Journal of the American Geriatrics Society最新文献_第5页

Is more care recipient time at home also a family caregiver-centered quality of life measure? 更多接受护理者在家的时间也是以家庭护理者为中心的生活质量衡量标准吗？

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-13 DOI: 10.1111/jgs.19115

Courtney H. Van Houtven PhD, Karen M. Stechuchak MS, Paul A. Dennis PhD, MSA, Kasey Decosimo MPH, Chelsea L. Whitfield MPH, Nina R. Sperber PhD, S. Nicole Hastings MD, MHS, Megan Shepherd-Banigan PhD, MPH, Brystana G. Kaufman PhD, Valerie A. Smith DrPH

Background

Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home—days in the emergency department (ED), inpatient (IP) care, and post-acute care (PAC)—to understand how care recipient days not at home correspond to family caregiver QoL.

Methods

Secondary data were linked to care recipient utilization data. Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted “days not at home” variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden).

Results

In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%–3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (−0.1%). An IP day had a slight protective effect (−0.2 to −0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. PAC had a slight protective effect for caregiver burden (−0.1%). Cumulative days in all settings combined generally was not associated with caregiver QoL.

Conclusion

Whereas total care recipient time away from home had some negative spillovers to family caregivers, the countervailing effects of unique settings on caregiver QoL may mask net QoL effects. This finding limits the utility of a single care recipient home time measure as a valid caregiver-centered measure. Considering cumulative care recipient time in individual settings separately may be needed to reveal the true net effects on caregiver QoL.

背景：在医疗机构的时间与患者生活质量（QoL）的下降有关，但对家庭护理者生活质量的影响尚不清楚。我们评估了护理对象不在家的天数--在急诊科（ED）、住院（IP）护理和急性期后护理（PAC）的天数--以了解护理对象不在家的天数与家庭护理者 QoL 的对应关系：方法：将二级数据与接受护理者的使用数据联系起来。我们使用弹性网机器学习模型来评估在每种环境中使用一天护理服务对二元 QoL 结果的影响。我们还比较了综合加权和非加权 "不在家天数 "变量。我们使用 6 个月和 18 个月这两个时间段来预测三种照顾者 QoL 指标（自评健康、抑郁症状和主观负担）：结果：在 6 个月的时间框架内，单日使用急诊室与所有三个评估结果的 QoL 较差可能性增加有关（范围：1.4%-3.2%）。一天的 PAC 与护理负担（0.2%）和抑郁症状（0.1%）的增加有一定程度的相关性，但对自评健康有轻微的保护作用（-0.1%）。IP 日也有轻微的保护作用（-0.2% 到 -0.1%）。在 18 个月时，ED 和 IP 与照顾者负担和抑郁症状的关系相似，但较为平淡。PAC 对照顾者的负担有轻微的保护作用（-0.1%）。在所有环境中的累计天数一般与护理者的 QoL 无关：虽然接受照护者离开家庭的总时间对家庭照护者有一些负面溢出效应，但独特环境对照护者 QoL 的反作用可能会掩盖 QoL 的净效应。这一发现限制了单一的受照护者在家时间测量作为以照护者为中心的有效测量方法的实用性。要揭示对照顾者 QoL 的真正净影响，可能需要单独考虑个别环境中照顾者的累计时间。

{"title":"Is more care recipient time at home also a family caregiver-centered quality of life measure?","authors":"Courtney H. Van Houtven PhD, Karen M. Stechuchak MS, Paul A. Dennis PhD, MSA, Kasey Decosimo MPH, Chelsea L. Whitfield MPH, Nina R. Sperber PhD, S. Nicole Hastings MD, MHS, Megan Shepherd-Banigan PhD, MPH, Brystana G. Kaufman PhD, Valerie A. Smith DrPH","doi":"10.1111/jgs.19115","DOIUrl":"10.1111/jgs.19115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home—days in the emergency department (ED), inpatient (IP) care, and post-acute care (PAC)—to understand how care recipient days not at home correspond to family caregiver QoL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Secondary data were linked to care recipient utilization data. Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted “days not at home” variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%–3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (−0.1%). An IP day had a slight protective effect (−0.2 to −0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. PAC had a slight protective effect for caregiver burden (−0.1%). Cumulative days in all settings combined generally was not associated with caregiver QoL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Whereas total care recipient time away from home had some negative spillovers to family caregivers, the countervailing effects of unique settings on caregiver QoL may mask net QoL effects. This finding limits the utility of a single care recipient home time measure as a valid caregiver-centered measure. Considering cumulative care recipient time in individual settings separately may be needed to reveal the true net effects on caregiver QoL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3098-3108"},"PeriodicalIF":4.3,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972444","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}

引用次数: 0

A Thank You to JAGS Reviewers 感谢 JAGS 评论员

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-12 DOI: 10.1111/jgs.19137

引用次数: 0

Cover 封面

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-12 DOI: 10.1111/jgs.17866

Connie S. Cole PhD, DNP, RN-GERO, NP-C, ACHPN, C. Robert Bennett PhD, CPNP-AC, Joan G. Carpenter PhD, CRNP, ACHPN, FPCN, Regina M. Fink PhD, APRN, CHPN, AOCN, FAAN, Amy Jackson BSN, Kathleen T. Unroe MD, MHA, MS, Cari R. Levy MD, PhD

Cover caption: Domains of screening for unmet palliative care needs in nursing home residents. See the related article by Cole et al., pages 2590–2594.

封面标题：筛查养老院居民未满足的姑息关怀需求的领域。参见科尔等人的相关文章，第 2590-2594 页。

引用次数: 0

Perspectives on the COVID-19 pandemic and life-space mobility in older adults 透视 COVID-19 大流行与老年人的生命空间流动性。

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-12 DOI: 10.1111/jgs.19118

Erta Cenko MSPH, PhD, Todd M. Manini PhD, Emily J. Smail PhD

Background

The COVID-19 pandemic significantly affected the physical health of older adults around the world, causing day-to-day disruptions in routines and changes to usual patterns of mobility. Despite the passing of 2 years since vaccinations, older adults continue to experience detriments, including social isolation and reduced mobility. This study aims to understand how views of the COVID-19 pandemic are associated with life-space mobility—moving about the community. We hypothesize that endorsing stronger perspectives about the persistence of COVID-19 is correlated with reduced life-space mobility.

Methods

Survey data were collected via online questionnaire in October and November of 2022. Linear regression models were used to examine the relationship between five perspectives on the COVID-19 pandemic (e.g., agreeing that “I wish people would take COVID-19 more seriously”) and life-space mobility, measured using a modified version of the life space assessment, in older adults (n = 510). Analyses were adjusted for demographic factors and mental and physical health indicators, including depressive symptoms and number of chronic conditions.

Results

In fully adjusted models, the study found that endorsing a stronger lingering impact of the COVID-19 pandemic across any of the five perspectives was associated with significantly lower life-space mobility.

Conclusions

The results of this study show that endorsing a stronger lingering impact of the COVID-19 pandemic is associated with reduced life-space mobility, which underscores the importance of designing public health strategies that carefully balance the safety concerns of older adults with opportunities for physical activity and social interaction.

背景：COVID-19 大流行严重影响了世界各地老年人的身体健康，导致日常生活习惯被打乱，通常的行动模式也发生了变化。尽管接种疫苗已过去两年，但老年人仍继续遭受着各种不利影响，包括社会隔离和行动不便。本研究旨在了解人们对 COVID-19 大流行的看法如何与生活空间的流动性--在社区中的移动性--相关联。我们假设，对COVID-19的持续性持更强烈观点的人与生活空间流动性降低相关：方法：我们于 2022 年 10 月和 11 月通过在线问卷收集了调查数据。线性回归模型用于研究老年人（n = 510）对 COVID-19 大流行的五种观点（例如，同意 "我希望人们能更认真地对待 COVID-19"）与生活空间流动性之间的关系。分析根据人口统计学因素和身心健康指标（包括抑郁症状和慢性病数量）进行了调整：结果：在完全调整模型中，研究发现，从五个角度中的任何一个角度来看，认可COVID-19大流行病更强烈的挥之不去的影响都与生活空间流动性显著降低有关：本研究的结果表明，COVID-19 大流行的持久影响越大，生活空间的流动性就越低，这就强调了设计公共卫生策略的重要性，这些策略应在老年人的安全问题与体育活动和社会交往机会之间取得谨慎的平衡。

{"title":"Perspectives on the COVID-19 pandemic and life-space mobility in older adults","authors":"Erta Cenko MSPH, PhD, Todd M. Manini PhD, Emily J. Smail PhD","doi":"10.1111/jgs.19118","DOIUrl":"10.1111/jgs.19118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic significantly affected the physical health of older adults around the world, causing day-to-day disruptions in routines and changes to usual patterns of mobility. Despite the passing of 2 years since vaccinations, older adults continue to experience detriments, including social isolation and reduced mobility. This study aims to understand how views of the COVID-19 pandemic are associated with life-space mobility—moving about the community. We hypothesize that endorsing stronger perspectives about the persistence of COVID-19 is correlated with reduced life-space mobility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Survey data were collected via online questionnaire in October and November of 2022. Linear regression models were used to examine the relationship between five perspectives on the COVID-19 pandemic (e.g., agreeing that “I wish people would take COVID-19 more seriously”) and life-space mobility, measured using a modified version of the life space assessment, in older adults (<i>n</i> = 510). Analyses were adjusted for demographic factors and mental and physical health indicators, including depressive symptoms and number of chronic conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In fully adjusted models, the study found that endorsing a stronger lingering impact of the COVID-19 pandemic across any of the five perspectives was associated with significantly lower life-space mobility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results of this study show that endorsing a stronger lingering impact of the COVID-19 pandemic is associated with reduced life-space mobility, which underscores the importance of designing public health strategies that carefully balance the safety concerns of older adults with opportunities for physical activity and social interaction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3448-3456"},"PeriodicalIF":4.3,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972499","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}

引用次数: 0

Pre-procedural nursing home length of stay and outcomes of transcatheter aortic valve replacement 经导管主动脉瓣置换术前疗养院住院时间和疗效。

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-10 DOI: 10.1111/jgs.19124

Preston N. Nicely MD, Laiji Yang MPH, Dae Hyun Kim MD, ScD, Sarah D. Berry MD, MPH

Background

Older adults with severe aortic stenosis (AS) may receive care in a nursing home (NH) prior to undergoing transcatheter aortic valve replacement (TAVR). NH level of care can be used to stabilize medical conditions, to provide rehabilitation services, or for long-term care services. Our primary objective is to determine whether NH utilization pre-TAVR can be used to stratify patients at risk for higher mortality and poor disposition outcomes at 30 and 365 days post-TAVR.

Methods

We conducted a retrospective cohort study among Medicare beneficiaries who spent ≥1 day in an NH 6 months before TAVR (2011–2019). The intensity of NH utilization was categorized as low users (1–30 days), medium users (31–89 days), long-stay NH residents (≥ 100 days, with no more than a 10-day gap in care), and high post-acute rehabilitation patients (≥90 days, with more than a 10-day gap in care). The probabilities of death and disposition were estimated using multinomial logistic regression, adjusting for age, sex, and race.

Results

Among 15,581 patients, 9908 (63.6%) were low users, 4312 (27.7%) were medium users, 663 (4.3%) were high post-acute care rehab users, and 698 (4.4%) were long-stay NH residents before TAVR. High post-acute care rehabilitation patients were more likely to have dementia, weight loss, falls, and extensive dependence of activities of daily living (ADLs) as compared with low NH users. Mortality was the greatest in high post-acute care rehab users: 5.5% at 30 days, and 36.4% at 365 days. In contrast, low NH users had similar mortality rates compared with long-stay NH residents: 4.8% versus 4.8% at 30 days, and 24.9% versus 27.0% at 365 days.

Conclusion

Frequent bouts of post-acute rehabilitation before TAVR were associated with adverse outcomes, yet this metric may be helpful to determine which patients with severe AS could benefit from palliative and geriatric services.

背景：患有严重主动脉瓣狭窄（AS）的老年人在接受经导管主动脉瓣置换术（TAVR）之前可能会在疗养院（NH）接受护理。疗养院的护理水平可用于稳定病情、提供康复服务或长期护理服务。我们的主要目的是确定经导管主动脉瓣置换术前使用 NH 的情况是否可用于对死亡率较高和经导管主动脉瓣置换术后 30 天和 365 天处置结果较差的患者进行分层：我们对 TAVR 术前 6 个月（2011-2019 年）在 NH 中停留时间≥1 天的医疗保险受益人进行了一项回顾性队列研究。疗养院使用强度分为低度使用者（1-30 天）、中度使用者（31-89 天）、长期疗养院居民（≥ 100 天，护理间隔不超过 10 天）和高度急性期后康复患者（≥ 90 天，护理间隔超过 10 天）。在对年龄、性别和种族进行调整后，使用多项式逻辑回归对死亡和处置的概率进行了估计：在15581名患者中，9908人（63.6%）为低度使用者，4312人（27.7%）为中度使用者，663人（4.3%）为高度急性期后护理康复使用者，698人（4.4%）为TAVR前长期住院的新罕布什尔州居民。与低度住院患者相比，高度护理后康复患者更容易出现痴呆、体重减轻、跌倒和日常生活活动（ADLs）广泛依赖等问题。急性期后护理康复患者的死亡率最高：30 天内死亡率为 5.5%，365 天内死亡率为 36.4%。相比之下，低住院率患者的死亡率与长期住院的患者相近：30天的死亡率为4.8%对4.8%，365天的死亡率为24.9%对27.0%：结论：TAVR术前频繁的急性期后康复治疗与不良预后有关，但这一指标可能有助于确定哪些严重AS患者可以从姑息治疗和老年医学服务中获益。

{"title":"Pre-procedural nursing home length of stay and outcomes of transcatheter aortic valve replacement","authors":"Preston N. Nicely MD, Laiji Yang MPH, Dae Hyun Kim MD, ScD, Sarah D. Berry MD, MPH","doi":"10.1111/jgs.19124","DOIUrl":"10.1111/jgs.19124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older adults with severe aortic stenosis (AS) may receive care in a nursing home (NH) prior to undergoing transcatheter aortic valve replacement (TAVR). NH level of care can be used to stabilize medical conditions, to provide rehabilitation services, or for long-term care services. Our primary objective is to determine whether NH utilization pre-TAVR can be used to stratify patients at risk for higher mortality and poor disposition outcomes at 30 and 365 days post-TAVR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study among Medicare beneficiaries who spent ≥1 day in an NH 6 months before TAVR (2011–2019). The intensity of NH utilization was categorized as low users (1–30 days), medium users (31–89 days), long-stay NH residents (≥ 100 days, with no more than a 10-day gap in care), and high post-acute rehabilitation patients (≥90 days, with more than a 10-day gap in care). The probabilities of death and disposition were estimated using multinomial logistic regression, adjusting for age, sex, and race.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 15,581 patients, 9908 (63.6%) were low users, 4312 (27.7%) were medium users, 663 (4.3%) were high post-acute care rehab users, and 698 (4.4%) were long-stay NH residents before TAVR. High post-acute care rehabilitation patients were more likely to have dementia, weight loss, falls, and extensive dependence of activities of daily living (ADLs) as compared with low NH users. Mortality was the greatest in high post-acute care rehab users: 5.5% at 30 days, and 36.4% at 365 days. In contrast, low NH users had similar mortality rates compared with long-stay NH residents: 4.8% versus 4.8% at 30 days, and 24.9% versus 27.0% at 365 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Frequent bouts of post-acute rehabilitation before TAVR were associated with adverse outcomes, yet this metric may be helpful to determine which patients with severe AS could benefit from palliative and geriatric services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3510-3519"},"PeriodicalIF":4.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914963","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}

引用次数: 0

Alzheimer's disease and related dementia diagnoses among American Indian and Alaska Native adults aged ≥45 years, Indian Health Service System, 2016–2020 2016-2020年印第安人健康服务系统中年龄≥45岁的美国印第安人和阿拉斯加原住民成年人的阿尔茨海默病和相关痴呆症诊断。

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-08 DOI: 10.1111/jgs.19058

Andria Apostolou PhD, MPH, Jordan L. Kennedy MSPH, Marissa K. Person MSPH, Eva M. J. Jackson MPH, Bruce Finke MD, Lisa C. McGuire PhD, Kevin A. Matthews PhD

Background

Alzheimer's disease is the most common type of dementia and is responsible for up to 80% of dementia diagnoses and is the sixth leading cause of death in the United States. An estimated 38,000 American Indian/Alaska Native (AI/AN) people aged ≥65 years were living with Alzheimer's disease and related dementias (ADRD) in 2020, a number expected to double by 2030 and quadruple by 2050. Administrative healthcare data from the Indian Health Service (IHS) were used to estimate ADRD among AI/AN populations.

Methods

Administrative IHS healthcare data from federal fiscal years 2016 to 2020 from the IHS National Data Warehouse were used to calculate the count and rate per 100,000 AI/AN adults aged ≥45 years with at least one ADRD diagnosis code on their medical record.

Results

This study identified 12,877 AI/AN adults aged ≥45 years with an ADRD diagnosis code, with an overall rate of 514 per 100,000. Of those, 1856 people were aged 45–64. Females were 1.2 times (95% confidence interval: 1.1–1.2) more likely than males to have a medical visit with an ADRD diagnosis code.

Conclusions

Many AI/AN people with ADRD rely on IHS, tribal, and urban Indian health programs. The high burden of ADRD in AI/AN populations aged 45–64 utilizing IHS health services highlights the need for implementation of ADRD risk reduction strategies and assessment and diagnosis of ADRD in younger AI/AN populations. This study provides a baseline to assess future progress for efforts addressing ADRD in AI/AN communities.

背景：阿尔茨海默病是最常见的痴呆症，占痴呆症诊断的 80%，是美国第六大死因。据估计，2020 年有 3.8 万名年龄超过 65 岁的美国印第安人/阿拉斯加原住民（AI/AN）患有阿尔茨海默病和相关痴呆症（ADRD），预计到 2030 年这一数字将翻一番，到 2050 年将翻两番。我们使用印第安人健康服务局（IHS）的医疗保健管理数据来估算阿拉斯加原住民/印第安人中的阿兹海默症和相关痴呆症患者人数：方法：使用 IHS 国家数据仓库（IHS National Data Warehouse）中 2016 至 2020 联邦财政年度的 IHS 医疗保健管理数据，计算每 10 万名年龄≥45 岁、医疗记录中至少有一个 ADRD 诊断代码的 AI/AN 成人的人数和比率：这项研究确定了 12,877 名年龄≥45 岁、有 ADRD 诊断代码的亚裔美国人/印第安人成年人，总比率为每 10 万人中有 514 人。其中，1856 人的年龄在 45-64 岁之间。女性使用 ADRD 诊断代码就诊的可能性是男性的 1.2 倍（95% 置信区间：1.1-1.2）：许多患有 ADRD 的印第安原住民/雅利安人依赖于 IHS、部落和城市印第安人健康计划。使用 IHS 医疗服务的 45-64 岁美国印第安人/原住民人群的 ADRD 负担很高，这凸显了在年轻的美国印第安人/原住民人群中实施 ADRD 风险降低策略以及评估和诊断 ADRD 的必要性。这项研究提供了一个基线，可用于评估未来在解决阿拉斯加原住民/印第安人社区 ADRD 问题方面所取得的进展。

{"title":"Alzheimer's disease and related dementia diagnoses among American Indian and Alaska Native adults aged ≥45 years, Indian Health Service System, 2016–2020","authors":"Andria Apostolou PhD, MPH, Jordan L. Kennedy MSPH, Marissa K. Person MSPH, Eva M. J. Jackson MPH, Bruce Finke MD, Lisa C. McGuire PhD, Kevin A. Matthews PhD","doi":"10.1111/jgs.19058","DOIUrl":"10.1111/jgs.19058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Alzheimer's disease is the most common type of dementia and is responsible for up to 80% of dementia diagnoses and is the sixth leading cause of death in the United States. An estimated 38,000 American Indian/Alaska Native (AI/AN) people aged ≥65 years were living with Alzheimer's disease and related dementias (ADRD) in 2020, a number expected to double by 2030 and quadruple by 2050. Administrative healthcare data from the Indian Health Service (IHS) were used to estimate ADRD among AI/AN populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Administrative IHS healthcare data from federal fiscal years 2016 to 2020 from the IHS National Data Warehouse were used to calculate the count and rate per 100,000 AI/AN adults aged ≥45 years with at least one ADRD diagnosis code on their medical record.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study identified 12,877 AI/AN adults aged ≥45 years with an ADRD diagnosis code, with an overall rate of 514 per 100,000. Of those, 1856 people were aged 45–64. Females were 1.2 times (95% confidence interval: 1.1–1.2) more likely than males to have a medical visit with an ADRD diagnosis code.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many AI/AN people with ADRD rely on IHS, tribal, and urban Indian health programs. The high burden of ADRD in AI/AN populations aged 45–64 utilizing IHS health services highlights the need for implementation of ADRD risk reduction strategies and assessment and diagnosis of ADRD in younger AI/AN populations. This study provides a baseline to assess future progress for efforts addressing ADRD in AI/AN communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2834-2841"},"PeriodicalIF":4.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904029","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}

引用次数: 0

The role of geriatricians in the atrial fibrillation management teams 老年病学专家在心房颤动管理团队中的作用。

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-08 DOI: 10.1111/jgs.19132

Esra Ates Bulut MD, Mert Evlice MD, Ibrahim Halil Kurt MD, Ahmet Turan Isik MD

<p>The world's aging population is increasing, making it essential and complex to manage multimorbid older adults. According to United Nations statistics, people aged 65 years or older will rise from 761 million in 2021 to 1.6 billion in 2050. The number of people aged 80 years or older is growing even faster.<span><sup>1</sup></span> Due to the need to evaluate patients holistically and monitor them from a single source, geriatric medicine has gained importance all over the world. Geriatricians use an exclusive assessment method, the Comprehensive Geriatric Assessment (CGA), to evaluate not only systemic medical diseases and pharmacologic agents of the patients but also functionality, gait, mood, cognitive impairment, and nutritional status. This multidimensional holistic approach enables healthcare providers to identify medical and social problems and meet the sophisticated needs of older adults.</p><p>One of the major systemic medical conditions frequently encountered in older adults is atrial fibrillation (AF). In Europe, in 2010, around 9 million individuals older than 55 years had AF, and it is estimated to jump to 14 million by 2060.<span><sup>2</sup></span> AF prevalence gets higher with age, and it is an important issue in all specialties to prevent ischemic stroke because of a major cause of functionality and independence loss. AF screening, recognition, and management require multidisciplinary coordination. Therefore, AF has particular importance for geriatricians' clinical practice. Geriatricians also follow and implement the European Society of Cardiology guidelines into clinical practice as the most reliable source, updated in 2020.<span><sup>3</sup></span> Integrated management of patients was suggested in the guideline.</p><p>On the other hand, it should be kept in mind that some geriatric syndromes, such as falls, polypharmacy, malnutrition, and dementia, which may pose a risk in prescribing anticoagulant drugs, may make AF management more difficult in older adults. In addition, healthcare professionals should be aware that managing older patients with AF and one of those geriatric syndromes needs a special, holistic geriatric perspective. It is important to consider the risk of falls, chronic medical conditions (such as chronic liver or kidney disease), and the routine use of drugs to prevent unwanted drug–drug interactions or drug–disease interactions. It is also challenging to maintain the international normalized ratio (INR) therapeutic range in bed-bound patients on warfarin. Therefore, individual treatment and provision plans should be organized considering these situations. However, geriatricians have not been defined as a part of the integrated AF management team in fig. 11 in the 2020 AF guideline.<span><sup>3</sup></span> We believe geriatricians should be one of the top priorities in AF management. Additionally, it is important to raise awareness and specialization in the geriatric population among healthcare professio

全球老龄化人口不断增加，这使得对患有多种疾病的老年人进行管理变得十分必要和复杂。据联合国统计，65 岁或以上人口将从 2021 年的 7.61 亿增加到 2050 年的 16 亿。1 由于需要对患者进行全面评估和从单一来源进行监测，老年医学在全世界都得到了重视。老年医学专家使用一种独特的评估方法，即老年医学综合评估（CGA），不仅评估患者的系统性内科疾病和药物，还评估患者的功能、步态、情绪、认知障碍和营养状况。这种多维度的整体方法使医疗服务提供者能够识别医疗和社会问题，满足老年人的复杂需求。在欧洲，2010 年约有 900 万 55 岁以上的老年人患有心房颤动，预计到 2060 年将跃升至 1400 万。2 心房颤动的患病率随年龄增长而升高，是所有专科预防缺血性中风的重要问题，因为它是导致老年人丧失功能和独立性的主要原因。心房颤动的筛查、识别和管理需要多学科协调。因此，心房颤动对老年病学医生的临床实践尤为重要。老年病学医生在临床实践中也要遵循并执行欧洲心脏病学会的指南，因为它是最可靠的来源，并在 2020 年进行了更新。3 该指南建议对患者进行综合管理。另一方面，应注意的是，一些老年综合征，如跌倒、多药并用、营养不良和痴呆，可能会给抗凝药物的处方带来风险，这可能会使老年人的房颤管理更加困难。此外，医护人员应意识到，管理患有房颤和其中一种老年综合征的老年患者需要一种特殊的、全面的老年医学视角。重要的是要考虑跌倒风险、慢性疾病（如慢性肝病或肾病）以及常规用药，以防止不必要的药物间相互作用或药物与疾病间相互作用。对于卧床服用华法林的患者来说，维持国际正常化比值（INR）在治疗范围内也是一项挑战。因此，应根据这些情况制定个性化的治疗和供应计划。然而，在 2020 年心房颤动指南图 11 中，老年病学家并未被定义为心房颤动综合管理团队的一部分。此外，提高医护人员对老年病人群的认识和专业化水平也很重要。据报道，多学科综合护理方法（如除常规专科护理外的护士主导护理）与降低心血管疾病住院率和全因死亡率有关。4 将老年病学专家、老年心脏病专家、老年病学护士和老年药学专家纳入多学科心房颤动团队有助于患者坚持治疗和治疗随访，并有助于预防副作用。我们相信，这种方法将提高人们对心房颤动的认识，并提高心房颤动管理的质量。ME和IHK进行了文献检索并协助撰写了稿件。所有作者均参与并批准了最终稿件。作者无利益冲突需要声明。

{"title":"The role of geriatricians in the atrial fibrillation management teams","authors":"Esra Ates Bulut MD, Mert Evlice MD, Ibrahim Halil Kurt MD, Ahmet Turan Isik MD","doi":"10.1111/jgs.19132","DOIUrl":"10.1111/jgs.19132","url":null,"abstract":"<p>The world's aging population is increasing, making it essential and complex to manage multimorbid older adults. According to United Nations statistics, people aged 65 years or older will rise from 761 million in 2021 to 1.6 billion in 2050. The number of people aged 80 years or older is growing even faster.<span><sup>1</sup></span> Due to the need to evaluate patients holistically and monitor them from a single source, geriatric medicine has gained importance all over the world. Geriatricians use an exclusive assessment method, the Comprehensive Geriatric Assessment (CGA), to evaluate not only systemic medical diseases and pharmacologic agents of the patients but also functionality, gait, mood, cognitive impairment, and nutritional status. This multidimensional holistic approach enables healthcare providers to identify medical and social problems and meet the sophisticated needs of older adults.</p><p>One of the major systemic medical conditions frequently encountered in older adults is atrial fibrillation (AF). In Europe, in 2010, around 9 million individuals older than 55 years had AF, and it is estimated to jump to 14 million by 2060.<span><sup>2</sup></span> AF prevalence gets higher with age, and it is an important issue in all specialties to prevent ischemic stroke because of a major cause of functionality and independence loss. AF screening, recognition, and management require multidisciplinary coordination. Therefore, AF has particular importance for geriatricians' clinical practice. Geriatricians also follow and implement the European Society of Cardiology guidelines into clinical practice as the most reliable source, updated in 2020.<span><sup>3</sup></span> Integrated management of patients was suggested in the guideline.</p><p>On the other hand, it should be kept in mind that some geriatric syndromes, such as falls, polypharmacy, malnutrition, and dementia, which may pose a risk in prescribing anticoagulant drugs, may make AF management more difficult in older adults. In addition, healthcare professionals should be aware that managing older patients with AF and one of those geriatric syndromes needs a special, holistic geriatric perspective. It is important to consider the risk of falls, chronic medical conditions (such as chronic liver or kidney disease), and the routine use of drugs to prevent unwanted drug–drug interactions or drug–disease interactions. It is also challenging to maintain the international normalized ratio (INR) therapeutic range in bed-bound patients on warfarin. Therefore, individual treatment and provision plans should be organized considering these situations. However, geriatricians have not been defined as a part of the integrated AF management team in fig. 11 in the 2020 AF guideline.<span><sup>3</sup></span> We believe geriatricians should be one of the top priorities in AF management. Additionally, it is important to raise awareness and specialization in the geriatric population among healthcare professio","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3273-3274"},"PeriodicalIF":4.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904032","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}

引用次数: 0

Progression of frailty and cardiovascular outcomes among Medicare beneficiaries 医疗保险受益人的虚弱程度和心血管疾病后果的进展。

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-01 DOI: 10.1111/jgs.19116

Yusi Gong MD, Yang Song MSc, Jiaman Xu MPH, Huaying Dong MSc, Daniel B. Kramer MD, MPH, Ariela R. Orkaby MD, MPH, John A. Dodson MD, MPH, Jordan B. Strom MD, MSc

Background

Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression on cardiovascular outcomes remains uncertain.

Methods

To determine whether frailty progression is associated with adverse cardiovascular outcomes, independent of baseline frailty and age, we evaluated all Medicare Fee-for-Service beneficiaries ≥65 years at cohort inception with continuous enrollment from 2003 to 2015. Linear mixed effects models, adjusted for baseline frailty and age, were used to estimate change in a validated claims-based frailty index (CFI) over a 5-year period. Survival analysis was used to examine frailty progression and risk of adverse health outcomes.

Results

There were 8.9 million unique patients identified, mean age 77.3 ± 7.2 years, 58.7% female, 10.9% non-White race. In total, 60% had frailty progression and 40% frailty regression over median follow-up of 2.4 years. Compared to those with frailty regression, when adjusting for age and baseline CFI, those with frailty progression had a significantly greater risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.31–1.31), all-cause mortality (HR 1.34, 95% CI 1.34–1.34), acute myocardial infarction (HR 1.08, 95% CI 1.07–1.09), heart failure exacerbation (HR 1.30, 95% CI 1.29–1.30), ischemic stroke (HR 1.14, 95% CI 1.14–1.15). There was also a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer days alive at home (DAH) with more rapid progression compared to the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87–0.88, p < 0.001).

Conclusions

In this large, nationwide sample of older Medicare beneficiaries, frailty progression, independent of age and baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and ischemic stroke compared to those with frailty regression.

背景：虚弱与心血管不良后果相关，与年龄和合并症无关：虚弱与不良心血管预后相关，与年龄和合并症无关，但虚弱进展对心血管预后的独立影响仍不确定：为了确定虚弱进展是否与不良心血管预后相关，而与基线虚弱和年龄无关，我们评估了所有在队列开始时年龄≥65 岁的联邦医疗保险付费服务受益人，他们在 2003 年至 2015 年期间连续参加了队列。根据基线虚弱程度和年龄进行调整后，使用线性混合效应模型来估算 5 年间基于索赔的有效虚弱指数（CFI）的变化。使用生存分析来检验虚弱程度的进展和不良健康后果的风险：共识别出 890 万名患者，平均年龄为 77.3 ± 7.2 岁，58.7% 为女性，10.9% 为非白人。在 2.4 年的中位随访中，60% 的患者体弱程度加深，40% 的患者体弱程度减轻。在调整年龄和基线 CFI 后，与体弱衰退者相比，体弱衰退者发生重大心脑血管不良事件 (MACCE) 的风险明显更高（危险比 [HR] 1.31，95% 置信区间 [CI] 1.31-1.31）、全因死亡率（HR 1.34，95% CI 1.34-1.34）、急性心肌梗死（HR 1.08，95% CI 1.07-1.09）、心衰加重（HR 1.30，95% CI 1.29-1.30）、缺血性中风（HR 1.14，95% CI 1.14-1.15）。与进展最慢的组别相比，进展较快的组别发生各种结果的风险也呈梯度增加，而且进展较快的组别在家中存活的天数（DAH）也明显较少（270.4 ± 112.3 对 308.6 ± 93.0 天，比率比为 0.88，95% CI 0.87-0.88，P 结论：这是一项全国性的大型样本研究，研究结果表明，与进展最慢的组别相比，进展较快的组别发生各种结果的风险也呈梯度增加：在这一大型的全国性老年医疗保险受益人样本中，与体弱衰退的受益人相比，体弱衰退与年龄和基线体弱无关，与较少的 DAH 以及 MACCE、全因死亡率、心肌梗死、心力衰竭和缺血性中风的分级风险相关。

{"title":"Progression of frailty and cardiovascular outcomes among Medicare beneficiaries","authors":"Yusi Gong MD, Yang Song MSc, Jiaman Xu MPH, Huaying Dong MSc, Daniel B. Kramer MD, MPH, Ariela R. Orkaby MD, MPH, John A. Dodson MD, MPH, Jordan B. Strom MD, MSc","doi":"10.1111/jgs.19116","DOIUrl":"10.1111/jgs.19116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression on cardiovascular outcomes remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To determine whether frailty progression is associated with adverse cardiovascular outcomes, independent of baseline frailty and age, we evaluated all Medicare Fee-for-Service beneficiaries ≥65 years at cohort inception with continuous enrollment from 2003 to 2015. Linear mixed effects models, adjusted for baseline frailty and age, were used to estimate change in a validated claims-based frailty index (CFI) over a 5-year period. Survival analysis was used to examine frailty progression and risk of adverse health outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 8.9 million unique patients identified, mean age 77.3 ± 7.2 years, 58.7% female, 10.9% non-White race. In total, 60% had frailty progression and 40% frailty regression over median follow-up of 2.4 years. Compared to those with frailty regression, when adjusting for age and baseline CFI, those with frailty progression had a significantly greater risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.31–1.31), all-cause mortality (HR 1.34, 95% CI 1.34–1.34), acute myocardial infarction (HR 1.08, 95% CI 1.07–1.09), heart failure exacerbation (HR 1.30, 95% CI 1.29–1.30), ischemic stroke (HR 1.14, 95% CI 1.14–1.15). There was also a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer days alive at home (DAH) with more rapid progression compared to the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87–0.88, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this large, nationwide sample of older Medicare beneficiaries, frailty progression, independent of age and baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and ischemic stroke compared to those with frailty regression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3129-3139"},"PeriodicalIF":4.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141877013","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}

引用次数: 0

Vaccine patterns among older adults with Guillain–Barré syndrome and matched comparators, 2006–2019 2006-2019 年患有格林-巴利综合征的老年人和匹配的比较者的疫苗接种模式。

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-08-01 DOI: 10.1111/jgs.19110

Samantha R. Eiffert MPH, Alan C. Kinlaw PhD, MSPH, Betsy L. Sleath PhD, Carolyn T. Thorpe PhD, MPH, Rebecca Traub MD, Sudha R. Raman PhD, Til Stürmer MD, PhD

Background

Some vaccines have a small risk of triggering Guillain–Barré syndrome (GBS), an autoimmune disorder where nerve damage leads to paralysis. There is a CDC precaution for patients whose GBS was associated with an influenza or tetanus toxoid-containing vaccine (GBS occurring within 42 days following vaccination).

Methods

We described vaccine patterns before and after a GBS diagnosis with a matched cohort design in a 20% random sample of fee-for-service Medicare enrollees. We defined the index date as an ICD-9-CM or ICD-10-CM GBS diagnosis code in the primary position of an inpatient claim. We matched each GBS patient to five non-GBS comparators on sex, exact age, racial and ethnic category, state of residence and the month of preventive health visits during baseline; used weighting to balance covariates; and measured frequency of vaccines received per 100 people during year before and after the index date using the weighted mean cumulative count (wMCC).

Results

We identified 1567 patients with a GBS diagnosis with at least 1 year of prior continuous enrollment in Medicare A and B that matched to five comparators each. The wMCCs in the 1 year before the index date were similar for both groups, with a wMCC of 74 vaccines/100 people in the GBS group (95% CI 71, 77). Within 1 year after the index date, patients with GBS had received 26 vaccines/100 people (95% CI 23, 28), which was 41 fewer vaccines than matched non-GBS comparators (95% CI −44, −38). Among GBS patients, 11% were diagnosed with GBS within 42 days after a vaccine.

Conclusions

GBS diagnosis has a strong impact on reducing subsequent vaccination even though there is no warning or precaution about future vaccines for most patients diagnosed with GBS. These data suggest discordance between clinical practice and current vaccine recommendations.

背景：某些疫苗有引发吉兰-巴雷综合征（GBS）的小风险，这是一种自身免疫性疾病，神经损伤会导致瘫痪。美国疾病预防控制中心（CDC）对因接种流感疫苗或含破伤风类毒素疫苗而引发吉兰-巴雷综合征的患者制定了预防措施（接种后 42 天内发生吉兰-巴雷综合征）：我们对 20% 的医疗保险付费服务参保者进行了随机抽样，通过匹配队列设计描述了 GBS 诊断前后的疫苗接种模式。我们将指数日期定义为住院索赔主要位置上的 ICD-9-CM 或 ICD-10-CM GBS 诊断代码。我们根据性别、确切年龄、种族和民族类别、居住州以及基线期间预防性健康检查的月份，将每位 GBS 患者与五位非 GBS 比较者进行匹配；使用加权法平衡协变量；并使用加权平均累积计数 (wMCC) 计算指数日期前后一年中每 100 人接种疫苗的频率：我们确定了 1567 名确诊为 GBS 的患者，他们之前至少连续参加了一年的 A 类和 B 类医疗保险，并分别与五个比较者匹配。两组患者在指数日期前 1 年内的疫苗接种率相似，GBS 组的疫苗接种率为 74 支/100 人（95% CI 71-77）。在指数日期后的 1 年内，GBS 患者每 100 人接种了 26 支疫苗（95% CI 23，28），比匹配的非 GBS 对照组少接种 41 支疫苗（95% CI -44，-38）。在 GBS 患者中，有 11% 在接种疫苗后 42 天内被确诊为 GBS：结论：GBS 诊断对减少后续疫苗接种有很大影响，尽管对大多数确诊为 GBS 的患者来说，未来的疫苗接种没有任何警告或预防措施。这些数据表明临床实践与当前疫苗接种建议之间存在不一致。

{"title":"Vaccine patterns among older adults with Guillain–Barré syndrome and matched comparators, 2006–2019","authors":"Samantha R. Eiffert MPH, Alan C. Kinlaw PhD, MSPH, Betsy L. Sleath PhD, Carolyn T. Thorpe PhD, MPH, Rebecca Traub MD, Sudha R. Raman PhD, Til Stürmer MD, PhD","doi":"10.1111/jgs.19110","DOIUrl":"10.1111/jgs.19110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Some vaccines have a small risk of triggering Guillain–Barré syndrome (GBS), an autoimmune disorder where nerve damage leads to paralysis. There is a CDC precaution for patients whose GBS was associated with an influenza or tetanus toxoid-containing vaccine (GBS occurring within 42 days following vaccination).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We described vaccine patterns before and after a GBS diagnosis with a matched cohort design in a 20% random sample of fee-for-service Medicare enrollees. We defined the index date as an ICD-9-CM or ICD-10-CM GBS diagnosis code in the primary position of an inpatient claim. We matched each GBS patient to five non-GBS comparators on sex, exact age, racial and ethnic category, state of residence and the month of preventive health visits during baseline; used weighting to balance covariates; and measured frequency of vaccines received per 100 people during year before and after the index date using the weighted mean cumulative count (wMCC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 1567 patients with a GBS diagnosis with at least 1 year of prior continuous enrollment in Medicare A and B that matched to five comparators each. The wMCCs in the 1 year before the index date were similar for both groups, with a wMCC of 74 vaccines/100 people in the GBS group (95% CI 71, 77). Within 1 year after the index date, patients with GBS had received 26 vaccines/100 people (95% CI 23, 28), which was 41 fewer vaccines than matched non-GBS comparators (95% CI −44, −38). Among GBS patients, 11% were diagnosed with GBS within 42 days after a vaccine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GBS diagnosis has a strong impact on reducing subsequent vaccination even though there is no warning or precaution about future vaccines for most patients diagnosed with GBS. These data suggest discordance between clinical practice and current vaccine recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3055-3067"},"PeriodicalIF":4.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141877029","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}

引用次数: 0

Impact of Veterans Affairs Geriatric Research, Education, and Clinical Centers: Incubators of innovation in geriatrics 退伍军人事务老年医学研究、教育和临床中心的影响：老年医学创新的孵化器。

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2024-07-31 DOI: 10.1111/jgs.19082

Timothy W. Farrell MD, AGSF, Beth B. Hogans MS (Biomath.), MD, PhD, Lauren Moo MD, Robin Jump MD, PhD, Alayne Markland DO, MSc, Cathy Alessi MD, Steven Barczi MD, Taissa Bej MS, Robert A. Bonomo MD, Jorie Butler PhD, G. Paul Eleazer MD, FACP, AGSF, Pamela Flinton MLS, MAAL, AHIP, Randall W. Rupper MD, MPH, Mark A. Supiano MD, AGSF, Marianne Shaughnessy PhD, AGPCNP-BC, GS-C, FAAN, the GRECC Directors Association

Since their inception in 1975, the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers (GRECCs) have served as incubators of innovation in geriatrics. Their contributions to the VA mission were last reviewed in 2012. Herein, we describe the continuing impact of GRECCs in research, clinical, and educational areas, focusing on the period between 2018 and 2022. GRECC research spans the continuum from bench to bedside, with a growing research portfolio notable for highly influential publications. GRECC education connects healthcare professions trainees and practicing clinicians, as well as Veterans and their caregivers, to engaging learning experiences. Clinical advancements, including age-friendly care, span the continuum of care and leverage technology to link disparate geographical sites. GRECCs are uniquely positioned to serve older adults given their alignment with the largest integrated health system in the United States and their integration with academic health centers. As such, the GRECCs honor Veterans as they age by building VA capacity to care for the increasing number of aging Veterans seeking care from VA. GRECC advancements also benefit non-VA healthcare systems, their academic affiliates, and non-Veteran older adults. GRECCs make invaluable contributions to advancing geriatric and gerontological science, training healthcare professionals, and developing innovative models of geriatric care.

自 1975 年成立以来，退伍军人事务部老年医学研究、教育和临床中心（GRECCs）一直是老年医学创新的孵化器。上一次对退伍军人事务部老年医学研究、教育和临床中心的贡献进行回顾是在 2012 年。在此，我们将重点介绍 2018 年至 2022 年期间，美国退伍军人事务部老年医学研究、教育和临床中心在研究、临床和教育领域的持续影响。全球遗传资源中心的研究横跨从工作台到床边的各个领域，研究组合不断扩大，发表了极具影响力的论文。全球遗传资源中心的教育将医疗保健专业的受训人员和执业临床医生以及退伍军人及其护理人员与引人入胜的学习体验联系在一起。临床医学的进步，包括适合老年人的护理，跨越了护理的连续性，并利用技术将不同的地理位置联系起来。鉴于其与美国最大的综合医疗系统保持一致，并与学术医疗中心相结合，全球老年人医疗中心在服务老年人方面具有独特的优势。因此，退伍军人老年保健中心通过建设退伍军人事务部的能力，为越来越多寻求退伍军人事务部护理的老龄退伍军人提供护理服务，从而在退伍军人老龄化的过程中向他们致敬。老年保健中心的进步也惠及非退伍军人医疗保健系统、其学术附属机构和非退伍军人老年人。全球老年医学研究、教育和培训中心为推动老年医学和老年学科学的发展、培训医疗保健专业人员以及开发创新的老年医学护理模式做出了宝贵的贡献。

{"title":"Impact of Veterans Affairs Geriatric Research, Education, and Clinical Centers: Incubators of innovation in geriatrics","authors":"Timothy W. Farrell MD, AGSF, Beth B. Hogans MS (Biomath.), MD, PhD, Lauren Moo MD, Robin Jump MD, PhD, Alayne Markland DO, MSc, Cathy Alessi MD, Steven Barczi MD, Taissa Bej MS, Robert A. Bonomo MD, Jorie Butler PhD, G. Paul Eleazer MD, FACP, AGSF, Pamela Flinton MLS, MAAL, AHIP, Randall W. Rupper MD, MPH, Mark A. Supiano MD, AGSF, Marianne Shaughnessy PhD, AGPCNP-BC, GS-C, FAAN, the GRECC Directors Association","doi":"10.1111/jgs.19082","DOIUrl":"10.1111/jgs.19082","url":null,"abstract":"<p>Since their inception in 1975, the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers (GRECCs) have served as incubators of innovation in geriatrics. Their contributions to the VA mission were last reviewed in 2012. Herein, we describe the continuing impact of GRECCs in research, clinical, and educational areas, focusing on the period between 2018 and 2022. GRECC research spans the continuum from bench to bedside, with a growing research portfolio notable for highly influential publications. GRECC education connects healthcare professions trainees and practicing clinicians, as well as Veterans and their caregivers, to engaging learning experiences. Clinical advancements, including age-friendly care, span the continuum of care and leverage technology to link disparate geographical sites. GRECCs are uniquely positioned to serve older adults given their alignment with the largest integrated health system in the United States and their integration with academic health centers. As such, the GRECCs honor Veterans as they age by building VA capacity to care for the increasing number of aging Veterans seeking care from VA. GRECC advancements also benefit non-VA healthcare systems, their academic affiliates, and non-Veteran older adults. GRECCs make invaluable contributions to advancing geriatric and gerontological science, training healthcare professionals, and developing innovative models of geriatric care.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3315-3326"},"PeriodicalIF":4.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857496","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}

引用次数: 0