Nicholas S. Reed, Sarah Y. Bessen, Pablo Martinez-Amezcua, Jennifer A. Deal, Danielle Powell, Julie Hoover Fong, Edgar R. Miller III, Frank R. Lin, Megan A. Morris, Esther S. Oh
Background
Hearing loss affects nearly two-thirds of adults over the age of 70 years, and is associated with lower satisfaction with health care, which may be mediated by patient-provider communication barriers. Accompaniment, the presence and support of a companion during health care interactions, may modify the association between hearing and satisfaction with care by providing an intermediary to assist with communication.
Methods
Cross-sectional study of 9698 Medicare beneficiaries from the 2016 Medicare Current Beneficiaries Survey. We used regression models to estimate the association between self-reported trouble hearing and satisfaction with care, which was measured through reported satisfaction with overall quality of care, satisfaction with information provided, and satisfaction with provider's concern. Interaction terms and stratification by being accompanied to healthcare visits were used to assess if accompaniment modified the association between hearing loss and satisfaction with care.
Results
Nearly 45% of Medicare beneficiaries reported at least a little trouble hearing. Adults with a little trouble hearing (Odds Ratio [OR] = 1.168; 95% Confidence Interval [CI] = 1.047–1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043–1.603) had higher odds of being dissatisfied with the quality of their health care over the previous year compared to those with no trouble hearing. Among accompanied participants, no association was found between level of hearing trouble and dissatisfaction with care. Among unaccompanied adults, trouble with hearing was associated with higher odds of dissatisfaction. The associations were consistent across the three dissatisfaction outcomes.
Conclusions
Medicare beneficiaries with hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Stratified models suggest that accompaniment may modify the association between hearing and dissatisfaction with care. Future research should consider interventions to support unaccompanied adults with hearing loss during health care interactions.
{"title":"Modification of the Association Between Hearing Trouble and Satisfaction With Care by Accompaniment to Health Care Visits","authors":"Nicholas S. Reed, Sarah Y. Bessen, Pablo Martinez-Amezcua, Jennifer A. Deal, Danielle Powell, Julie Hoover Fong, Edgar R. Miller III, Frank R. Lin, Megan A. Morris, Esther S. Oh","doi":"10.1111/jgs.70176","DOIUrl":"10.1111/jgs.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hearing loss affects nearly two-thirds of adults over the age of 70 years, and is associated with lower satisfaction with health care, which may be mediated by patient-provider communication barriers. Accompaniment, the presence and support of a companion during health care interactions, may modify the association between hearing and satisfaction with care by providing an intermediary to assist with communication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional study of 9698 Medicare beneficiaries from the 2016 Medicare Current Beneficiaries Survey. We used regression models to estimate the association between self-reported trouble hearing and satisfaction with care, which was measured through reported satisfaction with overall quality of care, satisfaction with information provided, and satisfaction with provider's concern. Interaction terms and stratification by being accompanied to healthcare visits were used to assess if accompaniment modified the association between hearing loss and satisfaction with care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nearly 45% of Medicare beneficiaries reported at least a little trouble hearing. Adults with a little trouble hearing (Odds Ratio [OR] = 1.168; 95% Confidence Interval [CI] = 1.047–1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043–1.603) had higher odds of being dissatisfied with the quality of their health care over the previous year compared to those with no trouble hearing. Among accompanied participants, no association was found between level of hearing trouble and dissatisfaction with care. Among unaccompanied adults, trouble with hearing was associated with higher odds of dissatisfaction. The associations were consistent across the three dissatisfaction outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Medicare beneficiaries with hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Stratified models suggest that accompaniment may modify the association between hearing and dissatisfaction with care. Future research should consider interventions to support unaccompanied adults with hearing loss during health care interactions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"85-95"},"PeriodicalIF":4.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380549","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}
Austin Murphy, Zihao Liu, Heidi G. De Souza, Erica Leigh Chilson, Robyn Moucka, Pete Kardel, Caitlin Sheetz, Reiko Sato
Cover caption: Cumulative RSV Vaccination Uptake Rate by State. See the related article by Murphy et al., pages 3196–3202.
封面标题：各州累计RSV疫苗接种率。参见墨菲等人的相关文章，第3196-3202页。
{"title":"Cover","authors":"Austin Murphy, Zihao Liu, Heidi G. De Souza, Erica Leigh Chilson, Robyn Moucka, Pete Kardel, Caitlin Sheetz, Reiko Sato","doi":"10.1111/jgs.70162","DOIUrl":"https://doi.org/10.1111/jgs.70162","url":null,"abstract":"<p><b>Cover caption</b>: Cumulative RSV Vaccination Uptake Rate by State. See the related article by Murphy et al., pages 3196–3202.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 10","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369990","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}
Bridget M. Mayrer, Roisin M. Sabol, Bryant Shuey, Payel J. Roy, Katie J. Suda, Tae Woo Park, Timothy S. Anderson
{"title":"Trends in Initiation of Buprenorphine for Opioid Use Disorder Among Older Adults","authors":"Bridget M. Mayrer, Roisin M. Sabol, Bryant Shuey, Payel J. Roy, Katie J. Suda, Tae Woo Park, Timothy S. Anderson","doi":"10.1111/jgs.70182","DOIUrl":"10.1111/jgs.70182","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"581-584"},"PeriodicalIF":4.5,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369353","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}
Hanin Harbi, Lotte Rasmussen, Emma Bjørk, Mikkel Højlund, Carina Lundby, Jens Søndergaard, Jesper Ryg, Helene Kildegaard
Background
The COVID-19 pandemic and related measures led to social isolation and disrupted daily routines for care home residents, potentially harming their mental health. This study explored changes in incident psychotropic drug use among Danish care home residents during and after the pandemic.
Methods
We conducted an interrupted time series analysis on all individuals admitted to Danish care homes between 2015 and 2023 (n = 128,915). We compared monthly rates of incident psychotropic drug use during and after the COVID-19 pandemic with predictions from the pre-pandemic trends, estimating the excess number of cases for each period.
Results
At care home admission, residents had a median age of 85 years (interquartile range: 78–90), and 51% used psychotropic drugs. During the pandemic, incident psychotropic drug use exceeded levels expected from the pre-pandemic trend (179 excess users/10,000 residents; 95% confidence interval (CI): 72–286), with small increases for antidepressants (68/10,000; 95% CI: 7.9–128) and antipsychotics (81/10,000; 95% CI: 36–126). In the post-pandemic period, overall incident psychotropic use remained higher than expected from the pre-pandemic trend (343/10,000; 95% CI: 29–656). Although on a declining trend, incidence rates for antidepressants and Z-drugs were slightly elevated in the post-pandemic period (antidepressants: 237/10,000; 95% CI: 83–390; Z-drugs: 60/10,000; 95% CI: 23–98), while incident antipsychotic use returned to the pre-pandemic trend. Benzodiazepines and melatonin showed no substantial changes. Among incident psychotropic drug users during and after the pandemic, 58% had recent exposure to another psychotropic drug class, and 71% continued treatment beyond 6 months.
Conclusions
Incident psychotropic drug use among Danish care home residents increased during the COVID-19 pandemic and remained slightly elevated afterward. This warrants closer scrutiny of prescribing practices and highlights the need for targeted interventions to optimize psychotropic drug use in the post-pandemic era.
{"title":"Psychotropic Drug Use Among Danish Care Home Residents During and After the COVID-19 Pandemic","authors":"Hanin Harbi, Lotte Rasmussen, Emma Bjørk, Mikkel Højlund, Carina Lundby, Jens Søndergaard, Jesper Ryg, Helene Kildegaard","doi":"10.1111/jgs.70172","DOIUrl":"10.1111/jgs.70172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic and related measures led to social isolation and disrupted daily routines for care home residents, potentially harming their mental health. This study explored changes in incident psychotropic drug use among Danish care home residents during and after the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an interrupted time series analysis on all individuals admitted to Danish care homes between 2015 and 2023 (<i>n</i> = 128,915). We compared monthly rates of incident psychotropic drug use during and after the COVID-19 pandemic with predictions from the pre-pandemic trends, estimating the excess number of cases for each period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At care home admission, residents had a median age of 85 years (interquartile range: 78–90), and 51% used psychotropic drugs. During the pandemic, incident psychotropic drug use exceeded levels expected from the pre-pandemic trend (179 excess users/10,000 residents; 95% confidence interval (CI): 72–286), with small increases for antidepressants (68/10,000; 95% CI: 7.9–128) and antipsychotics (81/10,000; 95% CI: 36–126). In the post-pandemic period, overall incident psychotropic use remained higher than expected from the pre-pandemic trend (343/10,000; 95% CI: 29–656). Although on a declining trend, incidence rates for antidepressants and Z-drugs were slightly elevated in the post-pandemic period (antidepressants: 237/10,000; 95% CI: 83–390; Z-drugs: 60/10,000; 95% CI: 23–98), while incident antipsychotic use returned to the pre-pandemic trend. Benzodiazepines and melatonin showed no substantial changes. Among incident psychotropic drug users during and after the pandemic, 58% had recent exposure to another psychotropic drug class, and 71% continued treatment beyond 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Incident psychotropic drug use among Danish care home residents increased during the COVID-19 pandemic and remained slightly elevated afterward. This warrants closer scrutiny of prescribing practices and highlights the need for targeted interventions to optimize psychotropic drug use in the post-pandemic era.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 2","pages":"493-499"},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357376","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}
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential in improving glycemic control and reducing adverse outcomes in patients with Type 2 diabetes mellitus (T2DM); however, their efficacy in individuals aged 80 years and older remains understudied. To evaluate the efficacy of GLP-1 RAs compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in patients aged ≥ 80 years with T2DM.
Participant and Setting
De-identified records from the TriNetX United States database identified 284,417 patients aged ≥ 80 years with T2DM, including 12,032 new GLP-1 RA users and 28,230 new DPP4i users, analyzed from January 2018 to December 2022.
Methods
This retrospective cohort study utilized a new-user and active comparator design to evaluate clinical outcomes between GLP-1 RA and DPP4i users during a follow-up period of up to 5 years. Propensity score matching, incorporating all the baseline covariates, was used to minimize baseline differences. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs) for clinical outcomes. Sensitivity analyses were performed to validate the findings.
Results
After 1:1 propensity score matching, 11,464 patients were included in each group. Both cohorts had a mean age of 81.6 years; 47.7% were female, and 67% were White. GLP-1 RA users had significantly lower risks of major adverse cardiovascular events (HR: 0.86, 95% CI: 0.81–0.91), major adverse kidney events (HR: 0.86, 95% CI: 0.82–0.91), all-cause hospitalization (HR: 0.91, 95% CI: 0.84–0.97), and all-cause mortality (HR: 0.82, 95% CI: 0.77–0.88) compared with DPP4i users. No significant differences were observed between the groups in the rate of heart failure or bone fractures.
Conclusions
GLP-1 RAs may offer substantial cardiorenal and survival benefits in patients aged 80 years and older with T2DM. These findings support the use of GLP-1 RAs as a therapeutic option in this high-risk, older population.
{"title":"GLP-1 Receptor Agonist Therapy and Cardiorenal Outcomes in Patients ≥ 80 Years Old With Type 2 Diabetes","authors":"Jui-Cheng Chen, Yu-Wei Fang, Ya-Fang Liu, Mon-Ting Chen, Ming-Hsien Tsai","doi":"10.1111/jgs.70187","DOIUrl":"10.1111/jgs.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential in improving glycemic control and reducing adverse outcomes in patients with Type 2 diabetes mellitus (T2DM); however, their efficacy in individuals aged 80 years and older remains understudied. To evaluate the efficacy of GLP-1 RAs compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in patients aged ≥ 80 years with T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participant and Setting</h3>\u0000 \u0000 <p>De-identified records from the TriNetX United States database identified 284,417 patients aged ≥ 80 years with T2DM, including 12,032 new GLP-1 RA users and 28,230 new DPP4i users, analyzed from January 2018 to December 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study utilized a new-user and active comparator design to evaluate clinical outcomes between GLP-1 RA and DPP4i users during a follow-up period of up to 5 years. Propensity score matching, incorporating all the baseline covariates, was used to minimize baseline differences. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs) for clinical outcomes. Sensitivity analyses were performed to validate the findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After 1:1 propensity score matching, 11,464 patients were included in each group. Both cohorts had a mean age of 81.6 years; 47.7% were female, and 67% were White. GLP-1 RA users had significantly lower risks of major adverse cardiovascular events (HR: 0.86, 95% CI: 0.81–0.91), major adverse kidney events (HR: 0.86, 95% CI: 0.82–0.91), all-cause hospitalization (HR: 0.91, 95% CI: 0.84–0.97), and all-cause mortality (HR: 0.82, 95% CI: 0.77–0.88) compared with DPP4i users. No significant differences were observed between the groups in the rate of heart failure or bone fractures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GLP-1 RAs may offer substantial cardiorenal and survival benefits in patients aged 80 years and older with T2DM. These findings support the use of GLP-1 RAs as a therapeutic option in this high-risk, older population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"96-106"},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sunny C. Lin, Shekinah Fashaw-Walters, Gmerice Hammond, Ganesh M. Babulal, Ellesse-Roselee Akré, Bailey A. Martin Giacalone, R. J. Waken, Karen Joynt Maddox
Background
Racial segregation is believed to play a critical role in enforcing racial disparities in nursing home quality. In this study, we test whether segregation exacerbates racial disparities in nursing home quality.
Methods
We used data from the 2023 Minimum Data Set (MDS) and 2025 public use files on nursing home quality from the Center for Medicare and Medicaid Services to compare the quality of nursing homes with a high versus low proportion of Black residents and assess whether that relationship varied depending on the level of racial segregation among nursing homes in the county. Racial segregation was measured based on how Black and non-Hispanic White nursing home residents were distributed across nursing homes in a county. Nursing home quality measures included: star ratings, nursing turnover rates, adjusted staffing hours, and inspection deficiency scores.
Results
Racial disparities existed at all levels of segregation. Nursing home segregation was associated with widening disparities in inspection deficiency scores; no statistically significant association was found between segregation and racial disparities in star rating, nursing turnover rates, or adjusted staffing hours.
Conclusions
Racial disparities in nursing home quality are stark, with disparities in inspection deficiency scores exacerbated in counties with more segregated nursing home markets. These findings highlight the need for targeted policies to mitigate the impact of systemic disinvestment on nursing homes that serve a high proportion of Black residents.
{"title":"Nursing Home Segregation and Quality of Care","authors":"Sunny C. Lin, Shekinah Fashaw-Walters, Gmerice Hammond, Ganesh M. Babulal, Ellesse-Roselee Akré, Bailey A. Martin Giacalone, R. J. Waken, Karen Joynt Maddox","doi":"10.1111/jgs.70165","DOIUrl":"10.1111/jgs.70165","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Racial segregation is believed to play a critical role in enforcing racial disparities in nursing home quality. In this study, we test whether segregation exacerbates racial disparities in nursing home quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the 2023 Minimum Data Set (MDS) and 2025 public use files on nursing home quality from the Center for Medicare and Medicaid Services to compare the quality of nursing homes with a high versus low proportion of Black residents and assess whether that relationship varied depending on the level of racial segregation among nursing homes in the county. Racial segregation was measured based on how Black and non-Hispanic White nursing home residents were distributed across nursing homes in a county. Nursing home quality measures included: star ratings, nursing turnover rates, adjusted staffing hours, and inspection deficiency scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Racial disparities existed at all levels of segregation. Nursing home segregation was associated with widening disparities in inspection deficiency scores; no statistically significant association was found between segregation and racial disparities in star rating, nursing turnover rates, or adjusted staffing hours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Racial disparities in nursing home quality are stark, with disparities in inspection deficiency scores exacerbated in counties with more segregated nursing home markets. These findings highlight the need for targeted policies to mitigate the impact of systemic disinvestment on nursing homes that serve a high proportion of Black residents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3757-3765"},"PeriodicalIF":4.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Derek Lake, Soryan Kumar, Fangli Geng, Pedro Gozalo
Background
Prior research suggests discharge to inpatient rehabilitation facilities (IRF) leads to improved outcomes for stroke and hip fracture patients relative to skilled nursing facilities (SNF), while incurring greater costs. However, these estimates are likely biased by non-random patient selection.
Methods
We used a quasi-experimental design to compare post-acute care outcomes among Medicare beneficiaries hospitalized for stroke or hip fracture in 55 US hospitals that closed their IRF units between 2009 and 2017. Primary and secondary outcomes were 30-, 90-, and 180-day readmission and mortality, and successful community discharge.
Results
Among 10,761 stroke and 13,963 hip fracture hospitalizations, IRF discharge declined sharply, offset by increases to SNF and home health. Relative to IRF, SNF discharge was associated with no significant differences in readmissions but an increase in 90-day mortality for stroke (+6.5%, 95% CI 1.5%–11.4%) and hip fracture (+5.8%, 95% CI 2.5%–9.0%). Successful community discharge did not differ for patients redirected to SNF, but stroke patients redirected to home health had significantly higher rates of successful discharge (DID estimate: +6.8%; 95% CI 0.1%–13.5%). The protective effect of IRF was concentrated within 20 days post-discharge.
Conclusions
Following hospitalization for stroke and hip fracture, discharge to an IRF was associated with lower mortality relative to SNF. However, given the potential for unmeasured confounding, this association should be interpreted with caution. Careful post-acute care referral protocols are critical to ensure good patient outcomes.
背景：先前的研究表明，相对于熟练护理设施（SNF），住院康复设施（IRF）可以改善中风和髋部骨折患者的预后，但会产生更高的费用。然而，这些估计可能因非随机患者选择而有偏差。方法：我们采用准实验设计，比较2009年至2017年期间关闭IRF单位的55家美国医院因中风或髋部骨折住院的医疗保险受益人的急性后护理结果。主要和次要结局是30、90和180天的再入院和死亡率，以及成功的社区出院。结果：在10,761例卒中和13,963例髋部骨折住院患者中，IRF出院率急剧下降，被SNF和家庭健康的增加所抵消。相对于IRF， SNF出院与再入院无显著差异，但卒中（+6.5%,95% CI 1.5%-11.4%）和髋部骨折（+5.8%,95% CI 2.5%-9.0%）的90天死亡率增加。转到SNF的患者成功出院的社区没有差异，但转到家庭健康的卒中患者成功出院的比例显著更高（did估计：+6.8%;95% CI 0.1%-13.5%）。IRF的保护作用在出院后20天内集中。结论：卒中和髋部骨折住院后，与SNF相比，IRF出院的死亡率较低。然而，考虑到潜在的无法测量的混杂，这种关联应该谨慎解释。仔细的急性后护理转诊协议对于确保良好的患者预后至关重要。
{"title":"Comparative Effectiveness of Inpatient Rehabilitation Versus Skilled Nursing Facilities for Stroke and Hip Fracture Patients","authors":"Derek Lake, Soryan Kumar, Fangli Geng, Pedro Gozalo","doi":"10.1111/jgs.70164","DOIUrl":"10.1111/jgs.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Prior research suggests discharge to inpatient rehabilitation facilities (IRF) leads to improved outcomes for stroke and hip fracture patients relative to skilled nursing facilities (SNF), while incurring greater costs. However, these estimates are likely biased by non-random patient selection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a quasi-experimental design to compare post-acute care outcomes among Medicare beneficiaries hospitalized for stroke or hip fracture in 55 US hospitals that closed their IRF units between 2009 and 2017. Primary and secondary outcomes were 30-, 90-, and 180-day readmission and mortality, and successful community discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 10,761 stroke and 13,963 hip fracture hospitalizations, IRF discharge declined sharply, offset by increases to SNF and home health. Relative to IRF, SNF discharge was associated with no significant differences in readmissions but an increase in 90-day mortality for stroke (+6.5%, 95% CI 1.5%–11.4%) and hip fracture (+5.8%, 95% CI 2.5%–9.0%). Successful community discharge did not differ for patients redirected to SNF, but stroke patients redirected to home health had significantly higher rates of successful discharge (DID estimate: +6.8%; 95% CI 0.1%–13.5%). The protective effect of IRF was concentrated within 20 days post-discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Following hospitalization for stroke and hip fracture, discharge to an IRF was associated with lower mortality relative to SNF. However, given the potential for unmeasured confounding, this association should be interpreted with caution. Careful post-acute care referral protocols are critical to ensure good patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"64-73"},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Krista L. Harrison, Sun Y. Jeon, W. James Deardorff, Alexandra K. Lee, Lauren J. Hunt, Claire Ankuda, Melissa D. Aldridge, Kenneth E. Covinsky, Irena Cenzer, W. John Boscardin, Sei J. Lee, Alexander K. Smith
<p>People with dementia (PWD) with less than a 6-month prognosis stand to benefit from discussions about goals of care, medications, and deprescribing, and hospice [<span>1</span>]. Hospice eligibility requires a 6-month prognosis, but existing 6-month prognostic models are not accurate [<span>2</span>] nor easily replicable [<span>3</span>] for community-dwelling PWD. The “Deardorff 1–10 year Mortality in Dementia Index” has been shown to be effective at assessing mortality at 1, 2, 5, and 10 years among community-dwelling PWD [<span>4</span>]. As indicators of its use in clinical practice, the original manuscript has been cited 36 times between 2022 and 2025; in addition, monthly use of the Index in ePrognosis (https://eprognosis.ucsf.edu/dementia.php) ranges from 8000 and 11,000 people in 2025. We tested its performance for a 6-month prognosis.</p><p>As previously reported, we used the Health and Retirement Study (HRS) 1998–2016 (internal validation) and the National Health and Aging Trends Study (NHATS) 2011–2019 (external validation). We also replicated the analyses with newer data: HRS 2018–2022 and NHATS 2020–2023 (temporal validation).</p><p>Participants were age 65+, community-dwelling, with a 50%+ probability of dementia per the Wu-Glymour algorithm [<span>5</span>]. Predictors were assessed at the time of dementia identification: age, sex, body mass index, smoking status, count of activities of daily living dependencies (1–5), count of instrumental activities of daily living difficulties (1–5), difficulty walking several blocks, participation in vigorous physical activity, and presence of cancer, heart disease, diabetes, or lung disease. The primary outcome was death within 6 months. Missing variables were multiply imputed (<i>m</i> = 20).</p><p>We assessed model performance for 6-month prognosis by applying the previously developed Deardorff index to obtain predicted risks and evaluated discrimination (time-specific area under the receiver operating characteristic curve [AUC]), accounting for survey weights, calibration (plots of predicted and observed mortality), and calculation of sensitivity, specificity, positive and negative predictive value for various 6-month mortality risk thresholds. We re-estimated coefficients and tested the model in a subpopulation with greater disability, but performance was not superior. Our reporting was guided by the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) guidelines [<span>6</span>]. The study was approved by the UCSF Human Research Protection Program.</p><p>Of 4267 PWD in HRS (internal validation), the mean (SD) age was 82.2 (7.6) years, 2930 (69.4%) were female, and 785 (survey-weighted 12.1%) identified as Black. Median (IQR) follow-up time was 3.9 (2.0–6.8) years. Of these, 239 died within 6 months (survey-weighted 5.3%). The time-specific AUC at 6 months was 0.76 (95% confidence interval [CI], 0.74–0.77).</p><p>Of 2404 PWD in NHATS
预后少于6个月的痴呆症（PWD）患者可以从关于护理目标、药物、处方和临终关怀bb10的讨论中获益。安宁疗护资格需要6个月的预后，但现有的6个月预后模型对于社区居住的残疾人士并不准确，也不容易复制。“Deardorff 1 - 10年痴呆死亡率指数”已被证明在评估社区居住的残疾儿童1、2、5和10年死亡率方面是有效的。作为临床应用的指标，2022 - 2025年间原稿被引36次；此外，到2025年，每月使用ePrognosis （https://eprognosis.ucsf.edu/dementia.php）指数的人数将在8000至11000人之间。我们测试了它六个月的预后。如前所述，我们使用了1998-2016年健康与退休研究（HRS）（内部验证）和2011-2019年国家健康与老龄化趋势研究（NHATS）（外部验证）。我们还使用更新的数据重复了分析：HRS 2018-2022和NHATS 2020-2023（时间验证）。参与者年龄在65岁以上，居住在社区，根据Wu-Glymour算法[5]，痴呆症的概率为50%以上。在痴呆识别时评估预测因素：年龄、性别、体重指数、吸烟状况、日常生活依赖活动计数（1-5）、日常生活困难的工具活动计数（1-5）、步行几个街区的困难、参与剧烈体育活动以及癌症、心脏病、糖尿病或肺部疾病的存在。主要结局为6个月内死亡。对缺失变量进行多重估算（m = 20）。我们通过应用先前开发的Deardorff指数来评估模型6个月预后的性能，以获得预测风险和评估歧视（受试者工作特征曲线下的时间特异性面积[AUC]），考虑调查权重，校准（预测和观察死亡率图），以及计算各种6个月死亡率风险阈值的敏感性，特异性，阳性和阴性预测值。我们重新估计了系数，并在残疾程度更高的亚群中测试了模型，但效果并不好。我们的报告是在透明报告个体预后或诊断多变量预测模型（TRIPOD）指南[6]的指导下进行的。这项研究得到了加州大学旧金山分校人类研究保护计划的批准。在HRS（内部验证）的4267名PWD中，平均（SD）年龄为82.2（7.6）岁，2930（69.4%）为女性，785（调查加权12.1%）为黑人。中位（IQR）随访时间为3.9（2.0 ~ 6.8）年。其中239人在6个月内死亡（调查加权5.3%）。6个月时的时间特异性AUC为0.76（95%可信区间[CI]， 0.74-0.77）。在NHATS的2404例PWD（外部验证）中，176例在6个月内死亡（调查加权7.1%）；25%的人在43天内死亡，75%的人在138天内死亡。6个月时的时间特异性AUC为0.71 （95% CI, 0.67-0.75）。校准图显示，在预测风险的十分位数上，观察到的风险和预测的风险之间存在很强的一致性（图1）。在5%风险阈值以上，特异性和阴性预测值较高，敏感性和阳性预测值较低（表1）。更新数据的时间验证发现HRS中新增n = 498例新诊断的PWD，其中31例在6个月内死亡；NHATS中新诊断的PWD患者n = 412例，其中17例在6个月内死亡。时间特异性auc相似(HRS为0.70 (95% CI, 0.61-0.79)；NHATS为0.77 （95% CI, 0.64-0.89）。通过模型性能的传统测量，Deardorff 1-10年痴呆死亡率指数在6个月的结果中表现良好，与1年Deardorff指数相似（AUC统计量0.73）。然而，在该社区居住的PWD样本中，6个月死亡率罕见（~5%），因此，该指数具有高特异性，低敏感性和低阳性预测值。局限性包括尽管使用了经过验证的算法，但仍可能对痴呆症进行错误分类，缺乏有关痴呆症病因或严重程度的信息，以及6个月时的低死亡率（这影响了阳性和阴性预测值的估计，但不影响敏感性或特异性）。在临床实践或卫生系统中，该指数可作为一种筛查工具，用于识别社区居住的痴呆症成人，以进行高可能受益和低伤害风险的姑息性干预，包括关于目标、开处方的机会和未来护理计划的对话。Sun Y. Jeon对研究中的所有数据有完全的访问权，并对数据的完整性和数据分析的准确性负责。研究概念与设计：Krista L. Harrison， W. James Deardorff, Kenneth E. Covinsky, Alexander K. Smith, Sei J. Lee。数据获取：Alexander K. Smith, Sei J。
{"title":"Six-Month Prognostic Tool for Community-Dwelling People With Dementia","authors":"Krista L. Harrison, Sun Y. Jeon, W. James Deardorff, Alexandra K. Lee, Lauren J. Hunt, Claire Ankuda, Melissa D. Aldridge, Kenneth E. Covinsky, Irena Cenzer, W. John Boscardin, Sei J. Lee, Alexander K. Smith","doi":"10.1111/jgs.70183","DOIUrl":"10.1111/jgs.70183","url":null,"abstract":"<p>People with dementia (PWD) with less than a 6-month prognosis stand to benefit from discussions about goals of care, medications, and deprescribing, and hospice [<span>1</span>]. Hospice eligibility requires a 6-month prognosis, but existing 6-month prognostic models are not accurate [<span>2</span>] nor easily replicable [<span>3</span>] for community-dwelling PWD. The “Deardorff 1–10 year Mortality in Dementia Index” has been shown to be effective at assessing mortality at 1, 2, 5, and 10 years among community-dwelling PWD [<span>4</span>]. As indicators of its use in clinical practice, the original manuscript has been cited 36 times between 2022 and 2025; in addition, monthly use of the Index in ePrognosis (https://eprognosis.ucsf.edu/dementia.php) ranges from 8000 and 11,000 people in 2025. We tested its performance for a 6-month prognosis.</p><p>As previously reported, we used the Health and Retirement Study (HRS) 1998–2016 (internal validation) and the National Health and Aging Trends Study (NHATS) 2011–2019 (external validation). We also replicated the analyses with newer data: HRS 2018–2022 and NHATS 2020–2023 (temporal validation).</p><p>Participants were age 65+, community-dwelling, with a 50%+ probability of dementia per the Wu-Glymour algorithm [<span>5</span>]. Predictors were assessed at the time of dementia identification: age, sex, body mass index, smoking status, count of activities of daily living dependencies (1–5), count of instrumental activities of daily living difficulties (1–5), difficulty walking several blocks, participation in vigorous physical activity, and presence of cancer, heart disease, diabetes, or lung disease. The primary outcome was death within 6 months. Missing variables were multiply imputed (<i>m</i> = 20).</p><p>We assessed model performance for 6-month prognosis by applying the previously developed Deardorff index to obtain predicted risks and evaluated discrimination (time-specific area under the receiver operating characteristic curve [AUC]), accounting for survey weights, calibration (plots of predicted and observed mortality), and calculation of sensitivity, specificity, positive and negative predictive value for various 6-month mortality risk thresholds. We re-estimated coefficients and tested the model in a subpopulation with greater disability, but performance was not superior. Our reporting was guided by the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) guidelines [<span>6</span>]. The study was approved by the UCSF Human Research Protection Program.</p><p>Of 4267 PWD in HRS (internal validation), the mean (SD) age was 82.2 (7.6) years, 2930 (69.4%) were female, and 785 (survey-weighted 12.1%) identified as Black. Median (IQR) follow-up time was 3.9 (2.0–6.8) years. Of these, 239 died within 6 months (survey-weighted 5.3%). The time-specific AUC at 6 months was 0.76 (95% confidence interval [CI], 0.74–0.77).</p><p>Of 2404 PWD in NHATS ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"269-271"},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12695061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brent R. Schell, Jesse R. Katz, Megan Carr, Maryam Hasan
{"title":"Combating Ageism and Improving Attitudes Towards Aging Among Medicine Residents","authors":"Brent R. Schell, Jesse R. Katz, Megan Carr, Maryam Hasan","doi":"10.1111/jgs.70179","DOIUrl":"10.1111/jgs.70179","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3947-3949"},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannah J. Wong, Hsien Seow, Anastasia Gayowsky, Robert C. Wu, Hilda Lim, Rinku Sutradhar
Background
Goals of care (GOC) discussions between the clinical team and nursing home (NH) residents provide the basis for decision-making on advance directives (AD) that include do-not-resuscitate (DNR) and do-not-hospitalize (DNH). Optimal timing and prompts for initiating GOC discussions are unclear. This study investigates recent emergency department (ED) use and clinical and demographic factors associated with subsequent AD changes.
Methods
Nested case–control study within a population-based retrospective cohort using linked administrative health care data of individuals admitted to NHs in Ontario, Canada between 2013 and 2017 and then followed up until 2019. Eligible cases and controls were residents with and without an AD change between 2013 and 2019, respectively. Cases and controls were matched 1:1 by sex, composite AD at NH admission, NH admission date (±90 days), and birthdate (±365 days). The primary outcome was incident AD change, and exposures included recent ED use (either ED visits discharged back to NH or ED visits that resulted in hospitalization) and clinical and demographic variables measured at the time of documented AD change. Conditional logistic regression provided adjusted odds ratios for associations between exposures and incident AD change.
Results
The cases and controls (27,942 residents) had a mean age of 84 years at NH admission and 67.1% were female. 48.3% had a baseline AD of “DNR Only” while the remaining were evenly divided between “Full Code” and “DNR+DNH.” The estimated adjusted odds ratio of AD change was 2.01 (95% CI, 1.83–2.21) in residents with recent hospitalization, 1.89 (95% CI, 1.67–2.13) in those having end-stage disease, and 1.82 (95% CI, 1.56–2.12) in residents who were mostly bedfast.
Conclusions
A recent hospitalization, end-stage disease, or being bedfast are significant predictors of AD change. These important predictors exhibited by NH residents present opportunities to reassess GOC.
{"title":"Predictors of Advance Directive Changes in Ontario Nursing Home Residents: A Case–Control Study","authors":"Hannah J. Wong, Hsien Seow, Anastasia Gayowsky, Robert C. Wu, Hilda Lim, Rinku Sutradhar","doi":"10.1111/jgs.70184","DOIUrl":"10.1111/jgs.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Goals of care (GOC) discussions between the clinical team and nursing home (NH) residents provide the basis for decision-making on advance directives (AD) that include do-not-resuscitate (DNR) and do-not-hospitalize (DNH). Optimal timing and prompts for initiating GOC discussions are unclear. This study investigates recent emergency department (ED) use and clinical and demographic factors associated with subsequent AD changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Nested case–control study within a population-based retrospective cohort using linked administrative health care data of individuals admitted to NHs in Ontario, Canada between 2013 and 2017 and then followed up until 2019. Eligible cases and controls were residents with and without an AD change between 2013 and 2019, respectively. Cases and controls were matched 1:1 by sex, composite AD at NH admission, NH admission date (±90 days), and birthdate (±365 days). The primary outcome was incident AD change, and exposures included recent ED use (either ED visits discharged back to NH or ED visits that resulted in hospitalization) and clinical and demographic variables measured at the time of documented AD change. Conditional logistic regression provided adjusted odds ratios for associations between exposures and incident AD change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cases and controls (27,942 residents) had a mean age of 84 years at NH admission and 67.1% were female. 48.3% had a baseline AD of “DNR Only” while the remaining were evenly divided between “Full Code” and “DNR+DNH.” The estimated adjusted odds ratio of AD change was 2.01 (95% CI, 1.83–2.21) in residents with recent hospitalization, 1.89 (95% CI, 1.67–2.13) in those having end-stage disease, and 1.82 (95% CI, 1.56–2.12) in residents who were mostly bedfast.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A recent hospitalization, end-stage disease, or being bedfast are significant predictors of AD change. These important predictors exhibited by NH residents present opportunities to reassess GOC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"107-118"},"PeriodicalIF":4.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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