Victoria A. Sanchez AuD, PhD, Michelle L. Arnold AuD, PhD, Emmanuel E. Garcia Morales PhD, Nicholas S. Reed AuD, PhD, Sarah Faucette AuD, PhD, Sheila Burgard MS, Haley N. Calloway AuD, Josef Coresh MD, PhD, Jennifer A. Deal PhD, Adele M. Goman PhD, Lisa Gravens-Mueller MS, Kathleen M. Hayden PhD, Alison R. Huang PhD, Christine M. Mitchell ScM, Thomas H. Mosley Jr PhD, James S. Pankow PhD, James R. Pike MBA, Jennifer A. Schrack PhD, Laura Sherry AuD, Jacqueline M. Weycker AuD, Frank R. Lin MD, PhD, Theresa H. Chisolm PhD, For the ACHIEVE Collaborative Study
Background
The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.
Methods
The ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70–84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory—Elderly Screening version (HHIE-S, range 0–40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.
Results
HHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of −8.9 (95% CI: −10.4, −7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, −9.3 (95% CI: −10.8, −7.9) to Year 1, −8.4 (95% CI: −9.8, −6.9) to Year 2, and − 9.5 (95% CI: −11.0, −8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.
Conclusions
Hearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.
{"title":"Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial","authors":"Victoria A. Sanchez AuD, PhD, Michelle L. Arnold AuD, PhD, Emmanuel E. Garcia Morales PhD, Nicholas S. Reed AuD, PhD, Sarah Faucette AuD, PhD, Sheila Burgard MS, Haley N. Calloway AuD, Josef Coresh MD, PhD, Jennifer A. Deal PhD, Adele M. Goman PhD, Lisa Gravens-Mueller MS, Kathleen M. Hayden PhD, Alison R. Huang PhD, Christine M. Mitchell ScM, Thomas H. Mosley Jr PhD, James S. Pankow PhD, James R. Pike MBA, Jennifer A. Schrack PhD, Laura Sherry AuD, Jacqueline M. Weycker AuD, Frank R. Lin MD, PhD, Theresa H. Chisolm PhD, For the ACHIEVE Collaborative Study","doi":"10.1111/jgs.19185","DOIUrl":"10.1111/jgs.19185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70–84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory—Elderly Screening version (HHIE-S, range 0–40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>HHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of −8.9 (95% CI: −10.4, −7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, −9.3 (95% CI: −10.8, −7.9) to Year 1, −8.4 (95% CI: −9.8, −6.9) to Year 2, and − 9.5 (95% CI: −11.0, −8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3784-3799"},"PeriodicalIF":4.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252189","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}
Kaleen N. Hayes PharmD, PhD, Meghan A. Cupp MPH, Richa Joshi MSc, Melissa R. Riester PharmD, Francesca L. Beaudoin MD, PhD, Andrew R. Zullo PharmD, PhD
Background
Appropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.
Methods
We conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post-acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g-formula to standardize for age and sex.
Results
We identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).
Conclusion
Racial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short- and long-term health outcomes.
{"title":"Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care","authors":"Kaleen N. Hayes PharmD, PhD, Meghan A. Cupp MPH, Richa Joshi MSc, Melissa R. Riester PharmD, Francesca L. Beaudoin MD, PhD, Andrew R. Zullo PharmD, PhD","doi":"10.1111/jgs.19160","DOIUrl":"10.1111/jgs.19160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Appropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post-acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g-formula to standardize for age and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Racial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short- and long-term health outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3730-3741"},"PeriodicalIF":4.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184910","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}
Emanuele Bizzi MD, Francesco Cavaleri MD, Ruggiero Mascolo MD, Edoardo Conte MD, Stefano Maggiolini MD, Caterina Chiara Decarlini MD, Silvia Maestroni MD, Valentino Collini MD, Ludovico Luca Sicignano MD, Elena Verrecchia MD, Raffaele Manna MD, Massimo Pancrazi MD, Lucia Trotta MD, Giuseppe Lopalco MD, Danilo Malandrino MD, Giada Pallini MD, Sara Catenazzi MD, Luisa Carrozzo MD, Giacomo Emmi MD, George Lazaros MD, Antonio Brucato MD, Massimo Imazio MD
<div> <section> <h3> Background</h3> <p>Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.</p> </section> <section> <h3> Objective of the Study</h3> <p>Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.</p> </section> <section> <h3> Materials and Methods</h3> <p>We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.</p> </section> <section> <h3> Results</h3> <p>One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (<i>p</i> < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (<i>p</i> < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (<i>p</i> = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, <i>p</i> < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, <i>p</i> = 0.016) and pericardiocentesis (16.5% vs 8.5%, <i>p</i> = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm<sup>3</sup> vs 11,208 + 285/mm<sup>3</sup>, <i>p</i> = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (<i>p</i> = 0.003), colchicine in 76.7% versus 87.3% (<i>p</i> = 0.023), corticosteroids in 49.6% versus 26.8% (<i>p</i> < 0.001), and anakinra in 14.3% versus 23.9% (<i>p</i> = 0.044).</p> </section> <section> <h3> Conclusions</h3> <p>Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely d
{"title":"Recurrent pericarditis in older adults: Clinical and laboratory features and outcome","authors":"Emanuele Bizzi MD, Francesco Cavaleri MD, Ruggiero Mascolo MD, Edoardo Conte MD, Stefano Maggiolini MD, Caterina Chiara Decarlini MD, Silvia Maestroni MD, Valentino Collini MD, Ludovico Luca Sicignano MD, Elena Verrecchia MD, Raffaele Manna MD, Massimo Pancrazi MD, Lucia Trotta MD, Giuseppe Lopalco MD, Danilo Malandrino MD, Giada Pallini MD, Sara Catenazzi MD, Luisa Carrozzo MD, Giacomo Emmi MD, George Lazaros MD, Antonio Brucato MD, Massimo Imazio MD","doi":"10.1111/jgs.19150","DOIUrl":"10.1111/jgs.19150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective of the Study</h3>\u0000 \u0000 <p>Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (<i>p</i> < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (<i>p</i> < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (<i>p</i> = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, <i>p</i> < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, <i>p</i> = 0.016) and pericardiocentesis (16.5% vs 8.5%, <i>p</i> = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm<sup>3</sup> vs 11,208 + 285/mm<sup>3</sup>, <i>p</i> = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (<i>p</i> = 0.003), colchicine in 76.7% versus 87.3% (<i>p</i> = 0.023), corticosteroids in 49.6% versus 26.8% (<i>p</i> < 0.001), and anakinra in 14.3% versus 23.9% (<i>p</i> = 0.044).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely d","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3467-3475"},"PeriodicalIF":4.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157066","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}
Hina Faisal MD, Faisal N. Masud MD, Kim Junhyoung PhD, Kenneth Podell PhD, Jiaqiong Xu PhD, Christina Boncyk MD, MPH, George E. Taffet MD, Malaz A. Boustani MD, MPH
{"title":"Virtual reality-based cognitive exercise games in geriatric surgical patients: A pilot trial","authors":"Hina Faisal MD, Faisal N. Masud MD, Kim Junhyoung PhD, Kenneth Podell PhD, Jiaqiong Xu PhD, Christina Boncyk MD, MPH, George E. Taffet MD, Malaz A. Boustani MD, MPH","doi":"10.1111/jgs.19181","DOIUrl":"10.1111/jgs.19181","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"293-296"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142243","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}
Antoinette B. Coe PharmD, PhD, Tingting Zhang MD, PhD, Andrew R. Zullo PharmD, PhD, Lauren B. Gerlach DO, MS, Lori A. Daiello PharmD, ScM, Hiren Varma MS, Derrick Lo ScM, Richa Joshi MS, Julie P. W. Bynum MD, MPH, Theresa I. Shireman PhD
Background
Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.
Methods
Among community-dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee-for-service claims using interrupted time series analyses across three periods (“Pre-Partnership”: July 1, 2010 to March 31, 2012; “Post-Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).
Results
We included 1,289,401 community dwellers with dementia contributing 26,609,697 person-months. The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (β = −0.06, 95% CI: −0.08, −0.05) and post-Partnership (β = −0.02, 95% CI: −0.02, −0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.
Conclusions
These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community-dwellers with dementia.
{"title":"Association of nursing home antipsychotic reduction policies with antipsychotic use in community dwellers with dementia","authors":"Antoinette B. Coe PharmD, PhD, Tingting Zhang MD, PhD, Andrew R. Zullo PharmD, PhD, Lauren B. Gerlach DO, MS, Lori A. Daiello PharmD, ScM, Hiren Varma MS, Derrick Lo ScM, Richa Joshi MS, Julie P. W. Bynum MD, MPH, Theresa I. Shireman PhD","doi":"10.1111/jgs.19184","DOIUrl":"10.1111/jgs.19184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among community-dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee-for-service claims using interrupted time series analyses across three periods (“Pre-Partnership”: July 1, 2010 to March 31, 2012; “Post-Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 1,289,401 community dwellers with dementia contributing 26,609,697 person-months. The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (<i>β</i> = −0.06, 95% CI: −0.08, −0.05) and post-Partnership (<i>β</i> = −0.02, 95% CI: −0.02, −0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (<i>β</i> = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community-dwellers with dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"214-222"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147224","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>Assessing the effectiveness of a health system intervention when randomized controlled trials (RCTs) are infeasible has long been a challenge for clinicians, health economists, and health service researchers alike. Difference-in-differences (DID) is a quasi-experimental study design that can be particularly appealing in addressing this challenge using observational data. Other nonexperimental study designs, such as regression adjustment or propensity score matching, attempt to examine the impact of an intervention by only accounting for the observed differences between groups. In contrast, an appropriately designed DID study aims to exploit randomness in intervention timing to identify the causal effects of the intervention. The number of published papers applying DID designs in the medical field has been increasing in recent years.<span><sup>1, 2</sup></span> Following this trend, the <i>Journal of the American Geriatrics Society</i> (JAGS) published 18 studies, mostly since 2018 (original data from the authors), that apply DID designs to examine a wide range of health system interventions that pertain to geriatrics care (Figure 1).</p><p>DID designs assess the effect of an intervention (e.g., health policy or program) applied to one or more groups (treated) by comparing their outcomes relative to a group that has never or not yet received the intervention (control) in terms of two differences.<span><sup>3, 4</sup></span> The first set of differences compares outcomes before and after the timing of the intervention for the treated and control groups, respectively. This process removes the observed and unobserved group-specific factors that do not change over time. Subtracting these differences (i.e., the second difference or difference-in-differences) removes the time-varying trends that are common to both groups. Together, DID identifies the causal effect of the intervention assuming that the treated would have experienced the same trend as the control group in the absence of the intervention (parallel trends).</p><p>In the recent issue of JAGS, a study by Burke and colleagues<span><sup>5</sup></span> used a DID design to evaluate changes in patient care outcomes following the Age-Friendly health systems recognition in the Veterans Health Administration. The authors incorporated recent advances in DID with staggered treatment timing developed by Sun and Abraham,<span><sup>6</sup></span> which is appropriate as the receipt of recognition across the medical sites happened at different times. This approach addresses potential biases in traditional DID estimation—often referred to as two-way fixed effects—when treatment effects are not constant over time and differ by late versus early treated sites.<span><sup>6-8</sup></span> Given the absence of an RCT in this setting, one of the notable strengths of this study stems from using observational data to measure the effect of recognition for implementing evidence-based care transformations (4Ms: wh
{"title":"Applying difference-in-differences design in quality improvement and health systems research","authors":"Yucheng Hou PhD, MPP, Abdelaziz Alsharawy PhD","doi":"10.1111/jgs.19180","DOIUrl":"10.1111/jgs.19180","url":null,"abstract":"<p>Assessing the effectiveness of a health system intervention when randomized controlled trials (RCTs) are infeasible has long been a challenge for clinicians, health economists, and health service researchers alike. Difference-in-differences (DID) is a quasi-experimental study design that can be particularly appealing in addressing this challenge using observational data. Other nonexperimental study designs, such as regression adjustment or propensity score matching, attempt to examine the impact of an intervention by only accounting for the observed differences between groups. In contrast, an appropriately designed DID study aims to exploit randomness in intervention timing to identify the causal effects of the intervention. The number of published papers applying DID designs in the medical field has been increasing in recent years.<span><sup>1, 2</sup></span> Following this trend, the <i>Journal of the American Geriatrics Society</i> (JAGS) published 18 studies, mostly since 2018 (original data from the authors), that apply DID designs to examine a wide range of health system interventions that pertain to geriatrics care (Figure 1).</p><p>DID designs assess the effect of an intervention (e.g., health policy or program) applied to one or more groups (treated) by comparing their outcomes relative to a group that has never or not yet received the intervention (control) in terms of two differences.<span><sup>3, 4</sup></span> The first set of differences compares outcomes before and after the timing of the intervention for the treated and control groups, respectively. This process removes the observed and unobserved group-specific factors that do not change over time. Subtracting these differences (i.e., the second difference or difference-in-differences) removes the time-varying trends that are common to both groups. Together, DID identifies the causal effect of the intervention assuming that the treated would have experienced the same trend as the control group in the absence of the intervention (parallel trends).</p><p>In the recent issue of JAGS, a study by Burke and colleagues<span><sup>5</sup></span> used a DID design to evaluate changes in patient care outcomes following the Age-Friendly health systems recognition in the Veterans Health Administration. The authors incorporated recent advances in DID with staggered treatment timing developed by Sun and Abraham,<span><sup>6</sup></span> which is appropriate as the receipt of recognition across the medical sites happened at different times. This approach addresses potential biases in traditional DID estimation—often referred to as two-way fixed effects—when treatment effects are not constant over time and differ by late versus early treated sites.<span><sup>6-8</sup></span> Given the absence of an RCT in this setting, one of the notable strengths of this study stems from using observational data to measure the effect of recognition for implementing evidence-based care transformations (4Ms: wh","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"8-11"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142215","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}
Sungchul Park PhD, Hye-Young Jung PhD, Jiani Yu PhD
Background
Medicare Advantage (MA) plans must cover all telehealth services offered by Traditional Medicare (TM), but have flexibility to provide additional telehealth services. It is not known whether these flexibilities are associated with telehealth availability and use. In this study, we examined differences in telehealth availability and use between TM and MA beneficiaries.
Methods
This cross-sectional study analyzed beneficiaries who participated in the 2021 Medicare Current Beneficiary Survey. Our primary outcomes were telehealth availability and use, assessed both overall and by modality (telephone only, video only, and both). Our key independent variable was full-year enrollment in MA versus TM. Differences in outcomes between TM and MA beneficiaries were estimated using logistic regression models that adjusted for beneficiary characteristics. The analysis of telehealth availability included all beneficiaries in the sample, while the analysis of telehealth use was limited to those offered telehealth services. In a secondary analysis, we examined differences between TM and MA beneficiaries in the availability of technology that may enable telehealth use and experience using the internet to seek information.
Results
Among 8130 Medicare beneficiaries, MA beneficiaries were 2.9 (95% CI: 0.6–5.2) percentage points more likely to have a provider who offered telehealth services than TM beneficiaries, including both telephone and video options. However, MA beneficiaries were 3.5 (−6.7, −0.4) percentage points less likely to use telehealth services than TM beneficiaries. Video-only options were used less frequently among MA beneficiaries compared to those in TM (−2.7 [−5.1, −0.3]). Despite lower telehealth use, MA beneficiaries had comparable or higher rates of technology access and internet experience compared to TM beneficiaries.
Conclusion
Our findings suggest that greater access to telehealth services among MA beneficiaries did not translate into greater telehealth use. Future research is warranted to explore the underlying mechanisms behind lower use of telehealth services among MA beneficiaries.
{"title":"Telehealth availability and use among beneficiaries in Traditional Medicare and Medicare Advantage","authors":"Sungchul Park PhD, Hye-Young Jung PhD, Jiani Yu PhD","doi":"10.1111/jgs.19183","DOIUrl":"10.1111/jgs.19183","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medicare Advantage (MA) plans must cover all telehealth services offered by Traditional Medicare (TM), but have flexibility to provide additional telehealth services. It is not known whether these flexibilities are associated with telehealth availability and use. In this study, we examined differences in telehealth availability and use between TM and MA beneficiaries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study analyzed beneficiaries who participated in the 2021 Medicare Current Beneficiary Survey. Our primary outcomes were telehealth availability and use, assessed both overall and by modality (telephone only, video only, and both). Our key independent variable was full-year enrollment in MA versus TM. Differences in outcomes between TM and MA beneficiaries were estimated using logistic regression models that adjusted for beneficiary characteristics. The analysis of telehealth availability included all beneficiaries in the sample, while the analysis of telehealth use was limited to those offered telehealth services. In a secondary analysis, we examined differences between TM and MA beneficiaries in the availability of technology that may enable telehealth use and experience using the internet to seek information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 8130 Medicare beneficiaries, MA beneficiaries were 2.9 (95% CI: 0.6–5.2) percentage points more likely to have a provider who offered telehealth services than TM beneficiaries, including both telephone and video options. However, MA beneficiaries were 3.5 (−6.7, −0.4) percentage points less likely to use telehealth services than TM beneficiaries. Video-only options were used less frequently among MA beneficiaries compared to those in TM (−2.7 [−5.1, −0.3]). Despite lower telehealth use, MA beneficiaries had comparable or higher rates of technology access and internet experience compared to TM beneficiaries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that greater access to telehealth services among MA beneficiaries did not translate into greater telehealth use. Future research is warranted to explore the underlying mechanisms behind lower use of telehealth services among MA beneficiaries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"545-551"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142221","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}
Jacqueline Martin-Kerry BAppSci(Hons) PhD, Sion Scott MPharm PhD, Jo Taylor BA (Hons) MRes PhD, David Wright BPharm (Hons) PGCHE PhD, Martyn Patel BMBCh MA, Jennie Griffiths, Victoria L. Keevil PhD BMBCh, Miles D. Witham BM BCh PhD, Allan Clark BSc(Hons) PhD, Ian Kellar PhD, David Turner BSc (Economics) MSc, Debi Bhattacharya BPharm PhD
<p>The use of core outcome sets (COS) by trials is widely accepted as best practice, aiming to improve research efficiency by enabling comparison and aggregation of results across trials for specific clinical areas.<span><sup>1</sup></span> A COS is an agreed minimum set of standardized outcomes that should be reported in all trials for a specific clinical area.<span><sup>1</sup></span> A COS should include only fundamental outcomes, that is, <i>core</i> to evaluating a treatment or intervention, rather than every relevant or important outcome.<span><sup>1, 2</sup></span> Trials can additionally measure other outcomes.<span><sup>1, 3</sup></span></p><p>Outcomes in a COS should be valid and important for all stakeholders. When developing a COS for hospital deprescribing trials,<span><sup>4</sup></span> we involved stakeholders that would be affected by the intervention: older patients and their carers; healthcare professionals who care for older people in hospital; hospital managers; and academics researching older people's medicine/deprescribing. We followed COMET (Core Outcome Measures in Effectiveness Trials) guidance for COS development<span><sup>1</sup></span>; this summarizes available methods for COS development but provides limited guidance on how to ensure meaningful involvement of patients, who historically have not been involved in deciding which outcomes should be measured in trials. The INCLUDE framework highlights that older people are often explicitly or implicitly excluded from healthcare research.<span><sup>5</sup></span> Despite anticipating some barriers to older people's participation in our COS study and addressing these in the study planning, we experienced several challenges to ensuring that the selection of outcomes for the COS included their views. We reflect on these challenges, discuss what worked to address them, and present further refinements that could better support equitable, meaningful participation of older people in COS development. <b>Study registration:</b> COMET (Core Outcome Measures in Effectiveness Trials) database (https://www.comet-initiative.org/Studies/Details/1825).</p><p>Developing a COS generally begins with generating a long list (10–100 s) of potentially relevant outcomes for participants to rate.<span><sup>1</sup></span> Although a range of techniques exist for approaching consensus, Delphi surveys dominate the literature regardless of the target population and clinical area.<span><sup>1, 6, 7</sup></span> Guidance states that during the Delphi, participants should consider each outcome individually, without comparing with other outcomes. We presented 49 outcomes (with plain English definitions) in the first Delphi round for participants to rate in terms of their importance to measure in hospital deprescribing trials. We grouped similar outcomes together and provided instructions informed by our Patient and Public Involvement (PPI) members, about how to review each outcome. Despite these strategi
{"title":"Supporting meaningful participation of older people in core outcome set development","authors":"Jacqueline Martin-Kerry BAppSci(Hons) PhD, Sion Scott MPharm PhD, Jo Taylor BA (Hons) MRes PhD, David Wright BPharm (Hons) PGCHE PhD, Martyn Patel BMBCh MA, Jennie Griffiths, Victoria L. Keevil PhD BMBCh, Miles D. Witham BM BCh PhD, Allan Clark BSc(Hons) PhD, Ian Kellar PhD, David Turner BSc (Economics) MSc, Debi Bhattacharya BPharm PhD","doi":"10.1111/jgs.19179","DOIUrl":"10.1111/jgs.19179","url":null,"abstract":"<p>The use of core outcome sets (COS) by trials is widely accepted as best practice, aiming to improve research efficiency by enabling comparison and aggregation of results across trials for specific clinical areas.<span><sup>1</sup></span> A COS is an agreed minimum set of standardized outcomes that should be reported in all trials for a specific clinical area.<span><sup>1</sup></span> A COS should include only fundamental outcomes, that is, <i>core</i> to evaluating a treatment or intervention, rather than every relevant or important outcome.<span><sup>1, 2</sup></span> Trials can additionally measure other outcomes.<span><sup>1, 3</sup></span></p><p>Outcomes in a COS should be valid and important for all stakeholders. When developing a COS for hospital deprescribing trials,<span><sup>4</sup></span> we involved stakeholders that would be affected by the intervention: older patients and their carers; healthcare professionals who care for older people in hospital; hospital managers; and academics researching older people's medicine/deprescribing. We followed COMET (Core Outcome Measures in Effectiveness Trials) guidance for COS development<span><sup>1</sup></span>; this summarizes available methods for COS development but provides limited guidance on how to ensure meaningful involvement of patients, who historically have not been involved in deciding which outcomes should be measured in trials. The INCLUDE framework highlights that older people are often explicitly or implicitly excluded from healthcare research.<span><sup>5</sup></span> Despite anticipating some barriers to older people's participation in our COS study and addressing these in the study planning, we experienced several challenges to ensuring that the selection of outcomes for the COS included their views. We reflect on these challenges, discuss what worked to address them, and present further refinements that could better support equitable, meaningful participation of older people in COS development. <b>Study registration:</b> COMET (Core Outcome Measures in Effectiveness Trials) database (https://www.comet-initiative.org/Studies/Details/1825).</p><p>Developing a COS generally begins with generating a long list (10–100 s) of potentially relevant outcomes for participants to rate.<span><sup>1</sup></span> Although a range of techniques exist for approaching consensus, Delphi surveys dominate the literature regardless of the target population and clinical area.<span><sup>1, 6, 7</sup></span> Guidance states that during the Delphi, participants should consider each outcome individually, without comparing with other outcomes. We presented 49 outcomes (with plain English definitions) in the first Delphi round for participants to rate in terms of their importance to measure in hospital deprescribing trials. We grouped similar outcomes together and provided instructions informed by our Patient and Public Involvement (PPI) members, about how to review each outcome. Despite these strategi","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"661-665"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142220","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}
Ilyas Akkar MD, Zeynep Iclal Turgut MD, Mustafa Hakan Dogan MD, Muhammet Cemal Kizilarslanoglu MD
<p>We read the article by Lane et al.<span><sup>1</sup></span> with great interest. They demonstrated that the early testing rate of serum sodium levels and the need for hospitalization due to hyponatremia were lower than expected in the study population that started on antidepressant therapy. In support of these findings, it was speculated by the authors that early sodium testing in all patients with antidepressant treatment may not be clinically beneficial. Although the study has a suitable methodology and an excellent presentation, further prospectively designed studies are warranted to test these hypotheses investigated in the recent study before changing routine clinical practice. We know that hyponatremia is a significant cause of morbidity and even mortality in this older patient population.<span><sup>2</sup></span> Current guidelines emphasize the importance of close follow-up of the patients by measuring their serum sodium levels, especially in older people who have newly started antidepressants because antidepressant-associated hyponatremia is usually observed within the first weeks after initiation of the treatment.<span><sup>3</sup></span></p><p>Moreover, it has been emphasized that sodium monitoring should not be forgotten after the initiation of antidepressant treatments, especially in older individuals who are concomitantly using drugs such as diuretics that may decrease serum sodium levels.<span><sup>4</sup></span> Supportingly, the recent study observed that the most common underlying comorbidities in patients requiring hospitalization due to hyponatremia were heart failure and urinary tract infection. Therefore, sodium monitoring should be kept in mind when evaluating patients who have additional conditions that may increase the risk of hyponatremia and started antidepressant therapy.</p><p>Another critical point taken from the recent study is the exclusion from the study of about four thousand patients who died during the follow-up period after antidepressant treatment initiation. If most of these excluded patients were in the group without monitoring serum sodium levels, this may cause a selection bias in the study. Therefore, if the data of these deceased patients can be accessed in detail and included in the analyses, it may strengthen the study's results. Alternatively, there are conflicting data in the literature regarding the cutoff point of serum sodium levels in patients using antidepressants to predict symptomatic hyponatremia.<span><sup>5</sup></span> The recent study reported that the median serum sodium value of patients requiring hospitalization was 132 mmol/L. However, we could not find any clear information about whether these hospital admissions were due to symptomatic hyponatremia or not. Therefore, some reasons for admission or symptoms in the study population may have derived from another clinical condition other than hyponatremia. A detailed examination of the symptoms in the hospitalized group may strengthe
{"title":"Comment on: Hyponatremia–associated hospital visits are not reduced by early electrolyte testing in older adults starting antidepressants","authors":"Ilyas Akkar MD, Zeynep Iclal Turgut MD, Mustafa Hakan Dogan MD, Muhammet Cemal Kizilarslanoglu MD","doi":"10.1111/jgs.19165","DOIUrl":"10.1111/jgs.19165","url":null,"abstract":"<p>We read the article by Lane et al.<span><sup>1</sup></span> with great interest. They demonstrated that the early testing rate of serum sodium levels and the need for hospitalization due to hyponatremia were lower than expected in the study population that started on antidepressant therapy. In support of these findings, it was speculated by the authors that early sodium testing in all patients with antidepressant treatment may not be clinically beneficial. Although the study has a suitable methodology and an excellent presentation, further prospectively designed studies are warranted to test these hypotheses investigated in the recent study before changing routine clinical practice. We know that hyponatremia is a significant cause of morbidity and even mortality in this older patient population.<span><sup>2</sup></span> Current guidelines emphasize the importance of close follow-up of the patients by measuring their serum sodium levels, especially in older people who have newly started antidepressants because antidepressant-associated hyponatremia is usually observed within the first weeks after initiation of the treatment.<span><sup>3</sup></span></p><p>Moreover, it has been emphasized that sodium monitoring should not be forgotten after the initiation of antidepressant treatments, especially in older individuals who are concomitantly using drugs such as diuretics that may decrease serum sodium levels.<span><sup>4</sup></span> Supportingly, the recent study observed that the most common underlying comorbidities in patients requiring hospitalization due to hyponatremia were heart failure and urinary tract infection. Therefore, sodium monitoring should be kept in mind when evaluating patients who have additional conditions that may increase the risk of hyponatremia and started antidepressant therapy.</p><p>Another critical point taken from the recent study is the exclusion from the study of about four thousand patients who died during the follow-up period after antidepressant treatment initiation. If most of these excluded patients were in the group without monitoring serum sodium levels, this may cause a selection bias in the study. Therefore, if the data of these deceased patients can be accessed in detail and included in the analyses, it may strengthen the study's results. Alternatively, there are conflicting data in the literature regarding the cutoff point of serum sodium levels in patients using antidepressants to predict symptomatic hyponatremia.<span><sup>5</sup></span> The recent study reported that the median serum sodium value of patients requiring hospitalization was 132 mmol/L. However, we could not find any clear information about whether these hospital admissions were due to symptomatic hyponatremia or not. Therefore, some reasons for admission or symptoms in the study population may have derived from another clinical condition other than hyponatremia. A detailed examination of the symptoms in the hospitalized group may strengthe","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"654-655"},"PeriodicalIF":4.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142216","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}
Jean-François Huon PharmD, PhD, Chiranjeev Sanyal PhD, Camille L. Gagnon PharmD, MSc, Justin P. Turner PhD, Ninh B. Khuong MSc, Émilie Bortolussi-Courval RN, PhD Student, Todd C. Lee MD, MPH, James L. Silvius MD, Steven G. Morgan PhD, Emily G. McDonald MD, MSc
Background
Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.
Methods
This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation-adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$.
Results
Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).
Conclusions
While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed.
{"title":"The cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study","authors":"Jean-François Huon PharmD, PhD, Chiranjeev Sanyal PhD, Camille L. Gagnon PharmD, MSc, Justin P. Turner PhD, Ninh B. Khuong MSc, Émilie Bortolussi-Courval RN, PhD Student, Todd C. Lee MD, MPH, James L. Silvius MD, Steven G. Morgan PhD, Emily G. McDonald MD, MSc","doi":"10.1111/jgs.19164","DOIUrl":"10.1111/jgs.19164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation-adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3530-3540"},"PeriodicalIF":4.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142242","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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