Journal of the American Geriatrics Society最新文献

Background: Dementia affects over 6.5 million people in the United States. The centers for medicare & medicaid services (CMS) introduced the guiding an improving dementia experience (GUIDE) Model to standardize and address gaps in dementia care. Whereas social and educational interventions form a major part of dementia care management, certain patients require medical interventions, such as referrals and medication for behavioral issues. This study aims to describe the dementia care provided by nurse practitioner (NP) dementia care managers within the Cedars-Sinai C.A.R.E.S. Program, a CMS GUIDE Model site.

Methods: This retrospective observational study analyzed 394 people living with dementia enrolled in the Cedars-Sinai C.A.R.E.S. Program from July 2021 to October 2024. Patient demographics, dementia stage, and provided medical interventions were extracted from electronic health records. Logistic regression models assessed predictors of dementia care use.

Results: Among 394 enrolled patients, 51% received a specialty referral, 30% were initiated on medication, and 4% underwent laboratory testing. NPs commonly prescribed dementia-specific medications (21.6%) and antidepressants (12.4%) and referred patients to neurology (36.6%), psychiatry (14.5%), and occupational therapy (4.8%). Whereas no significant disparities in care delivery were observed, Black or African Americans with mild dementia (CDR ≤ 1) had higher odds of receiving any medical intervention (aOR = 2.69, 95% CI: 1.07-7.78, p = 0.046) and starting medications (aOR = 3.37, 95% CI: 1.52-7.56, p = 0.003) relative to their White counterparts. Patients residing in care facilities, including board-and-care homes and assisted living communities, were significantly less likely to receive referrals (aOR = 0.31, 95% CI: 0.09-0.88, p = 0.038).

Conclusion: As dementia care managers, NPs can support the diverse dementia care needs of enrolled patients with dementia. Integrating NPs into dementia care models, such as the CMS GUIDE Model, may enhance care quality and equity, particularly for populations with complex medical needs or those facing barriers to adequate dementia care.

Background: Black family caregivers of older adults living with dementia are at high risk for physical, spiritual, and psychosocial challenges. Culturally responsive interventions are needed to address disparities in this population. Peer mentorship may improve caregiving support for Black caregivers. The purpose of this National Institute on Aging Stage Model 1A study was to test the feasibility, acceptability, and fidelity of the Peer Support for Black Family Caregivers of Persons Living with Dementia (Pair 2 Care) intervention.

Methods: Pair 2 Care is a culturally responsive, non-judgmental, flexible, co-designed virtual peer support intervention in which former caregivers are paired as peer mentors with current caregivers for 6 months. We enrolled 11 former caregivers (mentors) and 15 current caregivers (mentees) for a total of 15 mentor-mentee pairs. Four mentors were double-paired while maintaining 1:1 mentor-mentee relationships. Mentors' and mentees' activities were monitored using surveys to ensure they were carried out as designed. Feasibility and acceptability were measured by evaluating inclusion and exclusion outcomes, recruitment, and retention data, satisfaction, and appropriateness of Pair 2 Care.

Results: All mentors and mentees were female and mostly daughters (65%) who currently or previously cared for an older adult parent who lived with dementia. Pair 2 Care was highly feasible and acceptable based on participant enrollment, mentor training completion, and mentee-mentor pairing within 10 weeks. Former caregiver mentors were retained at 90% and mentees at 93% over 6 months. On average, participants rated their overall Pair 2 Care satisfaction as very high (4.6/5).

Conclusions: Pair 2 Care may provide an innovative strategy to improve family caregiver health outcomes such as quality of life among Black caregivers of Black people living with dementia to promote health equity. As a next step, a fully powered trial is needed to determine Pair 2 Care intervention efficacy.

Trial registration: ClinicalTrials.gov: USGOV NCT06064955.

Background: While the immediate effect of exposure to severe weather from hurricanes on mortality is well documented, it is unknown whether mortality in the year following exposure to severe weather differs across older Americans with specific vulnerable characteristics. This paper sought to determine whether the association between exposure to high rain and one-year mortality differs across vulnerable subgroups of older adults.

Methods: This retrospective cohort study used Medicare claims data from fee-for-service beneficiaries aged ≥ 65 in Texas and Louisiana in the year before and after Hurricane Harvey. Historical weather data was used to construct a 4-day measure of cumulative rainfall, the primary severe weather caused by Hurricane Harvey. We identified vulnerable subgroups based on five chronic health conditions requiring regular healthcare access, and sociodemographic factors (e.g., ≥ 85 years, dual eligibility). Cox proportional hazards regression was used to adjust for covariates when estimating the association between high rain exposure and mortality up to 1 year after exposure.

Results: In adjusted models, high rain exposure was significantly associated with greater mortality risk (HR 1.03, 95% CI 1.01-1.05). Among those with chronic health conditions including Alzheimer's disease and related dementias (ADRD) (HR 1.05 [95% CI 1.03, 1.08]), diabetes (HR 1.04 [1.02, 1.07]), and chronic kidney disease (HR 1.04 [1.01, 1.06]) exposed to high rain versus those unexposed to high rain, associations with high rain were found. Higher mortality was also observed among Non-Hispanic Black (HR 1.06 [95% CI 1.01, 1.11]) and Hispanic and Latino populations (HR 1.13 [95% CI 1.08, 1.19]).

Conclusion: Exposure to high rain from Hurricane Harvey was associated with higher one-year mortality that varied across vulnerable groups. The largest associations were observed among older adults with health conditions that require regular healthcare (e.g., CKD, ADRD) and minoritized racial and ethnic groups.

This scoping review provides key trends in the use of the Delphi method applied to geriatrics and gerontology research, and documents key information that can be used in the planning of future Delphi studies, like recruitment rates, number of Delphi rounds and panelists, attrition, consensus definitions, and stakeholders engaged.

Background: Functional impairment (FI) is a key criterion for diagnosing dementia. However, subtle functional changes may occur during preclinical and prodromal phases but may not be accurately characterized. Furthermore, research linking FI to Alzheimer disease (AD) biofluid biomarkers is limited. Here we examined cross-sectional associations between cerebrospinal fluid (CSF) AD biomarkers and persistent versus transient FI in dementia-free older adults, and the longitudinal association of FI with incident dementia.

Methods: Data from 1000 participants (age 72.9 ± 7.0; 45.2% female; 62.8% MCI) from the Alzheimer's Disease Neuroimaging Initiative were analyzed. CSF biomarkers included p-tau181, Aβ42, and ptau-181/Aβ42 ratio. Three Functional Activities Questionnaire items of "preparing a hot beverage," "preparing a balanced meal," and "shopping alone" were identified by factor analysis as assessing function rather than cognition directly. Persistent-FI was operationalized as FI present at> two-thirds of pre-dementia visits. Comparator groups included Transient-FI and No-FI. Linear regression modeled the association between FI status and baseline biomarker levels, while Cox regression assessed the association between FI and incident dementia. Models adjusted for age, sex, education, APOE-ε4 status, and MMSE.

Results: Compared to No-FI, Persistent-FI was associated with lower Aβ42 (Beta = -8.93; 95% CI: -13.56 to -4.03; p < 0.001), higher p-tau181 (Beta = 10.81; 95% CI: 0.44-22.26; p = 0.041), and ptau181/Aβ42 ratio (Beta = 21.66; 95% CI: 7.02-38.31; p = 0.003). In contrast, Transient-FI showed no significant associations. APOE-ε4 carrier status was more prevalent in the Persistent-FI group compared to No-FI (p = 0.009), but not in Transient-FI (p = 0.931). Compared to No-FI, Persistent-FI had a 6.66-fold greater dementia incidence rate (95% CI: 4.98-8.91, p < 0.001), while Transient-FI had a 1.72-fold greater incidence rate (95% CI: 1.09-2.72, p = 0.021).

Conclusions: Findings extend the limited research on the association of FI with CSF AD biomarkers in dementia-free populations. Operationalizing FI-related risk by persistence enhances prognostication, identifying individuals with greater AD pathology and progression risk. This approach could enhance screening, early detection, and risk stratification, informing timely interventions before dementia onset.

Background: Rapid increase in cardiometabolic diseases in India may contribute to increased incidence of late-life cognitive impairment. This study focuses on associations between baseline cardiometabolic risk factors and subsequent decline in cognitive function among older adults in India, leveraging data from two waves (Wave 1: 2017-2020, Wave 2: 2022-2024) of the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD).

Methods: Analysis included longitudinal data of 1554 study participants. A summary measure of different cognitive functional domains was used. Cognitive decline was defined as annual decline in cognitive score ≥ 0.05 times the standard deviation of the summary score. Cardiometabolic risk was characterized using cardiovascular, metabolic, and inflammatory biomarkers. Multivariate, multinomial logistic regression analysis was used to examine the associations between cardiometabolic risk and cognitive decline.

Results: At baseline, 71.7% of the sample had elevated homocysteine levels, 44.4% had elevated blood pressure, 23% had elevated glycosylated hemoglobin (HbA1c), and 6.7% had elevated uric acid levels. Between the two waves, 34.8% experienced significant cognitive decline, while 35.6% died. Multivariate multinomial logistic regression showed significant cognitive decline was associated with elevated blood pressure [odds ratio (OR): 1.7, 95% confidence interval (CI) 1.3-2.2], elevated HbA1c (OR: 1.1, 95% CI: 1.0-1.2), being overweight (OR: 1.4, 95% CI: 1.0-2.0), and elevated uric acid level (OR: 1.2, 95% CI: 1.0-1.3). Those with hypertension had 1.5 times higher odds of mortality (95% confidence interval: 1.2-2.0), while those with diabetes mellitus or elevated pro-brain natriuretic peptide had 1.2 times (95% CI: 1.1-1.4), and 1.8 times (95% CI: 1.1-1.4) higher odds of mortality.

Conclusion: Cardiometabolic risk factors play a significant role in late-life cognitive decline and death among older Indians. These longitudinal relationships from LASI-DAD highlight potentially modifiable risk factors and inform potential prevention policies.

Background: Older adult patients with dementia experience higher rates of traumatic injury, yet little is known about long-term recovery trajectories in this population. This multi-center retrospective cohort study examined differences in long-term patient-reported outcomes after traumatic injury in older adults with and without dementia.

Study design: Secondary analysis of trauma patients ≥ 65 years with moderate or severe trauma (Injury Severity Score > 9) admitted to three Level I trauma centers and interviewed 6-12 months post-injury. Primary outcomes were loss of community living and activities of daily living (ADL) impairment. Multivariable logistic and linear regression adjusted for age, sex, educational level, and injury mechanism.

Results: Among 3210 older adult trauma patients, 291 (9.1%) had dementia before injury. Dementia patients presented with similar injury severity compared to those without dementia (mean ISS 12.1 (5.7) vs. 12.8 (6.2), p = 0.076); however, they had a greater number of new ADL limitations post-injury (1.86 (2.07) vs. 1.0 (1.55), p < 0.001). Among patients living at home pre-injury, 16.5% with dementia were discharged to institutionalized settings, compared to 4.9% without dementia (p = 0.185). Older women with dementia had significantly higher odds of losing community living status compared to older women without dementia (OR = 2.12 [1.17, 3.84], p = 0.013).

Conclusion: Older adults with dementia who sustain traumatic injuries face a substantial risk of functional deterioration and loss of independence in the critical 6-12 months post-injury. These findings highlight the need for interventions aimed at preserving autonomy and minimizing premature transitions to long-term care.

Background: Nursing home residents (NHRs) remain at high risk for severe outcomes following SARS-CoV-2 infection. Omicron descendants have dominated circulating strains, with XBB in 2023 and KP.2 strain by mid-2024, leading to immune escape and increased transmissibility. We aimed to assess the immunogenicity of one versus two prior doses of the XBB.1.5 vaccines and potential differences in the subsequent response to the KP.2 booster.

Methods: We conducted a longitudinal immunologic evaluation of 131 NHRs in Ohio and Rhode Island. Samples were collected 2-6 weeks after the first and second XBB.1.5 vaccination doses, 60 days before KP.2 vaccination, and 2-6 weeks after the KP.2 booster. We measured anti-spike and neutralizing antibody titers to both XBB.1.5 and KP.2.

Results: NHRs who received two booster doses of the XBB.1.5 vaccine developed higher peak anti-spike antibody levels (29,777 AU/mL) and neutralizing titers (7082) compared to those with only one dose (13,788 AU/mL and 1293, respectively). Over time, anti-spike antibody and neutralizing titers declined, but both remained higher in the two-dose group before receiving the KP.2 vaccine. After vaccination with XBB.1.5, neutralization against KP.2 was significantly lower than against XBB.1.5, suggesting reduced cross-reactivity and highlighting the potential for immune escape. However, KP.2 vaccination markedly boosted neutralizing titers in all participants, regardless of their prior XBB.1.5 dose history.

Conclusion: NHRs who received a two-dose regimen of the XBB.1.5 vaccine demonstrated stronger immune responses and higher pre-KP.2 titers than those who received a single dose. However, the diminished cross-protective neutralization of KP.2 highlights the variant's immune evasiveness. The KP.2 booster effectively elicited anti-KP.2 levels, supporting the continued use of updated, variant-matched boosters to protect high-risk populations such as NHRs.