Journal of the American Geriatrics Society最新文献

Cannabis use in older adults may have a broad range of effects in older adults impacting Mind, Mobility, Medications, Multi-complexity, and what Matters Most.

Background: In older adults with osteoarthritis (OA) and hypertension (HTN), analgesic use may elevate blood pressure and cardiovascular risk. Whether comorbid HTN influences initial analgesic choice remains unclear; we examined initial analgesic use in Medicare beneficiaries with incident OA, comparing those with and without HTN.

Methods: We conducted a retrospective cohort study using 2011-2022 nationally representative Medicare beneficiaries (≥ 65 years) with incident OA who initiated an analgesic within 30 days of diagnosis and had continuous enrollment for ≥ 365 days prior through ≥ 30 days post-index. Patients with baseline HTN were classified as OA + HTN; others as OA-only. We assessed overall analgesic trends using the Cochran-Armitage test and evaluated differences by HTN status using logistic regression with year as an interaction term. For stratified analyses by joint type, we applied weighted logistic regression.

Results: Among 179,033 beneficiaries (mean age 75 ± 7.3 years; 62.7% women; 80.7% White), 57.1% had baseline HTN. Overall, the most commonly initiated analgesic classes were intra-articular injections (30.3%), and oral NSAIDs only (28.2%). Notable changes from 2012 to 2022 were increase in topical NSAIDs use (3.1%-5.7%) and decrease in opioid combination use (25.4%-13.9%), with no significant trend differences by HTN status. In joint-specific analyses, OA + HTN versus OA-only showed no differences in odds of initiating oral opioids (OR: 0.97, 95% CI: 0.92-1.03), intra-articular injections (OR: 1.01, 95% CI: 0.96-1.07) or topical NSAIDs (OR: 0.88, 95% CI: 0.78-1.01) versus oral NSAIDs.

Conclusion: Baseline HTN did not influence the choice of initial analgesic in incident OA patients. Safer, evidence-based alternatives are needed for older adults with comorbid HTN.

Background: Days spent at home have been identified as a clinically meaningful patient-centered outcome, especially in older persons. Serious health events in this population have pronounced deleterious effects on functional well-being. Our objective was to determine whether and how days spent at home differ in the 6 months after specific types of serious health events.

Methods: From a prospective longitudinal study of 754 community-living persons, aged 70 years or older, we calculated the number of days at home as 180 minus the number of overnight days in a health care facility and days not alive. The occurrence of serious health events, including critical illness, major surgery (non-elective and elective), and other hospitalizations, were ascertained primarily through linkages with Medicare data.

Results: Days at home were diminished in the 180 days after each type of serious health event. Relative to a reference group, the adjusted rate ratios (95% CI), representing the mean number of days at home as a proportion, were 0.70 (0.64-0.77) for critical illness, 0.70 (0.64-0.76) for non-elective major surgery, 0.87 (0.84-0.91) for elective major surgery, and 0.86 (0.83-0.89) for other hospitalization. The corresponding absolute reductions (95% CI) in mean days at home were 48.6 (37.9-59.3), 50.1 (39.7-60.5), 20.7 (14.3-27.0), and 22.9 (17.9-28.0), respectively. Of the time not spent at home, days in a nursing facility were most common except for critical illness, which had the highest mortality; days in a hospice facility were least common; and days in a hospital differed relatively little across the groups.

Conclusion: Days spent at home are considerably diminished after serious health events. These findings may help guide older persons, their families, and physicians about what to expect after hospital discharge for different types of serious health events, and they suggest potential strategies that may optimize time spent at home.

Background: Evidence supporting the use of statins for primary prevention of cardiovascular disease (CVD) in individuals aged ≥ 80 years remains limited. This study aimed to evaluate the long-term clinical benefits and safety of statins for primary prevention in patients aged 80 years and older.

Methods: We conducted a population-based retrospective cohort study using electronic medical records and pharmacy dispensing data from Clalit Health Services in Israel, covering the period from January 2015 to December 2020. Patients aged ≥ 80 years without prior CVD who were persistent statin users were compared with similar patients not receiving statins. Exclusions included prior CVD, dialysis, or death within 1 year of follow-up. Outcomes included all-cause mortality, new coronary events, myopathy, dementia, and diabetes mellitus. Cox proportional hazards models, adjusted for potential confounders, were used to assess the association between statin use and clinical outcomes.

Results: Among 15,745 patients (mean age 84.5 years; 66% female), 8413 were statin users. Over a 4-year mean follow-up, statin use was associated with a 31% reduction in mortality (HR 0.69; 95% CI: 0.34-0.74; p < 0.001) and a 20% reduction in new coronary events (HR 0.80; 95% CI: 0.68-0.94; p = 0.008). No significant differences were observed in the incidence of myopathy, diabetes, or dementia. Benefits were not observed in patients who discontinued statins before age 80.

Conclusions: In patients aged ≥ 80 years, statin therapy for primary prevention was associated with reduced all-cause mortality and coronary morbidity, without increased risk of adverse events. Early discontinuation diminished these benefits.

Geriatricians have struggled to describe a complex and sometimes ambiguous professional identity. Unlike other medical specialties anchored in discrete organ systems, diagnostic and interventional technologies, or clearly defined clinical settings, geriatric medicine encompasses the care of a heterogeneous population of older adults with widely varying clinical needs, priorities, and trajectories relevant to function, multimorbidity, and complexity. This Special Article examines four distinct but overlapping perspectives on geriatrician identity-the complexivist, the healthful longevitist, the syndromist, and the contextualist. The complexivist perspective emphasizes expertise in managing multimorbidity, frailty, and the interplay of medical, functional, cognitive, and social challenges. The healthful longevitist reframes the discipline around extending healthspan, promoting resilience, and supporting healthy aging. The syndromist reflects a trend toward syndrome-specific specialization, such as "brain health," in some respects, paralleling subspecialty evolution in other fields. The contextualist highlights geriatricians who center their work within specific care settings or models of care, including home-based primary care, skilled nursing facilities, PACE programs, ACE units, co-management models of care with other specialties, and Age-Friendly Health Systems. While each perspective offers valuable insights, none alone fully captures the breadth of geriatric medicine or resolves long-standing tensions around recognition, prestige, and the profession's future. Debates over identity should not be viewed as divisive, but rather as essential to strengthening the profession. Continued examination of geriatrician identity is critical to ensuring that the specialty remains relevant, valued, and morally ambitious in the face of an aging population, major advances in geroscience and technology, and an evolving healthcare system.