Journal of the American Geriatrics Society最新文献

Background: The growing older adult population in the United States creates a demand for professionals in the field of aging, though this remains a space that is overlooked by young adults beginning their career exploration. Perfect Pair is a nonprofit organization that connects older adults with college students to foster intergenerational connections. In this retrospective study, we assessed the impact that participation in Perfect Pair's programming had on college students' interest in working in the aging field as a future career.

Participants and setting: Study participants included current and past college student participants of the Perfect Pair program across 17 college chapters.

Methods: We administered a retrospective survey that assessed participants' attitudes toward a career in aging. Survey questions included pre-post and post-program questions assessed by a Likert scale, and data was analyzed by non-parametric statistical analysis.

Results: The survey was completed by 100 participants, a response rate of 10.1%. We found statistically significant differences between general members and students who engaged more with the program, such as "matched" members who met weekly with an older adult and executive board members who led their college chapter. Members that were more involved showed higher perceived preparedness to work with older adults in the future (p < 0.001) and engagement with issues associated with aging (p = 0.002). Overall, all members of the program reported an increase in their interest in working with older adults after participating in Perfect Pair (p < 0.001). This is corroborated by narrative responses, where students share excitement to pursue a career in aging.

Conclusion: Perfect Pair encourages and prepares college students to pursue a career in aging and engages them in issues associated with aging. This has strong implications for future intergenerational programming that aims to promote workforce development in the aging space.

Background: In 2015, the Netherlands implemented long-term care (LTC) reforms to promote aging-in-place, potentially impacting nursing home (NH) access for older individuals with dementia. This study examines how the reform affected NH admission rates and waiting list prevalence for this population.

Methods: We performed interrupted time series analyses to evaluate trends in NH admissions (2011-2019, Statistics Netherlands) and waiting list prevalence (2013-2018, National Healthcare Institute) before and after the 2015 LTC reform. Incidence rate ratios (IRR) were calculated for monthly NH admission rates and waiting list prevalence.

Results: Among 270,706 older people with dementia, the reform was negatively associated with NH admission rates (IRR 0.610 [0.547-0.681]), halting the pre-reform decline and stabilizing the post-reform trend (IRR 1.001 [0.999-1.002]). The reform was positively associated with NH waiting list prevalence (IRR 1.159 [1.048-1.282]).

Conclusion: Among older Dutch people with dementia, the 2015 Dutch LTC reform was associated with fewer NH admissions and longer waiting lists. While stabilization of the NH admissions may reflect prioritization of persons with dementia within stricter eligibility criteria, the concurrent rise in waiting list prevalence suggests that institutional capacity did not keep pace with persistent need. As a result, many older people with dementia remain longer in the community, raising concerns regarding their health and safety as well as the burden on their informal caregivers.

Background: The COVID-19 pandemic presented unprecedented challenges to hospital system and critical care resources, leading to significant changes to operations and patient care. There are limited national data on these changes and instances of unsanctioned deviations from patient care, yet understanding the COVID response is key to future preparedness efforts. We sought to understand how hospitals and states navigated scarcity during COVID-19, particularly in the absence of a declaration of crisis standards of care.

Methods: Between February 2022 and September 2022 we conducted 34 interviews with 36 leaders of U.S. states' COVID-19 planning and response efforts. Interviews were transcribed verbatim and verified. We analyzed interviews using iterative inductive thematic analysis for descriptions of resource scarcity and changes to policies and procedures to prevent rationing lifesaving care.

Results: Nearly all participants described equipment and personnel scarcity in their home institution or state during COVID-19. Hospitals across regions and states developed formal and informal coordination processes for load and resource sharing in response to influxes of high-acuity patients, avoiding formal rationing of lifesaving resources in many regions. Participants also described unsanctioned patient triage, early discharge, and patients counseled to accept less aggressive care (e.g., premature transition to hospice) in states that had not declared crisis standards of care.

Conclusions: Extending limited resources and inter-institutional collaboration helped avoid formal rationing. Yet, patient care was unquestionably impacted due to scarcity, both real and perceived. Reports of using hospital triage protocols to deny patients lifesaving care outside of formally recognized crisis conditions and attempts to nudge patients to accept less-resource-intensive care are concerning. This may have had disproportionate effects on older adults, individuals with disabilities, and racial and ethnic minoritized groups. To avoid unsanctioned deviations from standard practice in future health emergencies, we recommend that transparent and equitable triage protocols are implemented with robust oversight.

Background: With an aging population globally, the number of older adults living with chronic diseases has increased. There is limited understanding of how spirituality and religiosity are pivotal for resilience among older people dealing with the burden of managing chronic illnesses.

Objective: To systematically identify, synthesize, and critically appraise the current evidence on how spirituality and religiosity serve as sources of resilience among older adults with chronic illness.

Methods: This review was registered with PROSPERO (CRD420250645463). Several online databases (PubMed, MEDLINE (Ovid), APA PsycINFO, and CINAHL) were searched from database inception to March 2025. Included articles were peer-reviewed, published in English, had adults aged ≥ 60 years with chronic conditions, and reported quantitative or qualitative findings on participant experiences and influence of spirituality and religiosity. The methodological quality of each included study was assessed. The qualitative and quantitative findings were analyzed separately, followed by an integrated analysis.

Results: Twenty-six articles (21 quantitative and 5 qualitative) were included. Most of the studies were conducted in the United States and among predominantly Christian populations. Varying measures were utilized in assessing spirituality and religiosity. From the integrative synthesis of both studies, spirituality and religiosity served as a source of resilience for older adults through four overarching domains: (i) Spiritual connection as a source of strength; (ii) Meaning, purpose, and life satisfaction through spiritual beliefs; (iii) Combining spirituality and medical care; and (iv) Faith communities as social support networks.

Conclusion: Spirituality and religiosity are important, yet underutilized, resources that promote resilience in older adults with chronic illness. Greater clinical attention to spiritual assessment, integration into chronic disease care, and referral for clerical intervention when indicated may enhance patient-centered outcomes. Future research should increase representation of diverse religious perspectives, ensure uniformity in assessing spirituality/religiosity to enhance comparability across studies, and explore clinician preparedness to deliver holistic care.

Background: Medication use complexity is associated with non-adherence, hospitalizations, and lower quality of life. It is most frequently measured with the Medication Regimen Complexity Index (MRCI). This instrument estimates the complexity of a patient's medication regimen, taking into account the pharmaceutical dosage forms and routes, dosage frequency, and instructions for use. This instrument was, however, developed without patient experience data and may overlook patient perspectives. Therefore, this study aimed to identify older patients' perspectives on medication use complexity.

Methods: This qualitative study used semi-structured interviews among patients aged ≥ 70 years using ≥ 5 chronic medications, recruited at community pharmacies and a geriatric outpatient clinic. After medication reconciliation, open-ended questions about the patient's medication use and four hypothetical medication regimens with similar MRCI scores but different schemes were discussed. Interviews were transcribed verbatim and coded independently by two researchers. Inductive and deductive thematic analysis using NVivo was applied to explore themes influencing medication use complexity according to patients.

Results: Sixteen patients were included (median age, 76; 56% female; median number of medications including OTC, 14). Four themes were identified, of which three are medication-related themes: medication characteristics, preparation for administration, and administration regimen. Factors that reduced medication use complexity included identification by medication appearance, use of medication aids or multidose drug dispensing systems, and development of routines. Factors that increased complexity included alterations in medication appearance or routine. The fourth theme was user-related and focused on the complexity of medication use in the context of an individual patient's attitudes and beliefs regarding medication and healthcare.

Conclusion: This study identified many themes that can influence medication use complexity for older patients, including new themes beyond those measured by the MRCI. Individualized assessments may better address patient-specific challenges in medication use, ultimately enhancing the potential effectiveness of complexity-reducing interventions.

Advanced chronic diseases, or multicomplexity in older adults presents unique challenges. Transthyretin cardiac amyloidosis (ATTR-CA) is one such scenario where heart failure is a common presentation, and management remains challenging. We describe the challenges involved in the diagnosis of ATTR-CA in older adults, which has implications on treatment options. We discuss the application of comprehensive geriatric assessment (CGA) and shared decision making (SDM) in the context of these challenges. Based on geriatric medicine principles, an innovative framework for applying SDM in ATTR-CA patients is proposed, including consideration of the patient priorities care approach. The proposed framework emphasizes assessing functionality, frailty, and life expectancy to help categorize risk. This framework can be applied in various advanced chronic diseases or multicomplexity. Based on risk categorization, treatment burden, and alignment with values and preferences, management pathways are suggested for each risk category. Incorporating CGA and SDM, the proposed framework supports patient-centered care, ensuring that clinical recommendations are tailored to each older adult's unique needs and goals. In ATTR-CA, a collaboration between cardiology and geriatric medicine provides significant value in managing older adults. The need to prevent age-related bias in clinical decision-making exists across all health conditions, and the proposed framework allows for a thorough evaluation of multimorbidity, frailty, disability, and patient preferences. While ATTR-CA is used as a prototype, this integrated approach can be applied across all health conditions and is essential for delivering holistic care, improving communication, and aligning treatment plans with patient values.

Background: Disturbances in sleep-wake homeostasis (Process S) and circadian rhythm (Process C) are common precipitants of delirium, especially among older hospitalized adults. We conducted a systematic review and meta-analysis to test whether four sleep-modulation agents-melatonin, ramelteon, suvorexant, and lemborexant-lower delirium incidence or shorten its duration in hospitalized patients, with stratified analyses by drug class, age, and surgical status.

Methods: We systematically searched PubMed, Embase, and CENTRAL through March 2025. We included randomized controlled trials (RCTs) and observational studies assessing delirium prevention with melatonin, ramelteon, suvorexant, and lemborexant in hospitalized adults (≥ 18 years), compared to placebo or standard care. Data synthesis was performed separately for RCTs and observational studies using random-effects models. Meta-regression was used to explore effect modifiers. Risk of bias was assessed using RoB2/ROBINS-I tools. Certainty of evidence was graded using the GRADE assessment.

Results: Thirty-seven studies (27 RCTs, 10 observational) comprising 7845 patients were included. Among RCTs, melatonin (RR 0.94; 95% CI 0.72-1.22) and ramelteon (RR 0.63; 95% CI 0.39-1.03) showed no significant effect on delirium incidence, whereas orexin receptor antagonists were associated with a lower risk (RR 0.55; 95% CI 0.35-0.87). Evidence for a class difference was inconsistent across analytic approaches: a subgroup heterogeneity test suggested differential effects (interaction-p = 0.09), but the meta-regression found no between-class difference (p = 0.14). No other specific test for subgroup differences was statistically significant in RCTs. Meta-regression confirmed patient setting as a significant modifier in observational studies, but not in RCTs.

Conclusion: Sleep-wake pharmacotherapies may reduce incident delirium in hospitalized adults. In randomized trials, melatonin and ramelteon did not significantly reduce delirium incidence, whereas dual orexin receptor antagonists showed a possible benefit, but the meta-regression did not demonstrate a reliable between-class difference, and the evidence remains limited. Adequately powered randomized trials across inpatient settings are needed to clarify any true differences and define clinical relevance.