Journal of the American Geriatrics Society最新文献

Objective: This study investigated the relationship between social engagement and epigenetic age acceleration (EAA) in older adults in the United States.

Methods: Participants were selected from the Health and Retirement Study (HRS). Social engagement was assessed using the 15-item social engagement scale. Thirteen epigenetic clocks based on DNA methylation data were obtained from the 2016 HRS Venous Blood Study. EAA was calculated for each clock by regressing the residual clock values on chronological age. The association between various social activities and 13 EAA was analyzed using multiple linear regression models.

Results: The average age of participants was 69.9 years, with 41.5% being male. In the fully adjusted model, more frequent engagement in social activities was linked to slower EAA in the Zhang, GrimAge, Weidner, and VidalBralo clocks. Specifically, more frequent community activities were significantly associated with slower EAA in the GrimAge clock after FDR correction. Unexpectedly, more cognitive activities were significantly associated with faster DunedinPoAm38. More physical activities were associated with slower EAA in the Zhang, PhenoAge, GrimAge, and DunedinPoAm38 clocks after FDR correction. Participants with consistent nonparticipation in overall social activities were associated with faster EAA in the Zhang clock.

Conclusion: The findings indicate that active engagement in social activities, encompassing community, cognitive, home-based creative, and physical activities, is associated with slower EAA, marked by several clocks in older adults, providing evidence for the benefit of social activities for health and offering valuable insights for promoting "Active Aging" initiatives.

Introduction: The Age-Friendly Health Systems (AFHS) initiative aims to improve care for older adults through the "4Ms" framework: What Matters, Medication, Mentation, and Mobility. Despite national momentum and evidence within individual M domains, limited evidence guides outpatient AFHS implementation of the 4Ms as a set. The objective of this systematic review was to summarize the evidence of the impact of AFHS implementation in outpatient settings.

Methods: We searched Medline, EMBASE, CINAHL, Cochrane, and clinicaltrials.gov from 2015 to November 22, 2024. Comparative studies that implemented all 4Ms in outpatient settings were included. Risk of bias was assessed using questions derived from the Cochrane Risk of Bias tool for RCTs and the Risk of Bias In Non-randomized Studies-of Intervention tool for other study designs, and results were summarized using GRADE methodology.

Results: Twelve US-based studies met inclusion criteria. Overall, implementing AFHS interventions was associated with improved process measures across all 4Ms, though the effectiveness of specific implementation strategies could not be determined. Outcome and structural measures were infrequently reported. Study heterogeneity and poor reporting limited generalizability.

Discussion: Findings underscore the urgent need for standardized, outcomes-oriented AFHS measurement before policy and payment reforms, such as CMS's Age-Friendly Hospital Measure, are expanded into outpatient settings. To advance meaningful transformation, future research must prioritize implementation fidelity, outcome evaluation, and measures that reflect older adults' values and lived experiences.

Background: Peripheral nerve blocks (PNBs) are increasingly recommended as analgesia for hip fractures. Their association with outcomes beyond the immediate pharmacological effects remains unclear. This study examined the association between the use of PNBs and the number of days alive and at home after hip fracture surgery among Medicare beneficiaries.

Methods: To examine the association between PNBs and long-term outcomes in older adults undergoing surgical fixation for hip fractures, we analyzed Medicare data from 2010 to 2018. Patients who received PNBs (exposure group) (n = 5701) were compared to those who did not receive a PNB (comparator group) using 1:1 propensity score matching, creating 5700 matched pairs. The primary outcome was days alive and at home within 120 days of admission. Secondary outcomes included days alive and at home within 365 days and 1-year mortality. A subgroup analysis of propensity score matched patients from 2018 examined outcomes when techniques had improved and use had increased.

Results: In the primary analysis (2010-2018), no significant differences were observed between groups for days alive and at home within 120 days (68.1 vs. 68.4 days; p = 0.64), days alive and at home within 365 days (244.5 vs. 240.7 days; p = 0.12), or 1-year mortality (21% vs. 22%; p = 0.22). In 2017 and 2018, when peripheral nerve block use increased, patients who received PNBs spent more days alive and at home within 365 days than patients who did not receive peripheral nerve blocks (248.6 vs. 241.6 days; p = 0.04).

Conclusion: PNBs showed no association with improved outcomes across the 2010-2018 study period. Analysis of 2017 and 2018 revealed more days alive and at home within 365 days and a trend toward reduced mortality among patients who received PNBs. PNBs may provide benefits beyond their immediate analgesic effects, potentially improving long-term outcomes.

Background: Advance care planning (ACP) supports seriously ill individuals in identifying and communicating their values and preferences for future care. However, disparities in ACP engagement persist, particularly among African American older adults. This study examined racial differences and predictors of readiness to engage in ACP among seriously ill African American and White older adults.

Methods: This cross-sectional analysis used baseline data from the EQUAL ACP cluster randomized trial testing two ACP interventions. Participants included 792 community-dwelling, non-Hispanic African American (n = 428) and White (n = 364) adults aged 65 and older with serious illness or multimorbidity, recruited from 10 primary care clinics across five Southern U.S. states. Readiness to engage in ACP was measured using a four-item scale assessing willingness to discuss and document care preferences. Predictor variables included religiosity, beliefs about death and dying, perceived discrimination and trust, provider communication, treatment preferences, and self-rated health. Mixed-effects regression models were used to examine predictors of ACP readiness in the overall sample and racial subgroups.

Results: Overall ACP readiness did not significantly differ by race. Across racial groups, greater comfort discussing death was associated with greater ACP readiness. Among African American participants, frequent religious service attendance was associated with higher ACP readiness (mean difference = 0.28; 95% CI: 0.08-0.47). Among White participants, a preference for pain relief over life extension in their current health status was associated with higher readiness (mean difference = 0.25; 95% CI: 0.05-0.45). Trust in providers, experiences of discrimination, and ratings of provider communication were not significantly associated with ACP readiness.

Conclusion: Although mean readiness scores were similar, predictors varied by race. Religious attendance may facilitate ACP readiness among African American patients, while comfort-focused treatment preferences appear more influential among White patients. Culturally tailored strategies are needed to equitably support ACP engagement among older adults.

Background: The Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) is a nationally representative study of cognitive aging and dementia in older adults. This study aims to investigate the longitudinal relationship between neurodegenerative biomarkers such as amyloid-beta (Aβ) 42/40 ratio, glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), phosphorylated tau (pTau), and total tau, and cognitive decline among older adults in India.

Methods: Data from 1181 participants (aged ≥ 60 years) who completed both Wave 1 (2017-2019) and Wave 2 (2022-2024) of LASI-DAD with biomarker data were analyzed. General cognitive factor score was used as a comprehensive measure of cognitive performance, and biomarkers including NFL, Aβ42/Aβ40 ratio, GFAP, pTau, and total Tau were measured using Simoa technology. Generalized Estimating Equations (GEE) were used to analyze the association between change in cognition and biomarkers, adjusting for demographic covariates and comorbidities.

Results: The median age at Wave 1 was 66 years (IQR: 63-71), with 51.9% female participants and 64.4% from rural areas. In Model 3, adjusted for age, sex, education, habitat, and comorbidities, higher GFAP levels (β = -1.68 × 10^-3, p = 0.005) and higher NfL (β = -1.94 × 10^-3, p = 0.002) were associated with greater cognitive decline over time. Domain-specific analysis showed GFAP and NfL were linked to language and memory decline; Aβ42/Aβ40 ratio was associated with language decline.

Conclusions: Our findings suggest that biomarkers, including GFAP and NfL, are associated with cognitive decline over time in older adults in India. These biomarkers may serve as important indicators for monitoring cognitive aging and dementia risk in this population.

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Background: The period following hospital discharge marks a precarious transition for older adults across medical, functional, and social domains. Paramedic-led mobile integrated health (MIH) programs offer a promising approach to bridging gaps in care, though their effectiveness in transitional care remains poorly characterized. The objective of this study was to evaluate the association of the Paramedic Assisted Community Evaluation (after) Discharge (PACED) intervention with 30-day rehospitalization rates among frail older adults.

Methods: In this prospective observational study, the clinical team offered older adults discharged from an urban academic medical center a paramedic-delivered home visit within 72 h. Patients who lived outside the program's geographical catchment area, did not have a system-affiliated primary care doctor, or who declined visits served as a comparator group to create a natural experiment. The primary outcome was 30-day rehospitalization. Secondary outcomes included 30-day emergency department (ED) utilization without admission. The characteristics of the sample and the content of the PACED visits for enrolled patients were presented descriptively. Modified Poisson regressions were used to estimate relative risks (RR) for 30-day rehospitalization and ED utilization, adjusting for demographics, comorbidities, frailty, and prior healthcare use with 95% confidence intervals (CIs).

Results: Of 297 subjects, 190 received the PACED intervention (median age 82.7, 66.8% female) and 107 served as comparators (median age 81.3, 58.0% female). Thirty-day rehospitalization was lower among PACED participants (12.6% vs. 21.5%, adjusted RR 0.45, 95% CI: 0.26-0.77, p = 0.003), and they experienced fewer 30-day ED visits (11.5% vs. 18.7%, adjusted RR 0.58, 95% CI: 0.33-0.98, p = 0.05).

Conclusions: An in-home mobile integrated health (MIH) transitional care program for frail older adults after hospital discharge was associated with lower 30-day readmission rates. These findings highlight MIH as a promising model to support aging in place and suggest its potential value for adoption within age-friendly health systems.

Background: Cognitive aging and dementia are major public health challenges in India's aging population. This study examines associations between cognition and neurodegenerative biomarkers among community-dwelling older adults using data from the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) Wave 2.

Methods: LASI-DAD Wave 2 included 4635 participants aged ≥ 60 years. Cognitive assessments covered memory, executive function, language, and visuospatial abilities. Age-, sex-, and education-adjusted cut-offs identified low cognitive performance. Blood biomarkers, including total tau, phosphorylated tau-181 (pTau-181), neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and β-amyloid (Aβ42/Aβ40 ratio) were collected and log-transformed. Generalized linear model (GLM) adjusted for demographic and clinical variables were used to examine the associations between biomarker levels and poor cognitive performance.

Results: Median participant age was 70 years (IQR: 66-76); 54.6% were female. Poor cognitive performance was present in 828 (27.6%) participants. Higher NfL (Median 27.2 vs. 21.8 pg/mL, p < 0.001), GFAP (Median 120.4 vs. 102.9 pg/mL, p < 0.001) and p-Tau 181 (Median 37.5 vs. 35.4, p = 0.003) were associated with poor cognition. In GLM, NfL (RR: 1.411, 95% CI 1.162-1.714, p = 0.001), GFAP (RR: 1.425, 95% CI 1.147-1.769, p = 0.003) were associated with poor cognition, while Aβ42/Aβ40 ratio total tau and p-Tau 181 were not (adjusted for age, sex, body mass index, serum creatinine, hypertension, diabetes, heart disease and stroke). Additionally, higher NfL and GFAP were associated with poor performance in most cognitive domains, except recognition memory. Higher Aβ42/Aβ40 ratio with poor recognition memory, higher p-Tau 181 with lower orientation scores, and lower total tau with lower recognition memory and visuospatial score.

Conclusion: Among older Indian adults, elevated NfL and GFAP levels were strongly associated with poor cognitive performance. These biomarkers could aid future dementia screening and prognostication efforts. Longitudinal studies are needed to validate their role in large-scale screening programs.