Journal of the American Geriatrics Society最新文献_第9页

Editor's Note on Association Between Frailty and Patients' Experience of Cancer Treatment and Care 编者注：虚弱与患者癌症治疗和护理经历之间的关系

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-08 DOI: 10.1111/jgs.70159

Elizabeth L. Cobbs

引用次数: 0

The Long Shadow of Incarceration: The Association of Incarceration History With Self-Reported Health Among Older Adults 监禁的漫长阴影：监禁历史与老年人自我报告健康的关系。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-08 DOI: 10.1111/jgs.70069

Louisa W. Holaday, Brita Roy, Brie Williams, Pranav Gwalani, Kim Stone, Albert L. Siu, Emily A. Wang

Background

The United States has one of the highest incarceration rates in the world. Prior incarceration is associated with adverse health effects. While the era of “mass incarceration” began in 1973, little work has focused on older adults, whose lives have spanned the five decades of mass incarceration.

Methods

We conducted a cross-sectional analysis using data on adults 50 or older from the nationally representative Family History of Incarceration Survey to test the independent association between prior incarceration and self-reported physical and mental health. In logistic regression models, we controlled for age, gender, race/ethnicity, education, income, employment, and marital status. We also tested for effect modification by race/ethnicity, gender, and time since last incarceration, as well as financial and social wellbeing.

Results

Among 1318 older adults, 21% had been incarcerated. Formerly incarcerated older adults were more likely to be men; non-Hispanic Black or “other” race/ethnicity; meet criteria for disability; be unmarried; and have lower income and education compared with those never incarcerated. In fully adjusted models, prior incarceration was independently associated with greater odds of reporting “fair” or “poor” physical health (aOR:1.88, 95% CI: 1.19–2.98; p = 0.007). Prior incarceration was associated with reporting “fair” or “poor” mental health after adjusting for demographic covariates (aOR: 2.12, 95% CI: 1.24–3.65; p = 0.006) but was nonsignificant after adding socioeconomic covariates. Length of time from last incarceration did not moderate the observed association, meaning that even those incarcerated > 10 years ago had poor self-reported health. Financial wellbeing moderated the association between incarceration and mental health.

Conclusion

Prior incarceration is a social determinant of health for older adults, even those with distant incarceration history, and is strongly associated with current poverty and meeting criteria for disability. Further research is needed to understand the mechanisms of these associations and means to mitigate health harms associated with prior incarceration.

背景：美国是世界上监禁率最高的国家之一。先前的监禁与不利的健康影响有关。虽然“大规模监禁”时代始于1973年，但很少有研究关注老年人，他们的生活跨越了50年的大规模监禁。方法：我们使用来自全国代表性监禁家族史调查的50岁或以上成年人的数据进行了横断面分析，以测试先前监禁与自我报告的身心健康之间的独立关联。在逻辑回归模型中，我们控制了年龄、性别、种族/民族、教育、收入、就业和婚姻状况。我们还测试了种族/民族、性别、上一次监禁后的时间以及经济和社会福利对效果的影响。结果：在1318名老年人中，21%曾被监禁。以前被监禁的老年人更有可能是男性；非西班牙裔黑人或“其他”种族/民族；符合残疾标准；是未婚的;他们的收入和受教育程度也比那些从未入狱的人低。在完全调整的模型中，先前的监禁与报告“一般”或“较差”的身体健康状况的更大几率独立相关（aOR:1.88, 95% CI: 1.19-2.98; p = 0.007）。在调整人口统计学协变量后（aOR: 2.12, 95% CI: 1.24-3.65; p = 0.006），先前的监禁与报告“一般”或“较差”的精神健康相关，但在加入社会经济协变量后不显著。距离上次监禁的时间长度并没有缓和观察到的关联，这意味着即使是那些10年前被监禁的人，自我报告的健康状况也不佳。经济状况缓和了监禁与心理健康之间的联系。结论：先前的监禁是老年人健康的一个社会决定因素，即使是那些有长期监禁历史的老年人，也与当前的贫困和符合残疾标准密切相关。需要进一步的研究来了解这些关联的机制以及减轻与先前监禁相关的健康危害的方法。

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引用次数: 0

Impact of Skilled Nursing Facility (SNF) Network Participation and Transitional Care Management on SNF Length of Stay 熟练护理机构（SNF）网络参与和过渡性护理管理对SNF住院时间的影响。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-08 DOI: 10.1111/jgs.70114

Amy W. Baughman, Michelle L. Frits, Kathleen Strand, Jenna Morrisey, Katie Carr, Atharva Vaidya, Kerry Markert, Mallika L. Mendu

Background

This evaluation highlights potential strategies to decrease unnecessary skilled-nursing facility (SNF) utilization. We evaluated the impact of a SNF network and transitional care management program (TCM) on SNF length of stay (LOS) for beneficiaries in a Medicare Shared Savings Plan (MSSP) Accountable Care Organization (ACO).

Methods

Design: Retrospective claims-based cohort study. Setting: Mass General Brigham (MGB) is a large integrated healthcare system. MGB Population Health develops value-based strategies to improve performance in shared savings ACOs, including nearly 130,000 Medicare beneficiaries.

Participants

Adult MSSP ACO beneficiaries admitted to a SNF between January 2022 and September 2023. Exclusions included death, admission to hospice or long-term care hospital; patients were excluded from the SNF LOS analysis if they experienced hospital readmission.

Intervention

The MGB SNF Collaborative Network included 60 SNFs in 2022 and 63 SNFs in 2023 based on quality metrics and collaboration with MGB hospitals. The TCM Program included 14 care managers, who optimize SNF utilization for beneficiaries discharged to MGB Network SNFs.

Main Outcome and Measure

The primary outcome of interest was SNF LOS. We conducted univariate regression analyses with variables that could impact SNF LOS; covariates with a p value ≤ 0.1 were included in the multivariable regression model. We assessed for collinearity with model diagnostics, including variance of inflation measures.

Results

Multivariable regression demonstrated that admission to a SNF network facility without TCM was associated with a reduction in LOS of 4 days, and admission to a SNF network facility with TCM resulted in a 5-day LOS reduction. Based on LOS reduction, we estimate a programmatic impact of $556 per beneficiary per day [1], with savings of $2224–$2780 per admission.

Conclusion

SNF networks and care management can mitigate unnecessary SNF utilization, offering a high-value approach for ACOs and other value-based care organizations.

背景：本评估强调了减少不必要的熟练护理设施（SNF）利用的潜在策略。我们评估了SNF网络和过渡性护理管理计划（TCM）对医疗保险共享储蓄计划（MSSP）责任医疗组织（ACO）受益人SNF住院时间（LOS）的影响。方法：设计：回顾性索赔为基础的队列研究。背景：布里格姆总医院（MGB）是一个大型综合医疗保健系统。MGB人口健康部门制定了基于价值的战略，以改善共享储蓄aco的绩效，其中包括近13万医疗保险受益人。参与者：2022年1月至2023年9月接受SNF的成人MSSP ACO受益人。排除因素包括死亡、入住临终关怀或长期护理医院；如果患者再次住院，则将其排除在SNF LOS分析之外。干预措施：根据质量指标和与MGB医院的合作，MGB SNF协作网络在2022年包括60个SNF，在2023年包括63个SNF。中医项目包括14名护理管理人员，他们优化了MGB网络SNF出院受益人的SNF利用率。主要结局和测量：主要结局为SNF LOS。我们对可能影响SNF LOS的变量进行了单变量回归分析；将p值≤0.1的协变量纳入多变量回归模型。我们评估了模型诊断的共线性，包括膨胀测量的方差。结果：多变量回归表明，在没有中药的SNF网络设施入住与4天的LOS减少相关，而在有中药的SNF网络设施入住导致5天的LOS减少。根据减少LOS，我们估计每个受益人每天的方案影响为556美元，每次入院可节省2224- 2780美元。结论：SNF网络和护理管理可以减少不必要的SNF使用，为ACOs和其他基于价值的护理组织提供高价值的方法。

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引用次数: 0

Does Neighborhood Deprivation Impact Readmission and Associated Costs After Hip Fracture Surgery? 邻里剥夺会影响髋部骨折术后再入院及相关费用吗？

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-08 DOI: 10.1111/jgs.70123

Mikhail A. Bethell, Hannah R. Mahoney, Lulla V. Kiwinda, Adam A. Sassoon, Milton T. Little, Amy G. Clark, Bradley G. Hammill, Malcolm R. DeBaun, Christian A. Péan

Introduction

In the context of value-based care, the influence of racial and socioeconomic factors on hip fracture care outcomes remains underexplored. This study investigates the association of the area deprivation index (ADI) on readmission rates and Centers for Medicare and Medicaid Services (CMS) payments following hip fracture surgery.

Methods

We conducted an analysis using United States Medicare fee-for-service claims from 2019 to 2021, identifying patients hospitalized for hip fracture surgery based on Diagnosis-Related Groups criteria. Our primary outcomes were 90-day unplanned readmissions and CMS payments. ADI was our primary exposure of interest, calculated at the census block level. The analysis adjusted for multiple factors using logistic regression models.

Results

The study included 248,691 patients with an average age of 82.3 ± 8.5 years. We noted a 20.7% (51,603/248,691) rate of 90-day unplanned readmissions. Adjusted findings showed a modest, independent association between unplanned readmission and neighborhood deprivation, especially in the most deprived groups (OR: 1.26 [95% CI 1.19, 1.35]). Fully adjusted analysis showed a null association between CMS payments and neighborhood deprivation. Black race had a stronger association with unplanned 90-day readmissions (OR: 1.06 [95% CI 1.00, 1.13]) compared to White race. Males had a stronger association with readmission (OR: 1.26 [95% CI 1.24, 1.29]) and higher CMS payments (OR: 1.07 [95% CI 1.06, 1.07]) compared to females.

Conclusion

Neighborhood deprivation is independently associated with higher odds of unplanned 90-day readmission after hip fracture surgery, though no significant association with CMS payments was identified. These findings support the need to address social drivers of health in clinical care and inform value-based payment and policy reform aimed at reducing disparities.

Level of Evidence

3.

引言：在基于价值的护理背景下，种族和社会经济因素对髋部骨折护理结果的影响仍未得到充分探讨。本研究调查了髋部骨折手术后再入院率和医疗保险和医疗补助服务中心（CMS）支付的区域剥夺指数（ADI）的关系。方法：我们使用2019年至2021年的美国医疗保险按服务收费索赔进行分析，根据诊断相关组标准确定髋部骨折手术住院患者。我们的主要结果是90天的计划外再入院和CMS支付。ADI是我们感兴趣的主要暴露量，以人口普查区水平计算。分析使用逻辑回归模型对多个因素进行调整。结果：纳入248691例患者，平均年龄82.3±8.5岁。我们注意到90天非计划再入院率为20.7%（51,603/248,691）。调整后的结果显示，意外再入院与社区剥夺之间存在适度的独立关联，尤其是在最贫困的群体中（OR: 1.26 [95% CI 1.19, 1.35]）。完全调整后的分析显示，CMS支付与邻里剥夺之间没有关联。与白人相比，黑人与计划外90天再入院的关联更强（OR: 1.06 [95% CI 1.00, 1.13]）。与女性相比，男性与再入院（OR: 1.26 [95% CI 1.24, 1.29]）和更高的CMS费用（OR: 1.07 [95% CI 1.06, 1.07]）的关联更强。结论：邻里剥夺与髋部骨折术后90天意外再入院的较高几率独立相关，但与CMS支付没有明显关联。这些发现支持有必要解决临床护理中健康的社会驱动因素，并为旨在减少差距的基于价值的支付和政策改革提供信息。证据等级：3；

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引用次数: 0

Cataract Surgery Under General Anesthesia in Older Adults With Advanced Cataracts and Dementia: Visual Acuity and Visual Function Outcomes 老年晚期白内障和痴呆患者全身麻醉下的白内障手术：视力和视觉功能的结果。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-08 DOI: 10.1111/jgs.70151

Hiroki Sano, Ryoji Yanai, Yoshinori Mitamura

引用次数: 0

Reply to: Comment on “Prevalence and Prognostic Implication of Sarcopenia Among Patients With Stage B Heart Failure: The PAPRIKA-HF Cohort Study” 回复：关于“B期心力衰竭患者肌肉减少症的患病率及预后意义：PAPRIKA-HF队列研究”的评论。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-07 DOI: 10.1111/jgs.70149

Koichiro Matsumura, Gaku Nakazawa

<p>We sincerely thank Decaix et al. for their thoughtful and constructive comments about our recent article [<span>1</span>]. We greatly appreciate their recognition of the importance of investigating sarcopenia in older adults with asymptomatic (stage B) heart failure (HF) and their emphasis on the need for preventive strategies.</p><p>The authors raised an important point regarding the potential baseline imbalances between patients with and without sarcopenia, such as higher E/e' ratios, more frequent valvular disease, and worse inflammatory and nutritional statuses in the sarcopenia group. We agree that these factors may represent markers of a more advanced-stage B HF phenotype that could contribute to the development of sarcopenia and adverse cardiovascular outcomes. In our analyses, we sought to account for major established prognostic factors; however, we acknowledge that residual confounding factors cannot be fully excluded. Thus, the interplay between cardiac dysfunction and sarcopenia remains complex.</p><p>Regarding the Cox regression models, we appreciate the suggestion to include additional echocardiographic parameters. As our study was designed as an exploratory investigation of a large geriatric HF registry, we selected variables with the most robust evidence and the lowest degree of missing data to avoid overfitting. While BNP values were available for nearly all patients and, therefore, used as a categorical variable, NT-proBNP was measured for only 18 of the 317 patients due to differences in institutional practice; thus, the latter could not be reliably incorporated into the multivariable model. We agree that continuous variable modeling of the biomarkers would be of interest; future studies with larger and more complete datasets will be required to address this point.</p><p>We appreciate the careful reading that identified the inconsistencies in the reporting of composite events. During the 2-year follow-up, 21 patients experienced at least one composite endpoint event (the number used in the survival analyses). However, because some patients experienced more than one type of event, there were a total of 26 events across the three components (all-cause death, myocardial infarction, and hospitalization for HF). We acknowledge that this distinction was insufficiently explained in the manuscript and are grateful for the opportunity to clarify it.</p><p>In conclusion, we agree with Decaix et al. that the relationship between sarcopenia and HF outcomes is likely bidirectional and multifactorial. Our study highlights the clinical importance of recognizing sarcopenia in patients with stage B HF. However, further studies of larger, harmonized cohorts are required to disentangle the causality. We are grateful for the authors' insightful comments, which have strengthened the interpretation of our findings and provided valuable guidance for future work.</p><p>All authors met the criteria for authorship. Preparation of manuscript: Koichiro

我们真诚地感谢Decaix等人对我们最近的文章b[1]所作的深思熟虑和建设性的评论。我们非常赞赏他们认识到研究老年无症状（B期）心力衰竭（HF）患者肌肉减少症的重要性，并强调需要采取预防策略。作者提出了一个重要的观点，即肌少症患者和非肌少症患者之间潜在的基线不平衡，如更高的E/ E比值，更频繁的瓣膜疾病，以及肌少症组更糟糕的炎症和营养状况。我们同意，这些因素可能代表更晚期B型HF表型的标志物，可能有助于肌肉减少症和不良心血管结局的发展。在我们的分析中，我们试图解释主要的既定预后因素；然而，我们承认残留的混杂因素不能完全排除。因此，心功能障碍和肌肉减少症之间的相互作用仍然很复杂。关于Cox回归模型，我们赞赏加入其他超声心动图参数的建议。由于我们的研究被设计为一项大型老年心衰登记的探索性调查，我们选择了证据最有力、数据缺失程度最低的变量，以避免过拟合。虽然BNP值几乎可用于所有患者，因此被用作分类变量，但由于机构实践的差异，仅对317例患者中的18例进行了NT-proBNP测量；因此，后者不能可靠地纳入多变量模型。我们同意生物标志物的连续变量建模将是有趣的；未来的研究需要更大更完整的数据集来解决这一点。我们赞赏在综合事件报告中发现不一致之处的仔细阅读。在2年的随访中，21名患者经历了至少一个复合终点事件（生存分析中使用的数字）。然而，由于一些患者经历了不止一种类型的事件，因此在三个组成部分（全因死亡、心肌梗死和心衰住院）中总共有26种事件。我们承认，这一区别在手稿中解释得不够充分，并感谢有机会澄清它。总之，我们同意Decaix等人的观点，即肌肉减少症和心衰预后之间的关系可能是双向和多因素的。我们的研究强调了在B期HF患者中识别肌肉减少症的临床重要性。然而，需要对更大的、协调的队列进行进一步的研究来解开因果关系。我们非常感谢作者提出的有见地的意见，这些意见加强了对我们研究结果的解释，并为今后的工作提供了宝贵的指导。所有作者都符合作者资格标准。手稿准备：松村光一郎和中泽乐。作者声明无利益冲突。本出版物链接到Decaix等人的相关评论。要查看本文，请访问https://doi.org/10.1111/jgs.70150。

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引用次数: 0

Comment on: Prevalence and Prognostic Implication of Sarcopenia Among Patients With Stage B Heart Failure: The PAPRIKA-HF Cohort Study 评论：B期心力衰竭患者肌肉减少症的患病率和预后意义：PAPRIKA-HF队列研究。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-07 DOI: 10.1111/jgs.70150

Théodore Decaix, Clémentine Rivière, Matthieu Lilamand

<p>We read with great interest the article by Matsumura et al. [<span>1</span>] assessing the prevalence of sarcopenia and its long-term prognostic impact in older adults with asymptomatic (stage B) heart failure (HF). The main finding was that sarcopenia was an independent long-term predictor of composite events, including death, incident myocardial infarction, or hospitalization for HF. The originality of the study lies in its focus on asymptomatic HF already marked by structural cardiac abnormalities and in the use of validated criteria to define sarcopenia. Sarcopenia represents a key target for intervention in older adults due to its reversible nature. Nevertheless, as the authors noted, interventions targeting sarcopenia at stage C HF (symptomatic disease) have yielded limited results, likely because they occur too late in the disease course [<span>2-4</span>].</p><p>However, one important point not emphasized by the authors, which complicates the interpretation of the relationship between sarcopenia and the studied outcomes, is that sarcopenia may also result from stage B HF and its specific determinants, potentially accounting for the reported prevalence (17.7%) being higher than in the general population. In Table 2 of [<span>1</span>], comparing laboratory and echocardiographic parameters between patients with and without sarcopenia, several significant baseline imbalances are evident. For instance, the E/e' ratio, the presence of valvular disease, as well as inflammatory markers and nutritional status were all worse among patients with sarcopenia. Although all participants technically met stage B criteria, those with sarcopenia may represent a “more advanced” phenotype within stage B at baseline. These factors may not only be consequences of sarcopenia but also potential contributors to its development, and they are themselves established predictors of cardiovascular outcomes. Thus, the excess risk observed in sarcopenic patients could reflect the complex interplay between sarcopenia and these baseline imbalances, rather than sarcopenia itself.</p><p>In Table 3 of [<span>1</span>], the Cox regression models did not include several relevant variables. For example, E/e' and valvular disease were not considered in univariable analyses and thus excluded from the multivariable model, despite their prognostic relevance. BNP and NT-proBNP were included, but their handling raises further concerns. First, BNP values were higher in the sarcopenic group, whereas NT-proBNP levels were paradoxically lower. This discrepancy is likely explained by substantial missing NT-proBNP data, which may have diluted its true effect. Second, both biomarkers were analyzed categorically using thresholds, but cut-off values remain debated in older adults and may be even less reliable in a pre-symptomatic HF population [<span>5</span>]. Have the authors considered reanalyzing the data using BNP as a continuous variable, while incorporating additional echocardiograph

我们非常感兴趣地阅读了Matsumura等人的文章，该文章评估了无症状（B期）心力衰竭（HF）的老年人肌肉减少症的患病率及其长期预后影响。主要发现是肌肉减少症是一个独立的长期预测因子，包括死亡、心肌梗死事件或心衰住院。该研究的独创性在于其重点关注已经以心脏结构性异常为标志的无症状心衰，并使用经过验证的标准来定义肌肉减少症。由于其可逆性，骨骼肌减少症是老年人干预的关键目标。然而，正如作者所指出的，针对C期HF（症状性疾病）的肌肉减少症的干预措施效果有限，可能是因为它们在病程中发生得太晚了[2-4]。然而，作者没有强调的一个重要问题使对肌肉减少症与研究结果之间关系的解释变得复杂，即肌肉减少症也可能由B期HF及其特定决定因素引起，这可能是报告的患病率（17.7%）高于普通人群的原因。在[1]的表2中，比较了有和没有肌肉减少症患者的实验室和超声心动图参数，有几个明显的基线不平衡。例如，肌少症患者的E/ E比值、瓣膜疾病的存在、炎症标志物和营养状况都更差。虽然所有参与者在技术上都符合B期标准，但在基线时，肌肉减少症患者可能代表B期“更高级”的表型。这些因素不仅可能是肌肉减少症的后果，而且可能是其发展的潜在因素，它们本身就是心血管结局的预测因素。因此，在肌少症患者中观察到的过度风险可能反映了肌少症与这些基线失衡之间复杂的相互作用，而不是肌少症本身。在[1]的表3中，Cox回归模型没有包含几个相关变量。例如，E/ E '和瓣膜病在单变量分析中未被考虑，因此被排除在多变量模型之外，尽管它们与预后相关。BNP和NT-proBNP也包括在内，但它们的处理方式引发了进一步的担忧。首先，肌肉减少组的BNP值较高，而NT-proBNP水平却自相矛盾地较低。这种差异可能是由于大量的NT-proBNP数据缺失，这可能削弱了其真实效果。其次，使用阈值对两种生物标志物进行分类分析，但在老年人中仍然存在争议，在症状前HF人群中可能更不可靠。作者是否考虑使用BNP作为连续变量重新分析数据，同时结合其他超声心动图标记物，以更好地证明肌肉减少症是否独立预测复合结果？我们还想指出在提出结果方面的一个小小的不一致之处。结果部分报道了26例患者达到了综合结果，但下一句具体说明了肌肉减少组14例，非肌肉减少组7例，共计21例。Kaplan-Meier曲线（[1]的图2）也显示了21个事件，而[1]的表S2正确地报告了26个事件。这可能反映了一个简单的转录错误，但澄清将是受欢迎的。尽管存在这些方法学上的问题，但我们希望强调这项研究在肌肉减少症和心血管衰老领域的重要性。通过研究症状前HF人群中的肌肉减少症，作者为肌肉减少症与血管合并症之间复杂的相互作用开辟了新的视角。未来的研究包括具有可比基线心血管特征的更大样本，对于澄清因果关系和确认肌肉减少症是否是B期HF预后的独立预测因素至关重要。目前，该研究没有解决“先有鸡还是先有蛋”的问题：是结构性心脏异常导致不良结果，还是肌肉减少症本身发挥独立的影响？正如文献所强调的，骨骼肌减少症和心衰之间的双向关系是非常可信的。总之，Matsumura等人引起了对心衰人群中肌肉减少症的关注，值得赞扬。我们同意作者的观点，即识别肌肉减少症患者是必要的，需要有针对性的干预措施来改善肌肉力量和身体功能。然而，肌少症本身并不能完全解释心血管事件的发生率。他们的发现强调了早期预防策略和未来研究的必要性，以解开老年人肌肉减少症和心衰结果之间的复杂机制。， c.r.和M.L. 写了这封信，并阅读并批准了手稿的最终版本。作者没有什么可报告的。作者声明无利益冲突。本出版物链接到Matsumura和Nakazawa的相关回复文章。要查看本文，请访问https://doi.org/10.1111/jgs.70149。

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引用次数: 0

SGLT2 Inhibitors in Older Adults With Cardiovascular Disease: A Systematic Review and Meta-Analysis SGLT2抑制剂在老年心血管疾病患者中的应用：一项系统综述和荟萃分析

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-07 DOI: 10.1111/jgs.70143

Kota Minami, Rika Terashima, Lina Freeman, Yuji Yamada, Amanda R. Vest, Yuichiro Yano, Toshio Naito, Satoshi Miyashita

Background

Sodium-glucose cotransporter-2 (SGLT2) inhibitors, developed for type 2 diabetes mellitus (T2DM), have demonstrated cardiorenal benefits in conditions including cardiovascular (CV) disease. However, few meta-analyses have synthesized outcomes in older adults with CV disease.

Methods

A systematic review and meta-analysis of randomized controlled trials published from January 2015 to January 2025 was conducted using MEDLINE (PubMed), Embase (Ovid), and CENTRAL. We included studies that reported the risk of CV outcomes for subgroups of older adults (≥ 65 years) with CV disease. The primary outcome was a composite of hospitalization for heart failure (HHF), urgent heart failure (HF) visits, and cardiovascular death (CVD). Secondary outcomes included all-cause mortality, CVD, and HHF individually. Subgroup analyses were conducted in patients with HF, T2DM, age strata (65–74 vs. ≥ 75), SGLT2 inhibitor agent, and adverse events.

Results

Analyzing nine studies, SGLT2 inhibitors were associated with reducing the risk of composite outcome (HR: 0.75, 95% CI: 0.67–0.83, I ² = 51%), all-cause mortality (HR: 0.80, 95% CI: 0.66–0.97, I ² = 68%), CVD (HR: 0.78, 95% CI: 0.65–0.94, I ² = 61%), and HHF (HR: 0.73, 95% CI: 0.65–0.83, I ² = 0%). Benefits were consistent in subgroups of HF only, T2DM only, and those aged ≥ 75 years. No significant differences were observed by SGLT2 inhibitor type (p = 0.090). SGLT2 inhibitors increased the risk of genital infections (RR: 3.18, 95% CI: 2.35–4.30, I ² = 0%) but decreased that of other serious adverse events (RR: 0.92, 95% CI: 0.86–0.97, I ² = 64%).

Conclusions

In adults aged ≥ 65 years with CV disease, SGLT2 inhibitors significantly reduce the composite risk of HHF, urgent HF visits, and CVD and secondary outcomes of all-cause mortality, CVD, and HHF, supporting their use in this population with careful monitoring of age-related risks.

背景：钠-葡萄糖共转运体-2 （SGLT2）抑制剂是针对2型糖尿病（T2DM）开发的，已经证明对包括心血管（CV）疾病在内的疾病有心脏肾脏益处。然而，很少有荟萃分析综合了老年人心血管疾病的结果。方法：使用MEDLINE （PubMed）、Embase （Ovid）和CENTRAL对2015年1月至2025年1月发表的随机对照试验进行系统回顾和荟萃分析。我们纳入了报道老年人（≥65岁）心血管疾病亚组心血管结局风险的研究。主要终点是因心力衰竭（HHF）住院、紧急心力衰竭（HF）就诊和心血管死亡（CVD）的综合结果。次要结局包括全因死亡率、心血管疾病和HHF。对HF、T2DM、年龄层（65-74 vs≥75）、SGLT2抑制剂和不良事件患者进行亚组分析。结果：分析9项研究，SGLT2抑制剂与降低综合结局（HR: 0.75, 95% CI: 0.67-0.83, I2 = 51%）、全因死亡率（HR: 0.80, 95% CI: 0.66-0.97, I2 = 68%）、心血管疾病（HR: 0.78, 95% CI: 0.65-0.94, I2 = 61%）和HHF （HR: 0.73, 95% CI: 0.65-0.83, I2 = 0%）的风险相关。仅HF、仅T2DM和年龄≥75岁的亚组获益一致。SGLT2抑制剂类型差异无统计学意义（p = 0.090）。SGLT2抑制剂增加生殖器感染的风险（RR: 3.18, 95% CI: 2.35-4.30, I2 = 0%），但降低其他严重不良事件的风险（RR: 0.92, 95% CI: 0.86-0.97, I2 = 64%）。结论：在年龄≥65岁的CV患者中，SGLT2抑制剂可显著降低HHF、紧急HF就诊和CVD的综合风险，以及全因死亡率、CVD和HHF的次要结局，支持在仔细监测年龄相关风险的情况下在该人群中使用SGLT2抑制剂。

{"title":"SGLT2 Inhibitors in Older Adults With Cardiovascular Disease: A Systematic Review and Meta-Analysis","authors":"Kota Minami, Rika Terashima, Lina Freeman, Yuji Yamada, Amanda R. Vest, Yuichiro Yano, Toshio Naito, Satoshi Miyashita","doi":"10.1111/jgs.70143","DOIUrl":"10.1111/jgs.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sodium-glucose cotransporter-2 (SGLT2) inhibitors, developed for type 2 diabetes mellitus (T2DM), have demonstrated cardiorenal benefits in conditions including cardiovascular (CV) disease. However, few meta-analyses have synthesized outcomes in older adults with CV disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis of randomized controlled trials published from January 2015 to January 2025 was conducted using MEDLINE (PubMed), Embase (Ovid), and CENTRAL. We included studies that reported the risk of CV outcomes for subgroups of older adults (≥ 65 years) with CV disease. The primary outcome was a composite of hospitalization for heart failure (HHF), urgent heart failure (HF) visits, and cardiovascular death (CVD). Secondary outcomes included all-cause mortality, CVD, and HHF individually. Subgroup analyses were conducted in patients with HF, T2DM, age strata (65–74 vs. ≥ 75), SGLT2 inhibitor agent, and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analyzing nine studies, SGLT2 inhibitors were associated with reducing the risk of composite outcome (HR: 0.75, 95% CI: 0.67–0.83, <i>I</i>\u0000 <sup>2</sup> = 51%), all-cause mortality (HR: 0.80, 95% CI: 0.66–0.97, <i>I</i>\u0000 <sup>2</sup> = 68%), CVD (HR: 0.78, 95% CI: 0.65–0.94, <i>I</i>\u0000 <sup>2</sup> = 61%), and HHF (HR: 0.73, 95% CI: 0.65–0.83, <i>I</i>\u0000 <sup>2</sup> = 0%). Benefits were consistent in subgroups of HF only, T2DM only, and those aged ≥ 75 years. No significant differences were observed by SGLT2 inhibitor type (<i>p</i> = 0.090). SGLT2 inhibitors increased the risk of genital infections (RR: 3.18, 95% CI: 2.35–4.30, <i>I</i>\u0000 <sup>2</sup> = 0%) but decreased that of other serious adverse events (RR: 0.92, 95% CI: 0.86–0.97, <i>I</i>\u0000 <sup>2</sup> = 64%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In adults aged ≥ 65 years with CV disease, SGLT2 inhibitors significantly reduce the composite risk of HHF, urgent HF visits, and CVD and secondary outcomes of all-cause mortality, CVD, and HHF, supporting their use in this population with careful monitoring of age-related risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 12","pages":"3708-3718"},"PeriodicalIF":4.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12748024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Latino Caregiver Experiences With Dementia Care and Healthcare Navigation 拉丁裔护理人员在痴呆症护理和医疗保健导航方面的经验。

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-06 DOI: 10.1111/jgs.70138

Leah V. Estrada, Thalia Porteny, Deanna Margius, Sasha Perez, Albert Siu, Nathan E. Goldstein, Jennifer M. Reckrey

Background

The prevalence of dementia among Latinos in the United States is growing. We explored the experiences of Latino family caregivers of Latino persons living with moderate to advanced dementia (PLWD), drawing on their extensive experience as caregivers navigating the healthcare system to identify opportunities to improve dementia care.

Participants and Setting

Nineteen Latino caregivers of PLWD who spoke English or Spanish were recruited from outpatient geriatrics clinics and a home-based primary care program in New York City.

Methods

We conducted one-on-one semi-structured interviews with family caregivers of PLWD. Interviews were conducted via phone, in-person, or virtual. Interviews were audio recorded, professionally transcribed, translated (if needed), and analyzed using thematic analysis.

Results

We identified two main themes (each with subthemes) that influence Latino dementia caregiver experiences with healthcare: (1) caregiving and understanding of dementia shaped by individual, family, and social factors (subthemes: Caregiver's own understanding of dementia; Lack of support and understanding from family; Latino cultural perspectives on dementia); and (2) navigating formal services amid gaps in cultural alignment and support (subthemes: Trial and error: education and resource gaps; Cultural tension with healthcare).

Conclusions

Culture and family dynamics shape Latino family caregivers' understanding of dementia. Although some had positive experiences, most faced challenges navigating healthcare and experienced gaps in culturally concordant information and support. A culturally centered approach is needed to address these challenges and gaps for the Latino dementia community, including culturally relevant education, resources, and support from the healthcare system and community.

背景：美国拉美裔人群中痴呆症的患病率正在上升。我们探讨了拉丁美洲家庭照顾中度至晚期痴呆症患者（PLWD）的经验，利用他们作为护理人员在医疗保健系统中导航的丰富经验，以确定改善痴呆症护理的机会。参与者和环境：从纽约市老年门诊诊所和家庭基础初级保健项目招募了19名讲英语或西班牙语的PLWD拉丁裔护理人员。方法：对PLWD患者家属进行一对一半结构化访谈。采访通过电话、面对面或虚拟的方式进行。采访录音，专业转录，翻译（如果需要），并使用专题分析进行分析。结果：我们确定了影响拉丁裔痴呆症护理者在医疗保健方面经历的两个主要主题（每个主题都有副主题）：(1)个人、家庭和社会因素对痴呆症的护理和理解（副主题：护理者自己对痴呆症的理解；缺乏家庭的支持和理解；拉丁裔文化对痴呆症的看法）；(2)在文化一致性和支持的差距中引导正式服务（副主题：尝试和错误：教育和资源差距；医疗保健的文化紧张）。结论：文化和家庭动态影响拉丁裔家庭照顾者对痴呆症的理解。虽然有些人有积极的经历，但大多数人在医疗保健方面面临挑战，并且在文化和谐的信息和支持方面存在差距。需要以文化为中心的方法来解决拉丁裔痴呆症社区的这些挑战和差距，包括与文化相关的教育、资源以及卫生保健系统和社区的支持。

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引用次数: 0

Editor's Note on Effectiveness of a Telephonic Aging Brain Care Model for Medicaid Home and Community Services for Dementia Patients and Their Caregivers 编者注：针对老年痴呆症患者及其护理者的医疗补助家庭和社区服务的电话老龄脑护理模式的有效性

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society

Pub Date : 2025-10-06 DOI: 10.1111/jgs.70145

Michael L. Malone

引用次数: 0