There are likely many contributors to variation in the rate of cognitive decline in middle and late adulthood, including individual and neighborhood socio-economic factors. This study examines whether individual socio-economic factors, namely income and wealth, correlate with cognitive decline, in part, through neighborhood-level social and material disadvantage.
Methods
Using the three waves of data collection from the Canadian Longitudinal Study on Aging (CLSA), this study included 51,338 participants between the age of 45 and 85 years at baseline (51% female). Individual socio-economic status (SES) was assessed by annual household income and by the current value of savings and investments. Neighborhood disadvantage was measured by area-based material and social deprivation indices. Cognition was measured at each wave using verbal fluency, mental alternations, and delayed word recall. Latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of individual SES on cognitive change through area-level disadvantage. Multi-group models were constructed on the basis of age-group (45–64 years; 65–74 years; or 75+ years) to allow for varying estimates across age.
Results
Among 45–64-year-olds, income and wealth had indirect effects on initial cognitive level and on rate of cognitive decline through material disadvantage (standardized indirect effects = 0.01, p < 0.001), but only wealth had an indirect effect through social disadvantage (p = 0.019). Among 65-74-year-olds, income and wealth had indirect effects on initial cognitive level (p < 0.01) but not on rate of cognitive decline (p > 0.05), and among 75+ year-olds, no indirect effects were observed (p > 0.05). Wealth and income had direct effects, independent of neighborhood disadvantage, on cognition in all age groups (p < 0.05).
Conclusions
Among middle-aged adults, greater individual SES may mitigate cognitive decline, in part, by allowing individuals to live in more materially and socially advantaged neighborhoods.
{"title":"Individual socioeconomic status, neighborhood disadvantage, and cognitive aging: A longitudinal analysis of the CLSA","authors":"John R. Best PhD","doi":"10.1111/jgs.19155","DOIUrl":"10.1111/jgs.19155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There are likely many contributors to variation in the rate of cognitive decline in middle and late adulthood, including individual and neighborhood socio-economic factors. This study examines whether individual socio-economic factors, namely income and wealth, correlate with cognitive decline, in part, through neighborhood-level social and material disadvantage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the three waves of data collection from the Canadian Longitudinal Study on Aging (CLSA), this study included 51,338 participants between the age of 45 and 85 years at baseline (51% female). Individual socio-economic status (SES) was assessed by annual household income and by the current value of savings and investments. Neighborhood disadvantage was measured by area-based material and social deprivation indices. Cognition was measured at each wave using verbal fluency, mental alternations, and delayed word recall. Latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of individual SES on cognitive change through area-level disadvantage. Multi-group models were constructed on the basis of age-group (45–64 years; 65–74 years; or 75+ years) to allow for varying estimates across age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 45–64-year-olds, income and wealth had indirect effects on initial cognitive level and on rate of cognitive decline through material disadvantage (standardized indirect effects = 0.01, <i>p</i> < 0.001), but only wealth had an indirect effect through social disadvantage (<i>p</i> = 0.019). Among 65-74-year-olds, income and wealth had indirect effects on initial cognitive level (<i>p</i> < 0.01) but not on rate of cognitive decline (<i>p</i> > 0.05), and among 75+ year-olds, no indirect effects were observed (<i>p</i> > 0.05). Wealth and income had direct effects, independent of neighborhood disadvantage, on cognition in all age groups (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among middle-aged adults, greater individual SES may mitigate cognitive decline, in part, by allowing individuals to live in more materially and socially advantaged neighborhoods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3335-3345"},"PeriodicalIF":4.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038126","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}
Brystana G. Kaufman PhD, MSPH, Sandra Woolson MS, Catherine Stanwyck BA, Madison Burns BS, Paul Dennis PhD, Jessica Ma MD, Shelli Feder PhD, APRN, Joshua M. Thorpe PhD, S. Nicole Hastings MD, David B. Bekelman MD, Courtney H. Van Houtven PhD
Background
Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters).
Methods
This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010–2017) to describe veteran demographics, socioeconomic status, life-limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241–99245).
Results
Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (n = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (n = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64).
Conclusions
This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one-third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults.
{"title":"Veterans' use of inpatient and outpatient palliative care: The national landscape","authors":"Brystana G. Kaufman PhD, MSPH, Sandra Woolson MS, Catherine Stanwyck BA, Madison Burns BS, Paul Dennis PhD, Jessica Ma MD, Shelli Feder PhD, APRN, Joshua M. Thorpe PhD, S. Nicole Hastings MD, David B. Bekelman MD, Courtney H. Van Houtven PhD","doi":"10.1111/jgs.19141","DOIUrl":"10.1111/jgs.19141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010–2017) to describe veteran demographics, socioeconomic status, life-limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241–99245).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (<i>n</i> = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (<i>n</i> = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one-third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3385-3397"},"PeriodicalIF":4.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047671","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}
Kerri Niino BS, Molly A. Patapoff BA, Brent T. Mausbach PhD, Hui Liu PhD, Alison A. Moore MD, MPH, Benjamin H. Han MD, MPH, Barton W. Palmer PhD, Dylan J. Jester PhD, MPH
Background
Spousal loss is a stressful life event that is associated with loneliness and social isolation, both of which affect mental and physical health. The primary objective of this paper was to synthesize longitudinal studies that investigated loneliness and social isolation in widowhood.
Methods
A systematic search of the literature was conducted using three electronic databases. 26 longitudinal studies published through June 2024 were included for further analysis. Participant characteristics, study design, and key findings were extracted.
Results
Most studies were from the United States or Europe, included more widows than widowers, and assessed loneliness in older adults aged >60 years. Loneliness peaked directly following spousal death, but findings were inconsistent regarding the lasting effects of widowhood. Heterogeneity in the longitudinal trajectories of loneliness was noted, with studies showing linear increases, decreases, or curvilinear relationships over time. Several factors modified the relationship between widowhood and loneliness, including volunteerism, military experience, income, and age. Widowers consistently reported greater loneliness and worse social isolation when compared with widows. Few studies investigated social isolation specifically, but those that did found that social isolation may decrease in widowhood.
Conclusions
As the world grapples with a social pandemic of loneliness and social isolation, widowed adults may be uniquely affected. Few studies investigated the longitudinal trajectory of loneliness and especially social isolation in widowhood, and those that did found heterogenous results. Future work is needed to understand why some widowed adults are uniquely affected by feelings of loneliness and social isolation while others are not, and whether potentially modifiable factors that moderate or mediate this relationship could be leveraged by psychosocial interventions.
{"title":"Development of loneliness and social isolation after spousal loss: A systematic review of longitudinal studies on widowhood","authors":"Kerri Niino BS, Molly A. Patapoff BA, Brent T. Mausbach PhD, Hui Liu PhD, Alison A. Moore MD, MPH, Benjamin H. Han MD, MPH, Barton W. Palmer PhD, Dylan J. Jester PhD, MPH","doi":"10.1111/jgs.19156","DOIUrl":"10.1111/jgs.19156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Spousal loss is a stressful life event that is associated with loneliness and social isolation, both of which affect mental and physical health. The primary objective of this paper was to synthesize longitudinal studies that investigated loneliness and social isolation in widowhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of the literature was conducted using three electronic databases. 26 longitudinal studies published through June 2024 were included for further analysis. Participant characteristics, study design, and key findings were extracted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most studies were from the United States or Europe, included more widows than widowers, and assessed loneliness in older adults aged >60 years. Loneliness peaked directly following spousal death, but findings were inconsistent regarding the lasting effects of widowhood. Heterogeneity in the longitudinal trajectories of loneliness was noted, with studies showing linear increases, decreases, or curvilinear relationships over time. Several factors modified the relationship between widowhood and loneliness, including volunteerism, military experience, income, and age. Widowers consistently reported greater loneliness and worse social isolation when compared with widows. Few studies investigated social isolation specifically, but those that did found that social isolation may decrease in widowhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As the world grapples with a social pandemic of loneliness and social isolation, widowed adults may be uniquely affected. Few studies investigated the longitudinal trajectory of loneliness and especially social isolation in widowhood, and those that did found heterogenous results. Future work is needed to understand why some widowed adults are uniquely affected by feelings of loneliness and social isolation while others are not, and whether potentially modifiable factors that moderate or mediate this relationship could be leveraged by psychosocial interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"253-265"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038124","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}
Máté Szilcz PhD, Jonas W. Wastesson PhD, Amaia Calderón-Larrañaga PhD, Daniel Prieto-Alhambra MD, PhD, Pierre-Olivier Blotière PhD, Géric Maura PharmD, PhD, Kristina Johnell PhD
<p>We sincerely thank Professor Montastruc for their letter.<span><sup>1</sup></span> We appreciate that our call for further research on the interaction between non-steroidal anti-inflammatory drugs (NSAIDs) and cholinesterase inhibitors (ChEIs) and their effects on peptic ulcer was noticed.<span><sup>2</sup></span> We value the use of established pharmacovigilance methods for detecting a signal for the drug–drug interaction we identified. Signal detection is an important first step in the process of establishing evidence, which we omitted in our research, where we directly moved to hypothesis testing with pharmacoepidemiologic methods.</p><p>Professor Montastruc investigated the drug–drug interaction using disproportionality analyses, which focuses on the differences in the proportion of adverse event reports in a global pharmacovigilance database. They found that the reporting odds ratios of peptic ulcer for the combination of ChEIs and NSAIDs were three times as high as for NSAIDs alone, an effect estimate that is in line with our findings. Furthermore, they highlighted that their study extends our research, as we compared treatment episodes with no treatment, whereas they compared the combination treatment with NSAIDs alone.</p><p>To quantify the comparison between combination of ChEIs and NSAIDs and NSAIDs alone, similarly to Montastruc, we performed a post hoc analysis on the results obtained from our self-controlled case series study. We found that the incidence rate ratio of peptic ulcer with concomitant use of ChEIs and NSAIDs is 1.74 (95% confidence interval: 1.27–2.38) compared to NSAIDs alone. This is a slightly smaller effect size than reported by Montastruc. This discrepancy could be due to the fact that Montastruc calculated <i>reporting</i> odds ratios, which might overestimate the true risk of adverse effects in pharmacovigilance databases, especially in the case of drug–drug interactions.<span><sup>3</sup></span></p><p>We appreciate that our work has inspired further research on the topic, but there are necessary next steps. Following the detected signal from Montastruc and our pharmacoepidemiologic research, future studies should use big data, for example via federated networks of health data.<span><sup>4</sup></span> Analyzing a large cohort would potentially allow for the examination of subgroups, such as different combinations of chemical substances in ChEIs (e.g., donepezil, rivastigmine, galantamine) and NSAIDs (e.g., diclofenac, naproxen, ibuprofen), and their effects on bleeding or non-bleeding peptic ulcers—analyses we could not perform. Increasing the size of the study population via federated networks would further enhance precision and enable wider generalizability of the results. Ultimately, when enough evidence is gathered, concomitant ChEIs and NSAIDs use should be carefully evaluated and potentially included in guidelines to prevent inappropriate medication use, ensuring better safety and outcomes for patients.<
{"title":"Reply to: Peptic ulcers with ChEIs, NSAIDs","authors":"Máté Szilcz PhD, Jonas W. Wastesson PhD, Amaia Calderón-Larrañaga PhD, Daniel Prieto-Alhambra MD, PhD, Pierre-Olivier Blotière PhD, Géric Maura PharmD, PhD, Kristina Johnell PhD","doi":"10.1111/jgs.19133","DOIUrl":"10.1111/jgs.19133","url":null,"abstract":"<p>We sincerely thank Professor Montastruc for their letter.<span><sup>1</sup></span> We appreciate that our call for further research on the interaction between non-steroidal anti-inflammatory drugs (NSAIDs) and cholinesterase inhibitors (ChEIs) and their effects on peptic ulcer was noticed.<span><sup>2</sup></span> We value the use of established pharmacovigilance methods for detecting a signal for the drug–drug interaction we identified. Signal detection is an important first step in the process of establishing evidence, which we omitted in our research, where we directly moved to hypothesis testing with pharmacoepidemiologic methods.</p><p>Professor Montastruc investigated the drug–drug interaction using disproportionality analyses, which focuses on the differences in the proportion of adverse event reports in a global pharmacovigilance database. They found that the reporting odds ratios of peptic ulcer for the combination of ChEIs and NSAIDs were three times as high as for NSAIDs alone, an effect estimate that is in line with our findings. Furthermore, they highlighted that their study extends our research, as we compared treatment episodes with no treatment, whereas they compared the combination treatment with NSAIDs alone.</p><p>To quantify the comparison between combination of ChEIs and NSAIDs and NSAIDs alone, similarly to Montastruc, we performed a post hoc analysis on the results obtained from our self-controlled case series study. We found that the incidence rate ratio of peptic ulcer with concomitant use of ChEIs and NSAIDs is 1.74 (95% confidence interval: 1.27–2.38) compared to NSAIDs alone. This is a slightly smaller effect size than reported by Montastruc. This discrepancy could be due to the fact that Montastruc calculated <i>reporting</i> odds ratios, which might overestimate the true risk of adverse effects in pharmacovigilance databases, especially in the case of drug–drug interactions.<span><sup>3</sup></span></p><p>We appreciate that our work has inspired further research on the topic, but there are necessary next steps. Following the detected signal from Montastruc and our pharmacoepidemiologic research, future studies should use big data, for example via federated networks of health data.<span><sup>4</sup></span> Analyzing a large cohort would potentially allow for the examination of subgroups, such as different combinations of chemical substances in ChEIs (e.g., donepezil, rivastigmine, galantamine) and NSAIDs (e.g., diclofenac, naproxen, ibuprofen), and their effects on bleeding or non-bleeding peptic ulcers—analyses we could not perform. Increasing the size of the study population via federated networks would further enhance precision and enable wider generalizability of the results. Ultimately, when enough evidence is gathered, concomitant ChEIs and NSAIDs use should be carefully evaluated and potentially included in guidelines to prevent inappropriate medication use, ensuring better safety and outcomes for patients.<","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3612-3613"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019934","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}
Jane S. Saczynski PhD, Benjamin Koethe MPH, Donna Marie Fick PhD, Quynh T. Vo MPH, John W. Devlin PharmD, Edward R. Marcantonio MD, Becky A. Briesacher PhD
<div> <section> <h3> Background</h3> <p>Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer's disease related dementias (ADRD) has not been examined.</p> </section> <section> <h3> Objective</h3> <p>To compare change in cognition and function among short-stay SNF patients with delirium, ADRD, or both.</p> </section> <section> <h3> Design</h3> <p>Retrospective cohort study using claims data from 2011 to 2013.</p> </section> <section> <h3> Setting</h3> <p>Centers for Medicare and Medicaid certified SNFs.</p> </section> <section> <h3> Participants</h3> <p>A total of 740,838 older adults newly admitted to a short-stay SNF without prevalent ADRD who had at least two assessments of cognition and function.</p> </section> <section> <h3> Measurements</h3> <p>Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD-9 codes, and incident ADRD by ICD-9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale.</p> </section> <section> <h3> Results</h3> <p>Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD-only and delirium-only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD.</p> </section> <section> <h3> Conclusions</h3> <p>Among older adults without dementia admitted to SNF for post-acute care following hospitalization, a positive screen for delirium and a new diagnosis
{"title":"Cognitive and functional change in skilled nursing facilities: Differences by delirium and Alzheimer's disease and related dementias","authors":"Jane S. Saczynski PhD, Benjamin Koethe MPH, Donna Marie Fick PhD, Quynh T. Vo MPH, John W. Devlin PharmD, Edward R. Marcantonio MD, Becky A. Briesacher PhD","doi":"10.1111/jgs.19112","DOIUrl":"10.1111/jgs.19112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer's disease related dementias (ADRD) has not been examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare change in cognition and function among short-stay SNF patients with delirium, ADRD, or both.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study using claims data from 2011 to 2013.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Centers for Medicare and Medicaid certified SNFs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>A total of 740,838 older adults newly admitted to a short-stay SNF without prevalent ADRD who had at least two assessments of cognition and function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD-9 codes, and incident ADRD by ICD-9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD-only and delirium-only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among older adults without dementia admitted to SNF for post-acute care following hospitalization, a positive screen for delirium and a new diagnosis ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3501-3509"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019931","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}
<p>We read with great interest the Szilcz's study showing that the risk of peptic ulcer increased for the combination of cholinesterase inhibitors (ChEIs) and non-steroidal anti-inflammatory drugs (NSAIDs) more than for NSAIDs alone<span><sup>1</sup></span> in patients ≥65 years. Their work was a self-controlled study. Since approaches in pharmacovigilance and pharmacoepidemiology should be multisource,<span><sup>2</sup></span> we investigated this possible drug interaction (DI) using disproportionality analyses<span><sup>3, 4</sup></span> in the global pharmacovigilance database Vigibase®.</p><p>All reports with ChEIs (N06DA following Anatomical Therapeutic Chemical (ATC) classification) and NSAIDs (M01AA butylpyrazolidines, M01AB acetic acid derivatives and related substances, M01AC oxicams, M01AE propionic and derivatives, M01AG fenamates, M01AH coxibs) registered as “suspected/interacting” in Vigibase® between 01/01/1994 and 31/12/2023 in adults (≥65 years) with known age and sex were included. Disproportionality analyses<span><sup>3, 4</sup></span> were performed with cases being reports of “<i>gastrointestinal ulcerations</i> and perforations” (GUP) (HLGT according to Standardized MedDRA Queries classification, excluding anal, rectal, and esophagus ulcers) with the drug(s) of interest and non-cases all other reports with the same drug(s) of interest. Following this case non-case analysis,<span><sup>3, 4</sup></span> results with ChEIs + NSAIDs were compared with NSAIDs alone. To minimize the potential reporting bias and increase the medical meaning, a sensitivity analyses was performed only including reports by physicians. Results are presented as reporting odds ratios (ROR),<span><sup>3, 4</sup></span> a ratio similar in concept to the odds ratio in case–control studies with their 95% confidence interval. The research was performed and paper written according to the READUS-PV consensus statement for drug safety signal detection using Individual case safety reports in pharmacovigilance.<span><sup>5, 6</sup></span></p><p>Among the 7,054,411 reports registered in VigiBase® according to the criteria defined above, 31,494 were GUP with 283 including ChEIs alone (mainly donepezil 49.5%), 9060 NSAIDs alone (mainly propionic drugs like ibuprofen 33.0%) and 29 the combination ChEIs + NSAIDs. Patients were mainly women (57.9% for NSAIDs, 54.1% for ChEIs, 82.8% for combination). Most of them were ≥75 years old (60.0% for NSAIDs, 78.4% for ChEIs, 79.3% for combination).</p><p>Table 1 shows the number of GUP reports. Significant ROR values were found for ChEIs alone, NSAIDs alone and their combination for all reports (whatever the reporter) as well as for reports only coming from physicians. ROR values for the comparison ChEIs + NSAIDs vs NSAIDs alone was 3.24 (2.18–4.81) for all reports and 2.64 (1.56–4.46) for physicians.</p><p>Using a validated method for detecting risk signals,<span><sup>3-6</sup></span> our results are in line with the self-contro
{"title":"Peptic ulcers with ChEIs, NSAIDs","authors":"Jean-Louis Montastruc MD, PhD","doi":"10.1111/jgs.19128","DOIUrl":"10.1111/jgs.19128","url":null,"abstract":"<p>We read with great interest the Szilcz's study showing that the risk of peptic ulcer increased for the combination of cholinesterase inhibitors (ChEIs) and non-steroidal anti-inflammatory drugs (NSAIDs) more than for NSAIDs alone<span><sup>1</sup></span> in patients ≥65 years. Their work was a self-controlled study. Since approaches in pharmacovigilance and pharmacoepidemiology should be multisource,<span><sup>2</sup></span> we investigated this possible drug interaction (DI) using disproportionality analyses<span><sup>3, 4</sup></span> in the global pharmacovigilance database Vigibase®.</p><p>All reports with ChEIs (N06DA following Anatomical Therapeutic Chemical (ATC) classification) and NSAIDs (M01AA butylpyrazolidines, M01AB acetic acid derivatives and related substances, M01AC oxicams, M01AE propionic and derivatives, M01AG fenamates, M01AH coxibs) registered as “suspected/interacting” in Vigibase® between 01/01/1994 and 31/12/2023 in adults (≥65 years) with known age and sex were included. Disproportionality analyses<span><sup>3, 4</sup></span> were performed with cases being reports of “<i>gastrointestinal ulcerations</i> and perforations” (GUP) (HLGT according to Standardized MedDRA Queries classification, excluding anal, rectal, and esophagus ulcers) with the drug(s) of interest and non-cases all other reports with the same drug(s) of interest. Following this case non-case analysis,<span><sup>3, 4</sup></span> results with ChEIs + NSAIDs were compared with NSAIDs alone. To minimize the potential reporting bias and increase the medical meaning, a sensitivity analyses was performed only including reports by physicians. Results are presented as reporting odds ratios (ROR),<span><sup>3, 4</sup></span> a ratio similar in concept to the odds ratio in case–control studies with their 95% confidence interval. The research was performed and paper written according to the READUS-PV consensus statement for drug safety signal detection using Individual case safety reports in pharmacovigilance.<span><sup>5, 6</sup></span></p><p>Among the 7,054,411 reports registered in VigiBase® according to the criteria defined above, 31,494 were GUP with 283 including ChEIs alone (mainly donepezil 49.5%), 9060 NSAIDs alone (mainly propionic drugs like ibuprofen 33.0%) and 29 the combination ChEIs + NSAIDs. Patients were mainly women (57.9% for NSAIDs, 54.1% for ChEIs, 82.8% for combination). Most of them were ≥75 years old (60.0% for NSAIDs, 78.4% for ChEIs, 79.3% for combination).</p><p>Table 1 shows the number of GUP reports. Significant ROR values were found for ChEIs alone, NSAIDs alone and their combination for all reports (whatever the reporter) as well as for reports only coming from physicians. ROR values for the comparison ChEIs + NSAIDs vs NSAIDs alone was 3.24 (2.18–4.81) for all reports and 2.64 (1.56–4.46) for physicians.</p><p>Using a validated method for detecting risk signals,<span><sup>3-6</sup></span> our results are in line with the self-contro","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3609-3611"},"PeriodicalIF":4.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019932","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}
Understanding patients' degree of frailty is crucial for tailoring clinical care for older adults based on their physiologic reserve and health needs (“frailty-guided clinical care”). Two prerequisites for frailty-guided clinical care are: (1) access to frailty information at the point of care and (2) evidence to inform decisions based on frailty information. Recent advancements include web-based frailty assessment tools and their electronic health records integration for time-efficient, standardized assessments in clinical practice. Additionally, database frailty scores from administrative claims and electronic health records data enable scalable assessments and evaluation of the effectiveness and safety of medical interventions across different frailty levels using real-world data. Given limited evidence from clinical trials, real-world database studies can complement trial results and help treatment decisions for individuals with frailty. This article, based on the Thomas and Catherine Yoshikawa Award lecture I gave at the American Geriatrics Society Annual Meeting in Long Beach, California, on May 5, 2023, outlines our group's contributions: (1) developing and integrating a frailty index calculator (Senior Health Calculator) into the electronic health records at an academic medical center; (2) developing a claims-based frailty index for Medicare claims; (3) applying this index to evaluate the effect of medical interventions for patients with and without frailty; and (4) efforts to disseminate frailty assessment tools through the launch of the eFrailty website and the forthcoming addition of the claims-based frailty index to the Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse. This article concludes with future directions for frailty-guided clinical care.
{"title":"Unleashing frailty from laboratory into real world: A critical step toward frailty-guided clinical care of older adults","authors":"Dae Hyun Kim MD, MPH, ScD","doi":"10.1111/jgs.19151","DOIUrl":"10.1111/jgs.19151","url":null,"abstract":"<p>Understanding patients' degree of frailty is crucial for tailoring clinical care for older adults based on their physiologic reserve and health needs (“frailty-guided clinical care”). Two prerequisites for frailty-guided clinical care are: (1) access to frailty information at the point of care and (2) evidence to inform decisions based on frailty information. Recent advancements include web-based frailty assessment tools and their electronic health records integration for time-efficient, standardized assessments in clinical practice. Additionally, database frailty scores from administrative claims and electronic health records data enable scalable assessments and evaluation of the effectiveness and safety of medical interventions across different frailty levels using real-world data. Given limited evidence from clinical trials, real-world database studies can complement trial results and help treatment decisions for individuals with frailty. This article, based on the Thomas and Catherine Yoshikawa Award lecture I gave at the American Geriatrics Society Annual Meeting in Long Beach, California, on May 5, 2023, outlines our group's contributions: (1) developing and integrating a frailty index calculator (Senior Health Calculator) into the electronic health records at an academic medical center; (2) developing a claims-based frailty index for Medicare claims; (3) applying this index to evaluate the effect of medical interventions for patients with and without frailty; and (4) efforts to disseminate frailty assessment tools through the launch of the eFrailty website and the forthcoming addition of the claims-based frailty index to the Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse. This article concludes with future directions for frailty-guided clinical care.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3299-3314"},"PeriodicalIF":4.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019935","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}
Carolyn W. Zhu PhD, Justin Choi MEd, William Hung MD, Mary Sano PhD
Introduction
Racial and ethnic disparities in potentially inappropriate medication (PIM) use among older adults with dementia are unclear.
Methods
Data were drawn from the baseline visits of participants who were ≥60 years old and diagnosed with dementia in the National Alzheimer's Coordinating Center Uniform Data Set (NACCUDS) recruited from National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADCs) throughout the United States. PIM utilization was evaluated using the 2019 American Geriatrics Society Beers Criteria for PIM Use in Older Adults. We estimated the association between race and ethnicity and the following outcomes and estimation models: (1) any PIM use, any PIM in each drug class, and any PIM best avoided in dementia patients using logistic regression models, (2) total number of medications, total number of PIMs, and anticholinergic burden scale (ACBS) using Poisson or negative binomial regression models, and (3) proportion of total medications that were PIMs using generalized linear models (GLM).
Results
Compared to White participants, Black, Hispanic, and Asian participants reported taking fewer total medications (incidence rate ratio [IRR] ± standard error[SE] = 0.903 ± 0.017, 0.875 ± 0.021, and 0.912 ± 0.041, respectively, all p < 0.01). Asian participants were less likely to be exposed to any PIM (odds ratio [OR] ± SE = 0.619 ± 0.118, p < 0.05). Compared to White participants, Black participants were less likely to be exposed to benzodiazepine (OR ± SE = 0.609 ± 0.094, p < 0.01) and antidepressant (OR ± SE = 0.416 ± 0.103, p < 0.001) PIMs, but greater antipsychotic (OR ± SE = 1.496 ± 0.204, p < 0.01), cardiovascular (OR ± SE = 2.193 ± 0.255, p < 0.001), and skeletal muscle relaxant (OR ± SE = 2.977 ± 0.860, p < 0.001) PIMs. Hispanic participants were exposed to greater skeletal muscle relaxant PIMs and had lower anticholinergic burden. Asian participants were exposed to fewer benzodiazepine PIMs.
Discussion
Significant racial and ethnic disparities in exposure to PIMs and PIMs by medication category in dementia research participants who have access to dementia experts found in the study suggest that disparities may be wider in the larger community.
{"title":"Racial and ethnic disparities in potentially inappropriate medication use in patients with dementia","authors":"Carolyn W. Zhu PhD, Justin Choi MEd, William Hung MD, Mary Sano PhD","doi":"10.1111/jgs.19152","DOIUrl":"10.1111/jgs.19152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Racial and ethnic disparities in potentially inappropriate medication (PIM) use among older adults with dementia are unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were drawn from the baseline visits of participants who were ≥60 years old and diagnosed with dementia in the National Alzheimer's Coordinating Center Uniform Data Set (NACCUDS) recruited from National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADCs) throughout the United States. PIM utilization was evaluated using the 2019 American Geriatrics Society Beers Criteria for PIM Use in Older Adults. We estimated the association between race and ethnicity and the following outcomes and estimation models: (1) any PIM use, any PIM in each drug class, and any PIM best avoided in dementia patients using logistic regression models, (2) total number of medications, total number of PIMs, and anticholinergic burden scale (ACBS) using Poisson or negative binomial regression models, and (3) proportion of total medications that were PIMs using generalized linear models (GLM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to White participants, Black, Hispanic, and Asian participants reported taking fewer total medications (incidence rate ratio [IRR] ± standard error[SE] = 0.903 ± 0.017, 0.875 ± 0.021, and 0.912 ± 0.041, respectively, all <i>p</i> < 0.01). Asian participants were less likely to be exposed to any PIM (odds ratio [OR] ± SE = 0.619 ± 0.118, <i>p</i> < 0.05). Compared to White participants, Black participants were less likely to be exposed to benzodiazepine (OR ± SE = 0.609 ± 0.094, <i>p</i> < 0.01) and antidepressant (OR ± SE = 0.416 ± 0.103, <i>p <</i> 0.001) PIMs, but greater antipsychotic (OR ± SE = 1.496 ± 0.204, <i>p</i> < 0.01), cardiovascular (OR ± SE = 2.193 ± 0.255, <i>p</i> < 0.001), and skeletal muscle relaxant (OR ± SE = 2.977 ± 0.860, <i>p <</i> 0.001) PIMs. Hispanic participants were exposed to greater skeletal muscle relaxant PIMs and had lower anticholinergic burden. Asian participants were exposed to fewer benzodiazepine PIMs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Significant racial and ethnic disparities in exposure to PIMs and PIMs by medication category in dementia research participants who have access to dementia experts found in the study suggest that disparities may be wider in the larger community.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3360-3373"},"PeriodicalIF":4.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019933","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}
Timothy W. Farrell MD, AGSF, Amalia Korniyenko BA, Grace Hu BA, Terry Fulmer PhD
<p>Much has been written over the past 40 years about workforce challenges in aging-related disciplines. Geriatric medicine has more recently been at the forefront of the debate, and the field has been characterized as waning.<span><sup>1, 2</sup></span> But is it?</p><p>Such bleak perspectives regarding the geriatrics workforce typically cite the number of practicing geriatricians, which remains stubbornly around 7000 board-certified geriatricians, yielding roughly 0.96 geriatricians for every 10,000 older adults. Reasons commonly cited for the inadequate number of geriatricians include low prestige, low compensation compared with other specialties, and low match rates into geriatric medicine fellowship programs.<span><sup>1</sup></span> Many argue that the number of geriatricians must increase to meet the projected need of 28,000 geriatricians by 2025.<span><sup>3</sup></span> The fact that only three residency programs—family medicine, internal medicine, and medicine/pediatrics—require geriatrics-focused training may contribute to the inadequate supply of geriatricians.<span><sup>3</sup></span> Geriatric medicine fellowship fill rates remain among the lowest of all medicine subspecialties, although the overall fill rate is higher than the 43% reported by Gurwitz, with a geriatric medicine fellowship fill rate of 70% for the 2022–23 match.<span><sup>4</sup></span> A metric that incorporates attention to both those who are exiting geriatric medicine and those who are embarking on careers as geriatricians is the American Board of Medical Specialties (ABMS) tracking of active geriatric medicine certificates. See Figure 1 below, which was developed by the American Geriatrics Society (AGS) based on a review of the last 18 years of data from ABMS.<span><sup>5</sup></span> This figure demonstrates that the number of board-certified geriatricians has remained stable at approximately 7000 each year. This number is probably a slight underestimate because ABMS does not include osteopathic physicians who receive geriatrics certification through the American Osteopathic Association. However, the ABMS does include osteopathic physicians who receive geriatrics board certification through the ABIM and ABFM.</p><p>What can be done to increase the supply of geriatricians? Simply placing health professions trainees where older adults are present and expecting them to develop adequate competency in geriatrics does not work.<span><sup>6</sup></span> However, immersion when accompanied by structured geriatrics educational experiences improves competence in caring for older adults.<span><sup>7</sup></span> Negative attitudes related to aging can be improved with various exposures to older adults.<span><sup>8</sup></span> Geriatrics care is best delivered by interprofessional teams, but interprofessional team training presents logistical barriers and is infrequently provided by academic health centers.<span><sup>9</sup></span> The Geriatrics Workforce Enhancement Prog
{"title":"Geriatric medicine is advancing, not declining: A proposal for new metrics to assess the health of the profession","authors":"Timothy W. Farrell MD, AGSF, Amalia Korniyenko BA, Grace Hu BA, Terry Fulmer PhD","doi":"10.1111/jgs.19143","DOIUrl":"10.1111/jgs.19143","url":null,"abstract":"<p>Much has been written over the past 40 years about workforce challenges in aging-related disciplines. Geriatric medicine has more recently been at the forefront of the debate, and the field has been characterized as waning.<span><sup>1, 2</sup></span> But is it?</p><p>Such bleak perspectives regarding the geriatrics workforce typically cite the number of practicing geriatricians, which remains stubbornly around 7000 board-certified geriatricians, yielding roughly 0.96 geriatricians for every 10,000 older adults. Reasons commonly cited for the inadequate number of geriatricians include low prestige, low compensation compared with other specialties, and low match rates into geriatric medicine fellowship programs.<span><sup>1</sup></span> Many argue that the number of geriatricians must increase to meet the projected need of 28,000 geriatricians by 2025.<span><sup>3</sup></span> The fact that only three residency programs—family medicine, internal medicine, and medicine/pediatrics—require geriatrics-focused training may contribute to the inadequate supply of geriatricians.<span><sup>3</sup></span> Geriatric medicine fellowship fill rates remain among the lowest of all medicine subspecialties, although the overall fill rate is higher than the 43% reported by Gurwitz, with a geriatric medicine fellowship fill rate of 70% for the 2022–23 match.<span><sup>4</sup></span> A metric that incorporates attention to both those who are exiting geriatric medicine and those who are embarking on careers as geriatricians is the American Board of Medical Specialties (ABMS) tracking of active geriatric medicine certificates. See Figure 1 below, which was developed by the American Geriatrics Society (AGS) based on a review of the last 18 years of data from ABMS.<span><sup>5</sup></span> This figure demonstrates that the number of board-certified geriatricians has remained stable at approximately 7000 each year. This number is probably a slight underestimate because ABMS does not include osteopathic physicians who receive geriatrics certification through the American Osteopathic Association. However, the ABMS does include osteopathic physicians who receive geriatrics board certification through the ABIM and ABFM.</p><p>What can be done to increase the supply of geriatricians? Simply placing health professions trainees where older adults are present and expecting them to develop adequate competency in geriatrics does not work.<span><sup>6</sup></span> However, immersion when accompanied by structured geriatrics educational experiences improves competence in caring for older adults.<span><sup>7</sup></span> Negative attitudes related to aging can be improved with various exposures to older adults.<span><sup>8</sup></span> Geriatrics care is best delivered by interprofessional teams, but interprofessional team training presents logistical barriers and is infrequently provided by academic health centers.<span><sup>9</sup></span> The Geriatrics Workforce Enhancement Prog","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"323-328"},"PeriodicalIF":4.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010164","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}
Jung Yoen Son MSN, RN, GNP-C, Deanna J. Marriott PhD, Laura M. Struble PhD, RN, GNP-BC, Weiyun Chen PhD, Janet L. Larson PhD, RN, FAAN
Background
Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time-varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS).
Methods
NHATS participants were included in this study if they: (1) resided in ALF from Round 1 (2011) through Round 8 (2018); (2) completed the sample person (SP) interview at baseline; (3) were admitted to ALF at age 65 years or older. We conducted Cox proportional hazards regression to examine candidate predictors (difficulty with basic activities of daily living (ADL), chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, self-reported health, participation in social and physical activity, and sociodemographic) associated with transfer to a nursing home. Employing backward elimination, we built parsimonious final models for analysis.
Results
The analytic sample included 970 participants of whom 143 transferred to nursing homes over 8 years. Those who had a better physical performance at baseline (HR = 0.83, 95% CI = 0.79–0.88) and were college educated (HR = 0.58, 95% CI = 0.36–0.92) demonstrated a significantly lower risk for transfer to a nursing home over 8 years. Residents who maintained physical activity (HR = 0.56, 95% CI = 0.37–0.86), better physical performance (HR = 0.87, 95% CI = 0.80–0.94), and difficulty with fewer basic ADLs (HR = 1.13, 95% CI = 1.02–1.26) were at lower risk for transfer to a nursing home over 8 years.
Conclusions
Our findings can be used to identify older adults in ALFs at risk of transfer to a nursing home. Strategies to promote physical function and physical activity could avoid/delay the need to transfer. Helping older residents to age in place will have important health and economic benefits.
{"title":"Factors associated with transfer from assisted living facilities to a nursing home: National Health Aging Trends Study 2011–2019","authors":"Jung Yoen Son MSN, RN, GNP-C, Deanna J. Marriott PhD, Laura M. Struble PhD, RN, GNP-BC, Weiyun Chen PhD, Janet L. Larson PhD, RN, FAAN","doi":"10.1111/jgs.19147","DOIUrl":"10.1111/jgs.19147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time-varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NHATS participants were included in this study if they: (1) resided in ALF from Round 1 (2011) through Round 8 (2018); (2) completed the sample person (SP) interview at baseline; (3) were admitted to ALF at age 65 years or older. We conducted Cox proportional hazards regression to examine candidate predictors (difficulty with basic activities of daily living (ADL), chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, self-reported health, participation in social and physical activity, and sociodemographic) associated with transfer to a nursing home. Employing backward elimination, we built parsimonious final models for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analytic sample included 970 participants of whom 143 transferred to nursing homes over 8 years. Those who had a better physical performance at baseline (HR = 0.83, 95% CI = 0.79–0.88) and were college educated (HR = 0.58, 95% CI = 0.36–0.92) demonstrated a significantly lower risk for transfer to a nursing home over 8 years. Residents who maintained physical activity (HR = 0.56, 95% CI = 0.37–0.86), better physical performance (HR = 0.87, 95% CI = 0.80–0.94), and difficulty with fewer basic ADLs (HR = 1.13, 95% CI = 1.02–1.26) were at lower risk for transfer to a nursing home over 8 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings can be used to identify older adults in ALFs at risk of transfer to a nursing home. Strategies to promote physical function and physical activity could avoid/delay the need to transfer. Helping older residents to age in place will have important health and economic benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3374-3384"},"PeriodicalIF":4.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006200","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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