Journal of the American Geriatrics Society最新文献

Background: In older people, medications with anticholinergic or sedative properties are associated with falls, frailty, and functional and cognitive impairment. These medications are often described as a subset of potentially inappropriate medications (PIMs). We examined the prevalence of anticholinergic or sedative medications to avoid in older people in France in 2023.

Methods: This cross-sectional study used anonymized data from a large electronic healthcare database, the French National Health Data System (Système National des Données de Santé, SNDS). All people aged 65 years or older from January 1, 2023, to December 31, 2023, were included in this study. Dispensations of anticholinergic and sedative medications were identified according to PIM criteria (2023 American Geriatrics Society Beers Criteria and REMEDI[e]S tool). The prevalence of anticholinergic or sedative medications was assessed for the study population and by age (65-84 and 85 or older) and living place (home and institutionalized patients) subgroups in terms of number and percentage of patients.

Results: This study included 16,938,152 patients aged 65 years or older (55% women). Among all patients, 79.8% were aged between 65 and 84 years and 20.2% were aged 85 years or older. Most patients lived at home (97.0%), and 3.0% were institutionalized. The prevalence of anticholinergic or sedative medications was 32.8% among all patients, 32.3% among 65-84 patients, and 34.8% among 85 or older patients, 32.1% among home patients, and 54.5% among institutionalized patients. The most commonly dispensed anticholinergic or sedative medications were oxazepam (5.27%), alprazolam (5.27%), zopiclone (4.85%), bromazepam (4.23%), metopimazine (2.88%), paroxetine (2.70%), nefopam (2.57%), and hydroxyzine (2.17%).

Conclusions: This study highlighted that anticholinergic and sedative medications to avoid in older people are still frequently prescribed despite the development and regular updating of PIM criteria. Future studies are needed to assess whether this has led to worsened outcomes among older adults who utilized these medications, and new initiatives should be developed to further promote deprescribing by prescribers and pharmacists.

Background: Life-space mobility can be a behavioral indicator of loneliness. This study examined the association between life-space mobility measured with motion sensors and weekly vs. annually reported loneliness.

Methods: Participants were older adults who lived alone. Passive infrared motion sensors were placed in the bathroom, bedroom, kitchen, and living room. Time spent in each room and out-of-home across the day was derived and used as the measure of life-space mobility. Participants reported via weekly questionnaires whether they felt lonely. In annual visits, the UCLA loneliness scale was administered to a subsample (n = 71), and the scores were categorized into high, moderate, and low groups. We used generalized estimating equations (GEE) to correlate life-space mobility with weekly and yearly loneliness. Repeated observations from each individual were bootstrapped for 1000 rounds to associate annual and weekly loneliness measures.

Results: We analyzed 4995 weeks of data from 139 participants (age = 78.1 ± 8.6, 74% female, 23% African Americans, 14% with MCI diagnosis). An additional hour in the bedroom in the afternoon was associated with a 21.4% increased odds (OR = 1.214, p = 0.049) of experiencing loneliness in the week. An additional hour out-of-home in the morning and in the afternoon was associated with 18.2% (OR = 0.818, p = 0.040) and 15.3% (OR = 0.847, p = 0.018) fewer odds of experiencing weekly loneliness. In the subsample with annual loneliness assessments, an additional hour out-of-home was associated with 38.1% (OR = 0.619, p = 0.006) fewer odds of being in the high UCLA loneliness group. Compared with the low UCLA group, those with high UCLA scores were five times more likely to report loneliness weekly (OR = 5.260, p = 0.0004).

Conclusions: Frequent and objective measurements of mobility combined with self-reported social wellbeing information can offer new insights into the experience of loneliness and provide opportunities for timely interventions.

Cancer and aging are inextricably linked, and older adults are a significant proportion of those diagnosed, treated, and living with and beyond a cancer diagnosis. Several large prospective studies have enhanced our understanding of how to improve the assessment, treatment, and outcomes of older adults with cancer starting therapy. This article summarizes three recent high-impact trials that produced practice-changing implications for the management of older adults with cancer that led to guideline updates. The key findings from these trials highlight that geriatric assessment-guided interventions in older adults with cancer: (1) facilitated higher rates of chemotherapy completion at planned doses with less modification among patients, (2) reduced grade 3 hematologic and non-hematologic toxicity during treatment delivery among patients of all stages of cancer receiving chemotherapy, and (3) influenced treatment decisions among advanced cancer patients receiving supportive care leading to reduced toxicity through reduced intensity of therapy without compromise of survival.

Background: Falls are a leading cause of fatal and non-fatal injuries for older adults in the United States with significant consequences for health, mobility, and independence. Understanding what barriers influence older adult engagement is essential to facilitating uptake of evidence-based interventions to prevent falls and fall-related injuries.

Methods: Semi-structured focus groups were held with 59 participants in three stakeholder groups: (1) community-dwelling older adults, (2) caregivers of older adults, and (3) healthcare providers who engage with older adults. Themes that emerged were categorized by the stakeholder group that identified them and evaluated using the social-ecological model and assigned to a level within that framework (individual, interpersonal, community, or societal).

Results: Barriers identified to older adult participation in fall prevention activities had the most themes emerge at the individual-level, which included denial; discomfort avoidance; fear of being a burden; pride; and self-perception. Interpersonal-level themes were the normalization of falls; healthcare provider attitude, behavior, and practices; social support; and well-intentioned family. Finally, the themes observed at the community level included cost; lack of education and awareness; limited healthcare resources; lack of transportation; and healthcare system timing and weaknesses. Some themes were identified across all stakeholder types, while others were recognized by only one or two. The only theme at the societal level was age-related stigma.

Conclusions: These findings demonstrate a variety of barriers across stakeholder types and provide valuable insights for developing strategies to effectively promote older adult participation in fall prevention activities to reduce falls and enhance healthy aging.

Background: With the growing number of Medicare beneficiaries attributed to Accountable Care Organizations (ACO) or enrolled in Medicare Advantage (MA) and their financial incentives to lower the cost of the cared patients, it is essential to understand how these alternative payment models affect post-acute outcomes among beneficiaries, with or without dementia diagnoses. In this study, we examined the quality of skilled nursing facilities (SNFs) that beneficiaries entered after hospital discharge under different payment models.

Study participants: Medicare beneficiaries who were discharged from hospitals and admitted to SNFs between 2013 and 2018.

Key measures: The exposure variable was a payment indicator, including ACO, MA, or non-ACO traditional Medicare (TM) fee-for-service. The dependent variable was high overall quality SNF, defined as with at least 4-star rating in the CMS Nursing Home Care Compare.

Analytic plan: We examined the payer distribution by dementia diagnosis using ZIP Code Tabulation Areas (ZCTAs) fixed effects and adjusted for age, gender, and race. We also estimated the probabilities of entering high-quality SNF as a function of payer status and dementia diagnosis each year using hospital and ZCTA fixed effects and accounting for beneficiary-level covariates.

Results: Among SNF admissions from 2013 to 2018, the share of ACO-attributed beneficiaries increased from 7.6% to 20.2%, MA enrollees increased from 25.2% to 32.8%, and non-ACO-attributed TM enrollees decreased from 67.2% to 47.3%. Consistently, ACO-attributed beneficiaries were the most likely, while MA enrollees were the least likely to enter high-quality SNFs, regardless of dementia diagnosis.

Conclusions: Our findings highlight significant differences in access to high-quality SNFs across Medicare payment models, with ACO-attributed beneficiaries consistently experiencing better access than their MA or traditional Medicare counterparts, regardless of dementia diagnosis. These results underscore the need for further investigation into how payment models influence care quality and access, particularly for vulnerable populations.

Background: Frailty screening instruments are increasingly studied as risk predictors for adverse postoperative outcomes. However, because of the lack of comparative research, it is unclear which screening instrument performs best. This study therefore compared the diagnostic accuracy of seven frailty screening instruments for adverse postoperative outcomes in patients aged ≥70 years undergoing colorectal surgery.

Methods: We conducted a prospective cohort study at an academic hospital, examining the Fried and Robinson frailty criteria, the Edmonton Frail Scale, the Rockwood Clinical Frailty Scale, the Modified Frailty Index, the FRAIL questionnaire, and the Geriatric 8 for predicting postoperative complications with a Clavien-Dindo (CD) severity grade ≥2. Secondary outcomes were complications with CD severity grade ≥3, prolonged length of stay, increased care level after discharge, and functional decline in basic or instrumental activities of daily living up to 1 month after surgery.

Results: The study included 172 consecutive patients. Positive frailty screening ranged from 13.4% to 73.8%. CD≥2 complications were present in 37.8% of patients. At the original cutoffs, most instruments had a high specificity (76.7%-92.4%) at the expense of sensitivity (21.5%-38.5%) with a moderate negative predictive value (NPV) for predicting CD≥2 complications. The Geriatric 8 showed the opposite pattern (sensitivity 81.5%-specificity 30.8%) and a high NPV. Diagnostic accuracy was moderate for all screening instruments, since the areas under the receiver operating characteristic curve did not exceed 0.61 across instruments. Altering the cutoff scores did not yield sufficient improvement. Comparable results were found for the secondary outcomes.

Conclusions: Comparing the predictive value of the screening instruments showed that frailty screening cannot be used in isolation as risk predictor for adverse postoperative outcomes. Further research should focus on a two-step approach in which additional diagnosis of frailty by means of comprehensive geriatric assessment is included in the prediction model.

Introduction: The COVID-19 pandemic accelerated the shift from in-person to virtual recruitment, prompting residency and fellowship programs to adopt innovative strategies, such as leveraging social media platforms to attract applicants and enhance visibility. Our aim was to identify and describe the presence of U.S. geriatric medicine fellowship programs on X.

Methods: We identified all U.S. geriatric medicine fellowship programs using FREIDA, and then located their X accounts through a stepwise process. Data were collected on account creation, number of followers, posts, and activity level, with an analysis of the last 100 posts from the most active accounts. Descriptive statistics were used to analyze the data.

Results: Among the 147 geriatric medicine fellowship programs identified, 38 (25.9%) had an X account. The majority of accounts were created after the start of the pandemic, reflecting likely the adaptation to virtual recruitment processes. Only a few accounts generated the majority of posts and followers. The accounts primarily posted or reposted educational content, research highlights, and promotional material.

Conclusion: The use of X by geriatric medicine programs is still significantly underutilized, with only one-fourth of them having an account. Half of the accounts were created after the COVID-19 pandemic began. Programs should focus on building a robust social media presence to increase their visibility, especially as virtual interviews have become a permanent part of recruitment.