Journal of the American Geriatrics Society最新文献

{"title":"A Hospice Intervention for Caregivers: Improving Home Hospice Management of End-Of-Life Symptoms (I-HoME) Pilot Study","authors":"Veerawat Phongtankuel,&nbsp;Sara J. Czaja,&nbsp;Taeyoung Park,&nbsp;Jerad Moxley,&nbsp;Ronald D. Adelman,&nbsp;Ritchell Dignam,&nbsp;Dulce M. Cruz-Oliver,&nbsp;Micah Denzel Toliver,&nbsp;M. C. Reid","doi":"10.1111/jgs.70113","DOIUrl":"10.1111/jgs.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While home-based hospice care seeks to reduce suffering at the end of life (EoL), patients continue to experience a high symptom burden. High symptom burden contributes to adverse outcomes, including patient suffering, burdensome care transitions, and caregiver burden. Yet, most caregivers lack formal education in patient symptom management despite providing up to 65 h of care per week. Interventions that provide symptom support and education to caregivers could improve EoL outcomes for patients and caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a pilot randomized controlled trial (<i>N</i> = 80) in a hospice organization to assess the feasibility, acceptability, and preliminary efficacy of the Improving Home Hospice Management of End-of-life Symptoms (I-HoME) intervention. This caregiver-focused intervention aims to reduce patient symptom burden through weekly tele-visits with a nurse practitioner and caregiver educational videos to provide symptom support and education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of caregivers (<i>N</i> = 80) was 60.3 (standard deviation ± 12.1); with a majority being women (79%) and children of the patient (67%). In the I-HoME group (<i>n</i> = 40), a total of 121 of a possible 145 tele-visits (83%) were completed. Over 96% of caregivers were either satisfied or very satisfied with the tele-visits. Eighty-three percent agreed or strongly agreed that it prepared them to manage symptoms better, while 88% agreed or strongly agreed that the intervention increased their confidence in managing symptoms. The average reduction in patient symptom burden, as measured by the Edmonton Symptom Assessment Scale, for the intervention group who received all six visits was 6.6 points compared to 2.9 for the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The I-HoME intervention was feasible to implement in the home hospice setting and acceptable to caregivers and hospice staff. Future efficacy trials are needed to determine whether this caregiver-focused intervention, which provides symptom support and education, can measurably improve patient and caregiver outcomes in the home hospice setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3495-3504"},"PeriodicalIF":4.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133129","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}

{"title":"Cover","authors":"Juliana Teruel Camargo,&nbsp;Jessica Otero Machuca,&nbsp;Amanda S. Hinerman,&nbsp;Erik J. Rodriquez,&nbsp;Christian S. Alvarez,&nbsp;George A. Mensah,&nbsp;Stephanie M. George,&nbsp;Frank Bandiera,&nbsp;Zhuochen Li,&nbsp;Dillon O. Sylte,&nbsp;Yekaterina O. Kelly,&nbsp;Theresa A. McHugh,&nbsp;Mathew M. Baumann,&nbsp;Michael Celone,&nbsp;Demewoz Haile,&nbsp;Wichada La Motte-Kerr,&nbsp;Christopher J. L. Murray,&nbsp;Laura Dwyer-Lindgren,&nbsp;Ali H. Mokdad,&nbsp;Eliseo J. Pérez-Stable","doi":"10.1111/jgs.70101","DOIUrl":"https://doi.org/10.1111/jgs.70101","url":null,"abstract":"<p><b>Cover caption</b>: County-level estimated age-standardized protein-energy malnutrition mortality rates for individuals aged ≥ 75 by race and/or ethnic population groups, 2019, U.S. Estimates are masked (shown in white) for county and race and/or ethnicity combinations with a mean annual population &lt;1000. See the related article by Camargo et al., pages 2868–2877.\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 9","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129393","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}

{"title":"Reply to: Comment on “Tooth Loss and 12-Year Mortality Risk in 8494 Older Adults From Ireland”","authors":"Lewis Winning,&nbsp;Brian O'Connell","doi":"10.1111/jgs.70115","DOIUrl":"10.1111/jgs.70115","url":null,"abstract":"&lt;p&gt;We thank Dr. Somay for her thoughtful commentary on our study examining the association between tooth loss and mortality risk in older Irish adults [&lt;span&gt;1, 2&lt;/span&gt;]. We appreciate the opportunity to address the important methodological considerations raised.&lt;/p&gt;&lt;p&gt;First, regarding the exposure variable relying on self-report dental status, we acknowledge that objective clinical assessments provide more granular data than self-report measures. However, we are able to validate our exposure variable, using objective oral health assessments conducted in a subsequent wave (Wave 3) of The Irish Longitudinal Study on Ageing in a subset of 2521 participants [&lt;span&gt;3&lt;/span&gt;]. As shown in Figure 1, plotting actual tooth count across our three self-report exposure categories reveals a clear stepwise pattern of decreasing tooth count. Dentate participants without dentures had a median of 24 teeth (IQR: 21–27), dentate participants with dentures had a median of 15 teeth (IQR: 9–20), and edentulous participants had a median of 0 teeth (IQR: 0–0). Although some outliers were present, they were relatively few and did not disrupt the clear monotonic pattern. The ordered self-report categories showed good monotonic association with actual tooth count (Spearman's &lt;i&gt;ρ&lt;/i&gt; = −0.737; &lt;i&gt;p&lt;/i&gt; &lt; 0.001), supporting the validity of our exposure classification for large-scale epidemiological studies. Although some misclassification may exist, particularly among participants with very few remaining teeth, any such non-differential misclassification would be expected to bias estimates towards the null, rendering our reported associations conservative [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, regarding our decision to combine the original five response categories into three groups, this recoding was performed to enhance statistical stability and power while maintaining clinically meaningful distinctions. We acknowledge this approach may obscure some clinically relevant nuances. However, a sensitivity analysis using the original five categories (presented in Supporting Information S1 in the online version of the article [&lt;span&gt;2&lt;/span&gt;]) yielded consistent results, supporting the robustness of our findings. The trend tests across categories remained significant in all models, indicating a dose-dependent response relationship in the risk for all-cause mortality.&lt;/p&gt;&lt;p&gt;Third, concerning potential residual confounding, we acknowledge that factors such as nutritional status, frailty, depression, and social isolation were not included in our analysis. Our models employed sequential adjustment across four stages: Model 1 (age, sex); Model 2 (education, socioeconomic status, marital status); Model 3 (smoking, alcohol, BMI); and Model 4 (diabetes, cardiovascular conditions, antihypertensive medication). Although unmeasured confounding cannot be entirely eliminated, the consistency of our findings with prior evidence and the dose–response pattern observed across dentition categories s","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"278-279"},"PeriodicalIF":4.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133140","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}

{"title":"Brain Health Is Central to Good Perioperative Care in Older Adults","authors":"Karen E. Blackmon","doi":"10.1111/jgs.70130","DOIUrl":"10.1111/jgs.70130","url":null,"abstract":"&lt;p&gt;We are living in an era the United Nations has proclaimed “The Decade of Healthy Aging” [&lt;span&gt;1&lt;/span&gt;]. The World Health Organization adopted a 2022–2031 intersectoral global action plan that envisages a “world in which brain health is valued, promoted, and protected across the life course; neurological disorders are avoided; and people affected by neurological disorders and their carers attain the highest possible level of health, with equal rights, opportunities, respect and autonomy” [&lt;span&gt;2&lt;/span&gt;]. In this era of global attention to brain health, Canales and co-authors highlight a striking blind spot in geriatric perioperative care. They surveyed a large sample of older adults undergoing elective surgery and found that only 7% reported preoperative discussion with their health care providers about cognitive risks associated with surgery [&lt;span&gt;3&lt;/span&gt;]. In follow-up interviews with people who experienced cognitive changes after surgery, they found that 90% did attempt to discuss their symptoms with a healthcare provider. Yet, none received counseling or guidance on how to manage or improve their cognitive symptoms. Instead, they were advised to wait and see if symptoms persisted.&lt;/p&gt;&lt;p&gt;This pattern represents a missed opportunity to promote active recovery, encourage healthy lifestyle behaviors, and protect the long-term brain health of older adults. Surgery can be life-extending, but if it accelerates or unmasks cognitive decline without empowering patients with the knowledge or tools they need for proactive management, then it risks undermining the very autonomy and quality of life that medical interventions aim to preserve.&lt;/p&gt;&lt;p&gt;Informed consent is not simply a legal formality; it is an ethical process that protects autonomy and builds trust. For older adults, especially those facing major surgery, autonomy extends beyond the right to say yes or no—it includes the right to understand the full spectrum of risks and benefits, including cognitive risks that affect identity, independence, and quality of life.&lt;/p&gt;&lt;p&gt;The American College of Surgeons National Surgical Quality Improvement Program, the American Geriatric Society Best Practices Guidelines, and the International Perioperative Neurotoxicity Working Group all recommend assessing cognitive ability for any patient older than 65 years to assess the risk of post-operative cognitive dysfunction [&lt;span&gt;4, 5&lt;/span&gt;]. This process not only highlights the risk of perioperative neurocognitive disorder (PND) but also offers older adults the opportunity to consider their values and preferences around brain health. It can provide them with the awareness and vocabulary to self-monitor and report perioperative cognitive changes. Evidence consistently shows that patient education and self-efficacy are associated with improved surgical outcomes [&lt;span&gt;6&lt;/span&gt;]. In the perioperative setting, structured education has been shown to reduce anxiety, improve pain management, and enhance recovery [&lt;","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3311-3313"},"PeriodicalIF":4.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133057","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}

{"title":"Comment on “Tooth Loss and 12-Year Mortality Risk in 8494 Older Adults From Ireland”","authors":"Efsun Somay","doi":"10.1111/jgs.70118","DOIUrl":"10.1111/jgs.70118","url":null,"abstract":"&lt;p&gt;I read with great interest the article by Winning et al. [&lt;span&gt;1&lt;/span&gt;], which meticulously examines the relationship between self-reported dental health and both all-cause and cause-specific mortality within a robust, nationally representative sample of older adults aged 50 and above. I commend the authors for leveraging a comprehensive dataset that is invaluable for aging research. Their study included a thorough 12-year follow-up period and effectively controlled for a variety of confounding factors such as socioeconomic status, health behaviors, and pre-existing medical conditions, which could otherwise skew the results. The findings are particularly striking, indicating a 42% increased risk of all-cause mortality (hazard ratio [HR]: 1.42) among edentulous participants. Additionally, the study revealed significant links to specific causes of death, including respiratory mortality (subdistribution HR [SHR]: 1.57) and cancer mortality (SHR: 1.31). These results provide essential evidence that oral health is intricately linked to systemic health outcomes in aging populations, suggesting that poor dental health could serve as an early indicator of broader health issues, including overall health and long-term survival. Moreover, they underscore the urgent need for integrating oral healthcare into comprehensive geriatric medical assessments and preventive strategies. However, despite these significant findings, several analytical considerations warrant further evaluation.&lt;/p&gt;&lt;p&gt;First, the exposure variable in this study relied exclusively on a single baseline self-report, categorized into “dentate, no denture,” “dentate, with denture(s),” and “edentulous.” Although this approach is practical for extensive cohort studies, it presents lower accuracy compared to clinical examinations. Research has shown that there is only moderate agreement between self-reported dentition and clinical assessments, which may result in non-differential misclassification, potentially biasing HRs toward the null hypothesis [&lt;span&gt;2&lt;/span&gt;]. This misclassification is particularly pertinent when distinguishing between partial and complete edentulism, as participants with limited residual teeth may misclassify themselves, especially when dental prostheses are involved. Moreover, factors such as denture fit, stability, and occlusal function—which significantly impact nutritional status and overall health—are not accounted for by a single self-reported item. Future research should focus on validating self-reported measures against clinical data or incorporating hybrid methods, such as dental records, photographs, or structured dental examinations, to improve the accuracy of these assessments. Additionally, the authors combined the original five response categories into three, resulting in the loss of valuable details, such as the distinction between partial dentition without dentures and complete dentition. Although this recoding may enhance statistical stability, it risk","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 1","pages":"276-277"},"PeriodicalIF":4.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.70118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133178","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}

{"title":"CAPABLE for People After Hospitalization: A Randomized Trial","authors":"Sarah L. Szanton,&nbsp;David L. Roth,&nbsp;Kathryn Bowles,&nbsp;Nicole Onorato,&nbsp;Laura N. Gitlin,&nbsp;Bruce Leff","doi":"10.1111/jgs.70116","DOIUrl":"10.1111/jgs.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Following hospitalization, nearly 30% of older adults lose some independence. This can lead to rehospitalization, nursing home admission, and increased dependence. CAPABLE, an evidence-based program, increases independence among older adults with functional limitations but has not been tested in recently hospitalized people.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This randomized clinical trial enrolled 268 low-income community-dwelling adults who had been discharged to home from the hospital 60 days prior, had a home health episode, yet had remaining difficulties in at least one activity of daily living. Participants were randomized to no further care or to CAPABLE, which involved up to 10 home visits over 5 months with an occupational therapist, a registered nurse, and a handyworker to address an older adult's self-identified functional goals. Main outcomes were (1) improvement in difficulty with and assistance needed for 10 activities of daily living (range 10–50); (2) five instrumental activities of daily living and mobility: walking up a set of stairs and walking a block.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The CAPABLE group decreased their ADL difficulty by −1.76 (CI −2.98, −0.54) and the control group decreased (−0.63: CI −1.86, 0.60) over 5 months, which was not statistically or clinically significant. However, the CAPABLE treatment group demonstrated greater improvement in a composite mobility measure than control participants (−0.52 and −0.02, respectively, <i>p</i> = 0.028). Additionally, among participants with four or more co-morbidities at baseline, the CAPABLE group showed significantly improved ADL independence compared to control participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among recently hospitalized persons receiving skilled home health care, CAPABLE did not improve ADLs. However, it improved functional mobility and benefited those with ≥ 4 comorbidities. This study provides novel information on targeting CAPABLE in the post-hospitalization period.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3663-3669"},"PeriodicalIF":4.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133152","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}

{"title":"Age of Patients in Trials Submitted to the FDA Versus Age in Average Patients With Cancer","authors":"Alyson Haslam,&nbsp;Vinay Prasad","doi":"10.1111/jgs.70000","DOIUrl":"10.1111/jgs.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The risk of cancer increases as people age, and yet, participants in oncology clinical trials have historically been younger than those in the general population with the respective tumor type, thus limiting our understanding of the safety and efficacy of trial results in the real world. The US Food and Drug Administration (FDA) has issued guidance on multiple occasions on the inclusion of older adults in clinical trials. We sought to evaluate whether there has been progress in the representativeness of older adults in oncology trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For oncology drug approvals since 2002, we searched for registration trials and collected data on the median age of study participants. We then searched SEER*Explorer to find the median age of the general population with the respective cancer type. We assessed linear trends to see if there were age gaps between the median ages of trial participants and SEER participants, and we assessed differences in time frames when guidance was issued.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The age gap between registration trials and SEER data for all 22 years was 5 years (62 years for registration trials vs. 67 years for SEER). The age gap has declined over time (Beta = −0.22, <i>p</i> = 0.004) but still persists. Between 2002 and 2012, the age gap between registration trials and the SEER population was 7 years (59 vs. 66 years, <i>p</i> &lt; 0.001); between 2013 and 2019, it was 5 years (62 vs. 67 years, <i>p</i> &lt; 0.001); and between 2020 and 2024, the age gap was 4 years (63 vs. 67 years, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found that the age gap between registration trial participants and the general population with the respective tumor type has declined over time, but the age-gap persists, despite guidance issued by the FDA. Efforts to include more representative study participants in clinical trials should be intensified, possibly through greater enforcement through regulatory oversight.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3655-3662"},"PeriodicalIF":4.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133077","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}

{"title":"Certified Nursing Assistant Training Opportunities: Insights From States' Administrative Data","authors":"Mallory Niemzak Johnson,&nbsp;Noli Brazil,&nbsp;Michelle Ko","doi":"10.1111/jgs.70108","DOIUrl":"10.1111/jgs.70108","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3903-3906"},"PeriodicalIF":4.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126759","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}

{"title":"“Someone to Remember I Need Help”: Multi-Site Mixed-Method Study of Older Inpatients' Experiences of Eating and Drinking","authors":"Rhiannon Young,&nbsp;Jessica King,&nbsp;Adrienne M. Young,&nbsp;Mary Hannan-Jones,&nbsp;Alison M. Mudge,&nbsp;Angela Byrnes","doi":"10.1111/jgs.70104","DOIUrl":"10.1111/jgs.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital mealtimes are complex, and older adults are at high risk of inadequate food and fluid intake, which contributes to poorer hospital outcomes. Interventions to improve mealtimes and mealtime care should consider patient perspectives. This multi-site study aims to describe the eating and drinking experiences and perceptions of older adults admitted to 12 hospitals across Queensland, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mixed-method study analyzing structured interviews with older inpatients (aged 65 years and older) collected within the Eat Walk Engage quality improvement program in 20 acute medical and surgical wards in 12 publicly funded hospitals (2019–20). Interviews were undertaken by trained staff and included patient perspectives, barriers, enablers, and suggestions related to eating and drinking in hospital. Qualitative data were coded using the Theoretical Domains Framework (TDF) and synthesized to create overarching belief statements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred interviews were analyzed. Nearly all (98%) patients described eating and drinking in hospital as important. Eighteen belief statements were generated across the seven most indexed TDF domains. Patients recognized eating and drinking as important to their strength and recovery and generally appreciated the quality and options in hospital food. However, they experienced multi-level challenges: at a personal level (e.g., reduced appetite, symptoms, and physical impairments); with mealtime care (e.g., lack of assistance and uncomfortable positioning); and from the broader hospital system (e.g., inflexible meal timing and meal sizes). Several enabling factors were identified, including self-motivation, encouragement and assistance from staff and family, greater choice around food, and familiar and simple foods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Eating and drinking in hospital is complex for older patients. Improvement solutions should be multi-faceted and multi-disciplinary to provide effective person-centered nutrition care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3444-3454"},"PeriodicalIF":4.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126737","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}

{"title":"Clinical and Prognostic Utility of the Essential Frailty Toolset in Older Patients With Heart Failure","authors":"Daichi Maeda,&nbsp;Yuya Matsue,&nbsp;Nobuyuki Kagiyama,&nbsp;Yudai Fujimoto,&nbsp;Tsutomu Sunayama,&nbsp;Taishi Dotare,&nbsp;Taisuke Nakade,&nbsp;Kentaro Jujo,&nbsp;Kentaro Kamiya,&nbsp;Hiroshi Saito,&nbsp;Yuki Ogasahara,&nbsp;Emi Maekawa,&nbsp;Masaaki Konishi,&nbsp;Takeshi Kitai,&nbsp;Kentaro Iwata,&nbsp;Hiroshi Wada,&nbsp;Masaru Hiki,&nbsp;Takatoshi Kasai,&nbsp;Hirofumi Nagamatsu,&nbsp;Tetsuya Ozawa,&nbsp;Katsuya Izawa,&nbsp;Shuhei Yamamoto,&nbsp;Naoki Aizawa,&nbsp;Kazuki Wakaume,&nbsp;Kazuhiro Oka,&nbsp;Shin-ichi Momomura,&nbsp;Tohru Minamino","doi":"10.1111/jgs.70103","DOIUrl":"10.1111/jgs.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure (HF) is associated with frailty, and most frailty assessment methods are subjective and complex. The Essential Frailty Toolset (EFT) is a simple, objective, and comprehensive frailty assessment tool. This study aimed to investigate the clinical and prognostic values of the EFT in patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from a multicenter, observational study on older (≥ 65 years old) patients hospitalized with HF, the FRAGILE-HF cohort, was used. The EFT includes a five-time chair stand test, cognitive function assessment, and hemoglobin and albumin measurements. Patients were divided into three groups based on their EFT points: robust (0 points), pre-frail (1–2 points), and frail (3–5 points). The primary endpoint was 2-year all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the total 1237 patients (80.1 ± 7.1 years; 43% females), the robust, pre-frail, and frail groups included 114 (11.6%), 606 (49.0%), and 487 (39.4%) patients, respectively. The prevalence of frailty, evaluated using the Fried phenotype model, increased with increased EFT points (<i>p</i> &lt; 0.001). Within the 2-year follow-up period, 256 deaths occurred. The frail group was significantly associated with a higher risk of the primary endpoint than the robust group (adjusted hazard ratio [aHR], 2.01; 95% confidence interval [CI], 1.12–3.61; <i>p</i> = 0.019). The EFT point, as a continuous variable, was significantly associated with the primary endpoint (aHR, 1.19; 95% CI, 1.08–1.31; <i>p</i> &lt; 0.001). A significant continuous net reclassification improvement was observed when the EFT groups were added to the conventional risk model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The EFT demonstrated valuable clinical and prognostic value in older patients with HF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 11","pages":"3455-3463"},"PeriodicalIF":4.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115760","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}