Journal of the American Geriatrics Society最新文献

We read with interest the prospective cohort study by Orenstein et al. (Journal of the American Geriatrics Society 2025; 1–11) on potentially inappropriate prescribing (PIP) and mortality in community-dwelling older adults [1]. As public health researchers, we appreciate the study's longitudinal design and use of updated 2023 Beers/STOPP-START criteria. The novel findings on sex-specific risks and differential PIP impacts across health strata contribute meaningfully to medication safety in aging populations.

While the community-based cohort is a strength, the limited inclusion of frail, cognitively impaired, or low-SES individuals may constrain translating findings to those most vulnerable to PIP. Frail older adults face 2.3-fold higher adverse drug event rates than healthier peers yet remain underrepresented here [2]. Future work could oversample these groups using validated tools like the Fried frailty index alongside geocoded SES data, which may better inform targeted interventions.

Beyond sample composition, the observed association between having ≥ 2 prescribing omissions (PPOs) and approximately twofold higher non-cancer mortality risk among men is noteworthy, underscoring the importance of timely identification and intervention. However, implementing the START criteria relies heavily on documented diagnoses, which may not fully reflect real-world clinical uncertainty—such as undiagnosed heart failure. Incorporating implicit clinician judgment alongside explicit criteria could enhance both the detection and the practical clinical relevance of PPOs [3].

Focusing medication review solely at baseline provides valuable initial insights but leaves the longitudinal dynamics of prescribing underexplored. As much as 40% of potentially inappropriate medications (PIMs) may be deprescribed within a year [4]; integrating longitudinal pharmacy claims or prescription records could better capture PIP fluctuations and clarify whether the observed mortality association is driven by persistent versus transient exposure.

In sum, Orenstein et al. provide pivotal evidence that PIP modifies mortality risk. Addressing translational gaps—particularly for high-risk subgroups through real-world data integration—could accelerate translating these findings into practice and policy.

Haoyue Jin: conceptualization, supervision, writing – review and editing. Huina Zhu: writing – original draft. Binru Wang: data curation, visualization.

The authors declare no conflicts of interest.

This publication is linked to a related reply article by Orenstein et al. To view this article, visit https://doi.org/10.1111/jgs.70160.

The conventional approach to caring for patients pursuing voluntarily stopping of eating and drinking (VSED) allows physicians to disagree with the patient's decisions to pursue VSED, but it assumes clinicians should accept the patient's choice and provide all aspects of supportive care after the patient has autonomously elected to pursue VSED. We argue this conventional approach problematically ignores the problem of complicity with what some physicians take to be an unethical action. We propose an alternative approach that makes space for clinicians opposed to VSED to advise against this course of action, and to provide palliative medicine while resisting interventions that facilitate VSED.

The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach. The National Dementia Care Collaborative (NDCC), a coalition of scientific and clinical leaders in evidence-based dementia care, works to promote comprehensive dementia care. Drawing from the experiences of six previously tested programs—Aging Brain Care, Alzheimer's and Dementia Care, BRI Care Consultation, Care Ecosystem, Integrated Memory Care, and MIND at Home—we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. Our guidance also emphasizes leveraging existing community assets, aligning efforts with organizational priorities, and using both storytelling and data to make the case for change. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.