associated with a greater probability of having a high anticholinergic burden (odds ratio (OR) [95% confidence interval (95% CI)] = 1.88[1.29;2.74] and 1.53[1.45;1.61], respectively). Patients with a high anticholinergic burden had a significantly higher probability of presenting cognitive impairment, compared with patients without an anticholinergic burden (OR[95% CI] = 1.76[1.12;2.75]) after adjustment for sociodemographic factors, comorbidities, laboratory data, and the number of medications taken daily.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results of our study emphasize the need for caution in the prescription of drugs with anticholinergic properties to patients with CKD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"533-544"},"PeriodicalIF":4.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741653","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}
Tracy Nguyen BA, Belinda Tang BS, Krista L. Harrison PhD, Susanne Stadler M.Arch, MBA, Louise C. Walter MD, Kate Hoepke MBA, Louise Aronson MD, MFA, Theresa A. Allison MD, PhD
Background
Few programs exist to support aging in place for older adults. Age Self Care is a novel program providing older adults with evidence-based information using group sessions embedded within the structure of a community-based organization (CBO) to facilitate behavior change and support aging in place. We report on a preliminary study of Age Self Care conducted in collaboration between the University of California, San Francisco (UCSF) Division of Geriatrics, At Home With Growing Older (AHWGO), and San Francisco Village (SF Village).
Methods
We recruited middle-income, community-dwelling adults aged 65+ from university outpatient clinics. Participants attended eight 90-min, video-based group sessions and enrolled in SF Village, a non-profit mutual support organization for older adults. Data collection included direct observations and a participant focus group. We used rapid analysis methods informed by the COM-B model (Capability, Opportunity, Motivation, Behavior Change) to assess behavior change.
Results
Fourteen participants completed the 8-week study (15 enrolled, 1 withdrew). Average attendance was 81% throughout the program. We found that 14 participants made concrete changes to optimize the ability to remain at home during the program. For example, participants engaged in evidence-based falls risk reduction activities such as decluttering and improving lighting. We identified three facilitators to behavior change. First, Age Self Care promoted self-management—the day-to-day management of health and chronic conditions by individuals—through education and community-based resources. Second, peer support empowered participants to take charge of their health, home environment, and social networks. Third, the online platform created a community and was a catalyst for social opportunity. We identified one non-modifiable barrier: pre-existing financial barriers hindered some behavior change.
Conclusions
In this preliminary study, Age Self Care facilitated behavior change, including minor home modifications, fall risk reduction, and engagement in social networks, all of which support aging in place.
{"title":"Age Self Care, a program to improve aging in place through group learning and incremental behavior change: Preliminary data","authors":"Tracy Nguyen BA, Belinda Tang BS, Krista L. Harrison PhD, Susanne Stadler M.Arch, MBA, Louise C. Walter MD, Kate Hoepke MBA, Louise Aronson MD, MFA, Theresa A. Allison MD, PhD","doi":"10.1111/jgs.19289","DOIUrl":"10.1111/jgs.19289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Few programs exist to support aging in place for older adults. <i>Age Self Care</i> is a novel program providing older adults with evidence-based information using group sessions embedded within the structure of a community-based organization (CBO) to facilitate behavior change and support aging in place. We report on a preliminary study of <i>Age Self Care</i> conducted in collaboration between the University of California, San Francisco (UCSF) Division of Geriatrics, At Home With Growing Older (AHWGO), and San Francisco Village (SF Village).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited middle-income, community-dwelling adults aged 65+ from university outpatient clinics. Participants attended eight 90-min, video-based group sessions and enrolled in SF Village, a non-profit mutual support organization for older adults. Data collection included direct observations and a participant focus group. We used rapid analysis methods informed by the COM-B model (Capability, Opportunity, Motivation, Behavior Change) to assess behavior change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourteen participants completed the 8-week study (15 enrolled, 1 withdrew). Average attendance was 81% throughout the program. We found that 14 participants made concrete changes to optimize the ability to remain at home during the program. For example, participants engaged in evidence-based falls risk reduction activities such as decluttering and improving lighting. We identified three facilitators to behavior change. First, <i>Age Self Care</i> promoted self-management—the day-to-day management of health and chronic conditions by individuals—through education and community-based resources. Second, peer support empowered participants to take charge of their health, home environment, and social networks. Third, the online platform created a community and was a catalyst for social opportunity. We identified one non-modifiable barrier: pre-existing financial barriers hindered some behavior change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this preliminary study, <i>Age Self Care</i> facilitated behavior change, including minor home modifications, fall risk reduction, and engagement in social networks, all of which support aging in place.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"920-929"},"PeriodicalIF":4.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741020","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}
Elizabeth M. Goldberg MD, ScM, Elizabeth Bloemen MD, Daniel M. Lindberg MD
<p>The popular conception of emergency departments (EDs) is that they primarily care for critically ill patients with sudden illness. It is all gunshot wounds, heart attacks, and sepsis. EDs are exceptionally adept at treating these illnesses, and many emergency clinicians chose their specialty due to an interest in addressing these acute life threats. In reality, ED clinicians and staff also work to address social determinants of health and help patients navigate increasingly complex medical and social care systems. On any given ED shift, one is much more likely to meet a person unable to access primary care due to homelessness, addiction, or social challenges, as to diagnose a heart attack or treat a gunshot wound.</p><p>In EDs, social needs are essentially bottomless—to address them all would devastate the ED's ability to complete its core mission. For older adults who are both medically and socially complex, EDs may be expensive and inefficient solutions for unmet care needs. Others have suggested several solutions: creating geriatric certified EDs, embedding pharmacists and physical therapists in the ED,<span><sup>1, 2</sup></span> screening for social determinants of health, and using ED navigators<span><sup>3</sup></span> to help patients establish care with a clinic or primary care clinician. One currently popular approach, identifying social concerns and referring to external resources, has the advantage of minimal impact on the ED's core mission; however, it is often ineffective for older, vulnerable adults who face barriers to following up on referrals due to cognitive, hearing, visual, and other functional impairments.<span><sup>4</sup></span></p><p>In this issue, Southerland et al. demonstrate the effectiveness of one approach to address the social needs of vulnerable elders.<span><sup>5</sup></span> As a result of a unique partnership with the local Office on Aging (OA), they embedded OA case managers within their ED to connect vulnerable older adults to nutrition services, emergency response systems, transportation, and other services, as needed. In this model, OA case managers work with ED social workers to identify community-dwelling older patients and perform in-person intake assessments during daytime hours whereas older patients are in the ED. Case workers arrange needed community services, often starting them immediately.</p><p>The advantages of the program are twofold. First, by matching the right professional to the task, the program bypasses several known barriers to hospital-to-community transitions, such as: the ED clinicians forgetting to screen or refer, patients forgetting to reach out, and failure to engage family members.<span><sup>6, 7</sup></span> Second, the program eliminates inefficient communication between older adult patients and OA programs, as when successful service provision relies on the older adult to reach out for care, and to be available and willing to answer the phone when the OA worker calls.</p><
{"title":"Caring for older adults' social needs in emergency departments: Where to draw the line?","authors":"Elizabeth M. Goldberg MD, ScM, Elizabeth Bloemen MD, Daniel M. Lindberg MD","doi":"10.1111/jgs.19296","DOIUrl":"10.1111/jgs.19296","url":null,"abstract":"<p>The popular conception of emergency departments (EDs) is that they primarily care for critically ill patients with sudden illness. It is all gunshot wounds, heart attacks, and sepsis. EDs are exceptionally adept at treating these illnesses, and many emergency clinicians chose their specialty due to an interest in addressing these acute life threats. In reality, ED clinicians and staff also work to address social determinants of health and help patients navigate increasingly complex medical and social care systems. On any given ED shift, one is much more likely to meet a person unable to access primary care due to homelessness, addiction, or social challenges, as to diagnose a heart attack or treat a gunshot wound.</p><p>In EDs, social needs are essentially bottomless—to address them all would devastate the ED's ability to complete its core mission. For older adults who are both medically and socially complex, EDs may be expensive and inefficient solutions for unmet care needs. Others have suggested several solutions: creating geriatric certified EDs, embedding pharmacists and physical therapists in the ED,<span><sup>1, 2</sup></span> screening for social determinants of health, and using ED navigators<span><sup>3</sup></span> to help patients establish care with a clinic or primary care clinician. One currently popular approach, identifying social concerns and referring to external resources, has the advantage of minimal impact on the ED's core mission; however, it is often ineffective for older, vulnerable adults who face barriers to following up on referrals due to cognitive, hearing, visual, and other functional impairments.<span><sup>4</sup></span></p><p>In this issue, Southerland et al. demonstrate the effectiveness of one approach to address the social needs of vulnerable elders.<span><sup>5</sup></span> As a result of a unique partnership with the local Office on Aging (OA), they embedded OA case managers within their ED to connect vulnerable older adults to nutrition services, emergency response systems, transportation, and other services, as needed. In this model, OA case managers work with ED social workers to identify community-dwelling older patients and perform in-person intake assessments during daytime hours whereas older patients are in the ED. Case workers arrange needed community services, often starting them immediately.</p><p>The advantages of the program are twofold. First, by matching the right professional to the task, the program bypasses several known barriers to hospital-to-community transitions, such as: the ED clinicians forgetting to screen or refer, patients forgetting to reach out, and failure to engage family members.<span><sup>6, 7</sup></span> Second, the program eliminates inefficient communication between older adult patients and OA programs, as when successful service provision relies on the older adult to reach out for care, and to be available and willing to answer the phone when the OA worker calls.</p><","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"3-5"},"PeriodicalIF":4.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741558","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}
Sascha Dublin MD, PhD, Ladia Albertson-Junkans MPH, Thanh Phuong Pham Nguyen PharmD, MBA, MSCE, Juliessa M. Pavon MD, MHS, S. Nicole Hastings MD, MHS, Matthew L. Maciejewski PhD, Allison Willis MD, MS, Lindsay Zepel MS, Sean Hennessy PharmD, PhD, Kathleen B. Albers MPH, Danielle Mowery PhD, MS, Amy G. Clark PhD, Sunil Thomas MBA/TM, Michael A. Steinman MD, Cynthia M. Boyd MD, MPH, Elizabeth A. Bayliss MD, MSPH
Background
Stopping or reducing risky or unneeded medications (“deprescribing”) could improve older adults' health. Electronic health data can support observational and intervention studies of deprescribing, but there are no standardized measures for key variables, and healthcare systems have differing data types and availability. We developed definitions for chronic medication use and discontinuation based on electronic health data and applied them in a case study of benzodiazepines and Z-drugs in five diverse US healthcare systems.
Methods
We conducted a retrospective cohort study of adults age 65+ from 2017 to 2019 with chronic benzodiazepine or Z-drug use. We determined whether sites had access to medication orders and/or dispensings. We developed definitions for chronic use and discontinuation using both data types. Discontinuation definitions were based on (1) gaps in medication availability during follow-up or (2) not having medication available at a fixed time point. We examined the impact of varying the gap length and requiring a 30-day period without orders/dispensings (“halo”) around the fixed time point. We compared results derived from orders versus dispensings at one site.
Results
Approximately 1.6%–2.6% of older adults had chronic benzodiazepine/Z-drug use (total N = 6775, ranging from 431 to 2122 across sites). Depending on the definition and site, the proportion discontinuing use during 12 months ranged from 6% to 49%. Requiring a longer gap or a 30-day “halo” resulted in lower estimates. At one site, only 56% of those with chronic use defined from orders also qualified based on dispensings, and the discontinuation rate at 180 days was 20% from orders versus 32% from dispensings.
Conclusions
Requiring a gap of ≥90 days or a “halo” around a time point may more accurately capture discontinuation than using a shorter gap or no halo. Orders data underestimate discontinuation compared to dispensings. Work is needed to adapt these definitions for other drug classes and settings.
{"title":"Defining key deprescribing measures from electronic health data: A multisite data harmonization project","authors":"Sascha Dublin MD, PhD, Ladia Albertson-Junkans MPH, Thanh Phuong Pham Nguyen PharmD, MBA, MSCE, Juliessa M. Pavon MD, MHS, S. Nicole Hastings MD, MHS, Matthew L. Maciejewski PhD, Allison Willis MD, MS, Lindsay Zepel MS, Sean Hennessy PharmD, PhD, Kathleen B. Albers MPH, Danielle Mowery PhD, MS, Amy G. Clark PhD, Sunil Thomas MBA/TM, Michael A. Steinman MD, Cynthia M. Boyd MD, MPH, Elizabeth A. Bayliss MD, MSPH","doi":"10.1111/jgs.19280","DOIUrl":"10.1111/jgs.19280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stopping or reducing risky or unneeded medications (“deprescribing”) could improve older adults' health. Electronic health data can support observational and intervention studies of deprescribing, but there are no standardized measures for key variables, and healthcare systems have differing data types and availability. We developed definitions for chronic medication use and discontinuation based on electronic health data and applied them in a case study of benzodiazepines and Z-drugs in five diverse US healthcare systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of adults age 65+ from 2017 to 2019 with chronic benzodiazepine or Z-drug use. We determined whether sites had access to medication orders and/or dispensings. We developed definitions for chronic use and discontinuation using both data types. Discontinuation definitions were based on (1) gaps in medication availability during follow-up or (2) not having medication available at a fixed time point. We examined the impact of varying the gap length and requiring a 30-day period without orders/dispensings (“halo”) around the fixed time point. We compared results derived from orders versus dispensings at one site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Approximately 1.6%–2.6% of older adults had chronic benzodiazepine/Z-drug use (total <i>N</i> = 6775, ranging from 431 to 2122 across sites). Depending on the definition and site, the proportion discontinuing use during 12 months ranged from 6% to 49%. Requiring a longer gap or a 30-day “halo” resulted in lower estimates. At one site, only 56% of those with chronic use defined from orders also qualified based on dispensings, and the discontinuation rate at 180 days was 20% from orders versus 32% from dispensings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Requiring a gap of ≥90 days or a “halo” around a time point may more accurately capture discontinuation than using a shorter gap or no halo. Orders data underestimate discontinuation compared to dispensings. Work is needed to adapt these definitions for other drug classes and settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"399-410"},"PeriodicalIF":4.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741489","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}
<p>When people ask my why I chose geriatrics as a speciality, my first reply is “stories.” I love speaking to patients – which is the reason I so enjoy the practice of medicine.</p><p>Stories propelled me to change my original plan to study engineering. Two books; A.J. Cronin's <i>The Citadel</i> and Paul de Kruif's <i>Microbe Hunters</i> that fascinated me. The next part of my story resulted from a junior year traversing Europe during my Brooklyn College studies. I ended up in Copenhagen where I befriended several female medical students. Invited to attend a few of their sessions at medical school, I was impressed with how much they enjoyed their studies and the brightness of their attitudes towards medicine; a sharp contrast to the American medical students I knew, who always seemed so serious and complained about the weight of their studies.</p><p>An example of this special story experience occurred when I reviewed a file of a patient who came to the Toronto Memory Clinic at which I was working part-time after I retired from the 44 years at the Baycrest Geriatric Centre. I read, “Place of birth: Dundee.”</p><p>I knew that this was going to be a special visit. Ian, an older gent, came in, with his daughter, born in Canada but who had twice visited Dundee with her father. As soon as he opened his mouth, I recognized the distinctive regional accent. How I ended up in Dundee rather than in the United States, my home country, was a story.</p><p>My decision to study in Europe, preferably Copenhagen, was not rejected by my liberal-minded parents. It was long before the internet; thus, the investigations required hours in our public library. I applied to medical schools in Denmark, Sweden, Switzerland, Belgium, England, and Scotland. As the answers returned, I was disappointed that the Danish schools did not accept foreign students; many of their own citizens studied needed to study abroad. I received acceptances from Basel in Switzerland and Louvain in Belgium. All the Scottish schools accepted me for the following year, when I would graduate from Brooklyn College.</p><p>That late August a telegraph delivery man came to my door. I ripped open the envelope. (remember telegrams??) “You are offered a position in 2nd year of the University of St. Andrews Medical School, beginning on the 1st of October 1961. Please indicate by telegram if you would prefer to do your pre-clinical period at St. Andrews followed by your clinical years in Dundee, or would you prefer to do your pre-clinical and clinical period in Dundee?”</p><p>I could not believe it, my dream. That evening after telling my parents, I sent the return telegram and the next day arranged to meet with my local US Army selective service branch to get permission to study overseas rather be drafted which in 1961 meant Vietnam.</p><p>My years in Dundee were among the most wonderful of my life. The studies were engrossing, the teaching outstanding and my classmates amazing. Of the 70 students in our cl
{"title":"Another Dundee story","authors":"Michael Gordon MD, MSc, FRCPC","doi":"10.1111/jgs.19279","DOIUrl":"10.1111/jgs.19279","url":null,"abstract":"<p>When people ask my why I chose geriatrics as a speciality, my first reply is “stories.” I love speaking to patients – which is the reason I so enjoy the practice of medicine.</p><p>Stories propelled me to change my original plan to study engineering. Two books; A.J. Cronin's <i>The Citadel</i> and Paul de Kruif's <i>Microbe Hunters</i> that fascinated me. The next part of my story resulted from a junior year traversing Europe during my Brooklyn College studies. I ended up in Copenhagen where I befriended several female medical students. Invited to attend a few of their sessions at medical school, I was impressed with how much they enjoyed their studies and the brightness of their attitudes towards medicine; a sharp contrast to the American medical students I knew, who always seemed so serious and complained about the weight of their studies.</p><p>An example of this special story experience occurred when I reviewed a file of a patient who came to the Toronto Memory Clinic at which I was working part-time after I retired from the 44 years at the Baycrest Geriatric Centre. I read, “Place of birth: Dundee.”</p><p>I knew that this was going to be a special visit. Ian, an older gent, came in, with his daughter, born in Canada but who had twice visited Dundee with her father. As soon as he opened his mouth, I recognized the distinctive regional accent. How I ended up in Dundee rather than in the United States, my home country, was a story.</p><p>My decision to study in Europe, preferably Copenhagen, was not rejected by my liberal-minded parents. It was long before the internet; thus, the investigations required hours in our public library. I applied to medical schools in Denmark, Sweden, Switzerland, Belgium, England, and Scotland. As the answers returned, I was disappointed that the Danish schools did not accept foreign students; many of their own citizens studied needed to study abroad. I received acceptances from Basel in Switzerland and Louvain in Belgium. All the Scottish schools accepted me for the following year, when I would graduate from Brooklyn College.</p><p>That late August a telegraph delivery man came to my door. I ripped open the envelope. (remember telegrams??) “You are offered a position in 2nd year of the University of St. Andrews Medical School, beginning on the 1st of October 1961. Please indicate by telegram if you would prefer to do your pre-clinical period at St. Andrews followed by your clinical years in Dundee, or would you prefer to do your pre-clinical and clinical period in Dundee?”</p><p>I could not believe it, my dream. That evening after telling my parents, I sent the return telegram and the next day arranged to meet with my local US Army selective service branch to get permission to study overseas rather be drafted which in 1961 meant Vietnam.</p><p>My years in Dundee were among the most wonderful of my life. The studies were engrossing, the teaching outstanding and my classmates amazing. Of the 70 students in our cl","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"626-628"},"PeriodicalIF":4.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735365","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}
Kristine E. Ensrud MD, MPH, John T. Schousboe MD, PhD, Allyson M. Kats MS, Howard A. Fink MD, MPH, Brent C. Taylor PhD, MPH, Kerry M. Sheets MD, Cynthia M. Boyd MD, MPH, Lisa Langsetmo PhD
Background
Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims-derived cost indicators.
Methods
Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community-dwelling fee-for-service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector-specific healthcare costs ascertained for 36 months after frailty assessment.
Results
Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims-based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors.
Conclusions
As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector-specific expenditures after accounting for claims-derived indicators. The parsimonious SOF phenotype can be readily assessed in space-constrained and time-limited practice settings to improve identification of older adults at high risk of costly care.
{"title":"Incremental healthcare costs of the simple SOF measure of phenotypic frailty in community-dwelling older adults","authors":"Kristine E. Ensrud MD, MPH, John T. Schousboe MD, PhD, Allyson M. Kats MS, Howard A. Fink MD, MPH, Brent C. Taylor PhD, MPH, Kerry M. Sheets MD, Cynthia M. Boyd MD, MPH, Lisa Langsetmo PhD","doi":"10.1111/jgs.19287","DOIUrl":"10.1111/jgs.19287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims-derived cost indicators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community-dwelling fee-for-service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector-specific healthcare costs ascertained for 36 months after frailty assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims-based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector-specific expenditures after accounting for claims-derived indicators. The parsimonious SOF phenotype can be readily assessed in space-constrained and time-limited practice settings to improve identification of older adults at high risk of costly care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"824-836"},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718076","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}
Jennifer L. Gabbard MD, Ellis Beurle BA, Zhang Zhang PhD, MS, Erica L. Frechman PhD, Kristin Lenoir PhD, Emilie Duchesneau PhD, Michelle M. Mielke PhD, Amresh D. Hanchate PhD
Background
The utilization of Annual Wellness Visits (AWVs), preventive healthcare visits covered by Medicare Part B, has grown steadily since their inception in 2011. However, longitudinal patterns and variations in use across enrollees, providers, and clinics remain poorly understood.
Objective
This study aimed to analyze AWV usage trends from 2018 to 2022 among a sizable cohort of Medicare beneficiaries, employing electronic health record (EHR) data. The goal was to assess AWV frequency and explore variations across enrollees, providers, and clinics.
Design
This retrospective observational study utilized EHR data from Medicare beneficiaries aged 66 and above, receiving continuous primary care from 2018 to 2022 (N = 24,549). Enrollees were classified into three categories based on their AWV utilization over a 5-year period: low users (0–1 AWVs), moderate users (2–3 AWVs), and regular users (4–5 AWVs). AWV usage patterns were examined across individual demographics and provider/clinic characteristics using multilevel regression models.
Key Results
Over the 2018–2022 period, 58.6% were regular AWV users, 27.7% were moderate users, and 13.7% were low users. Differences in primary care providers and clinics accounted for 56.4% (95% CI, 45.3%–66.9%) of the variation between low and regular users. Among enrollees who visited the same providers and clinics, individuals were less likely to be regular users of AWVs if they were 85 and older, Hispanic, from socioeconomically disadvantaged areas, or had multiple comorbidities.
Conclusions
The majority of Medicare beneficiaries in the study engaged with AWVs, with 86% having two or more over the 5-year period. These findings underscore the broad acceptance of AWVs among beneficiaries but also show that clinic and provider factors influence usage, especially among older, minoritized, and socioeconomically disadvantaged populations. Interventions at the provider and clinic levels are necessary to further improve AWV uptake, particularly for vulnerable groups.
{"title":"Longitudinal analysis of Annual Wellness Visit use among Medicare enrollees: Provider, enrollee, and clinic factors","authors":"Jennifer L. Gabbard MD, Ellis Beurle BA, Zhang Zhang PhD, MS, Erica L. Frechman PhD, Kristin Lenoir PhD, Emilie Duchesneau PhD, Michelle M. Mielke PhD, Amresh D. Hanchate PhD","doi":"10.1111/jgs.19263","DOIUrl":"10.1111/jgs.19263","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The utilization of Annual Wellness Visits (AWVs), preventive healthcare visits covered by Medicare Part B, has grown steadily since their inception in 2011. However, longitudinal patterns and variations in use across enrollees, providers, and clinics remain poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to analyze AWV usage trends from 2018 to 2022 among a sizable cohort of Medicare beneficiaries, employing electronic health record (EHR) data. The goal was to assess AWV frequency and explore variations across enrollees, providers, and clinics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This retrospective observational study utilized EHR data from Medicare beneficiaries aged 66 and above, receiving continuous primary care from 2018 to 2022 (<i>N</i> = 24,549). Enrollees were classified into three categories based on their AWV utilization over a 5-year period: low users (0–1 AWVs), moderate users (2–3 AWVs), and regular users (4–5 AWVs). AWV usage patterns were examined across individual demographics and provider/clinic characteristics using multilevel regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Results</h3>\u0000 \u0000 <p>Over the 2018–2022 period, 58.6% were regular AWV users, 27.7% were moderate users, and 13.7% were low users. Differences in primary care providers and clinics accounted for 56.4% (95% CI, 45.3%–66.9%) of the variation between low and regular users. Among enrollees who visited the same providers and clinics, individuals were less likely to be regular users of AWVs if they were 85 and older, Hispanic, from socioeconomically disadvantaged areas, or had multiple comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The majority of Medicare beneficiaries in the study engaged with AWVs, with 86% having two or more over the 5-year period. These findings underscore the broad acceptance of AWVs among beneficiaries but also show that clinic and provider factors influence usage, especially among older, minoritized, and socioeconomically disadvantaged populations. Interventions at the provider and clinic levels are necessary to further improve AWV uptake, particularly for vulnerable groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"759-770"},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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