Journal of the American Geriatrics Society最新文献

Background: Sensorimotor impairments, including sensory (vision and hearing) and motor (standing balance, gait, chair stands, grip strength) deficits, are prevalent in older adults and are associated with an increased risk of dementia. Understanding the individual and combined effects of these impairments on dementia risk may enhance early detection and preventive strategies. We examined the association between baseline sensory difficulties and motor impairments, individually and collectively, with dementia over up to 11 years.

Methods: We used data from the National Health and Aging Trends Study (NHATS), a nationally representative study of US community-dwelling Medicare beneficiaries aged ≥ 65 years. Participants cognitively unimpaired at baseline in 2011 were followed annually through 2022. Baseline exposures included self-reported sensory difficulties (vision, hearing) and objectively measured motor impairments (standing balance, gait speed, chair stand, grip strength). The primary outcome was incident dementia, assessed annually based on NHATS consensus procedures. Survey-weighted Cox proportional hazards models assessed the association between each impairment and number of impairments and incident dementia, adjusting for demographics and clinical conditions.

Results: The analytic sample included 3847 participants (weighted average age 73.9 (95% CI, 73.7-74.1) years, 56% women). Over an average follow-up of 5.2 years, vision difficulty (HR = 1.34; 95% CI, 1.13-1.60), standing balance impairment (HR = 1.23; 95% CI, 1.10-1.39), slow gait speed (HR = 1.49; 95% CI, 1.34-1.67), impaired chair stand performance (HR = 1.31; 95% CI, 1.18-1.47), and weak grip strength (HR = 1.31; 95% CI, 1.13-1.51) were each independently associated with higher dementia risk. Compared to no impairments, dementia risk increased significantly with three or more sensorimotor impairments (HR = 1.44 to 1.96).

Conclusions: In this nationally representative cohort, vision difficulty and motor impairments were independently associated with increased dementia risk over up to 11 years. The presence of multiple sensory difficulties and motor impairments substantially increased the risk of dementia, emphasizing the importance of their early detection and management to reduce dementia risk.

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: Falls are a leading cause of injury and death in older adults (age ≥ 65 years). The onset of the COVID-19 pandemic in the United States (US) marked a transition into a period of greater social isolation to curb the spread of disease. The pandemic additionally greatly strained the US healthcare system. As a result, older adults participated in less physical activity and experienced greater hesitancy to seek medical care in an effort to minimize their risk of infection. They additionally may have experienced delays and incomplete access to such care. It is possible that such changes worsened frailty and increased vulnerability to falls and fall-related sequelae among this population. We hypothesized that the COVID-19 pandemic led to an increase in fall-related fatalities generally and an increase in fall-related fatalities that occurred in the home.

Methods: We conducted an interrupted time series analysis using a regression model on monthly fall fatalities among older adults from January 2015 through December 2020. Fall fatality data were extracted from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER), along with the estimated annual population of US residents aged ≥ 65. The COVID-19 pandemic, defined as starting in the US in March 2020, was the interruption variable.

Results: There were 192,586 fall fatalities among older adults in the study period, with a mean of 2614 deaths per month ( $\sigma$  = 228.4) pre-pandemic, and 3051 deaths per month ( $\sigma$  = 215.1) post-pandemic onset. There was no statistically significant change in the incidence of all fall-related fatalities following pandemic onset. However, there was a 25% increase in incidence of fall-related fatalities that occurred within fall victims' homes, specifically (IRR = 1.25, 95% CI 1.14, 1.36).

Conclusion: There was a significant increase in fall-related fatalities within homes among older adults in the US after the onset of the COVID-19 pandemic. During pandemic type situations and times of social distancing, increased social supports and resources must be maintained for older adults to reduce the incidence of falls within the home and fall-related injuries.

Introduction: Of the 6 million people living with dementia (PLWD) in the United States, half visit an emergency department (ED) annually. Little is known about the specific emergency care preferences and priorities of PLWD and their care partners. This descriptive qualitative study engaged PLWD and care partners to identify their ED care priorities and the factors that influence their overall evaluation of ED care.

Methods: We recruited PLWD receiving care in a large academic ED and their care partners to participate in individual or dyadic interviews. Interviews were analyzed using thematic analysis and member checking interviews were completed to confirm and expand on study findings.

Results: We conducted interviews with 55 participants (N = 19 PLWD, 24 care partners, 6 dyads). PLWD and care partners evaluated ED care experiences through a summative lens shaped by: (1) universal priorities common across all participants and (2) individual values that varied in importance and quality between individuals. Universal priorities included feeling respected, clear communication, and being informed about and involved in their emergency care decisions. Individual values included preferences around the who and how of decision-making, attention to cognitive health, and degree of escalation of care. Several contextual factors shaped the appraisal of ED visits including the timing of evaluation and nature of the precipitating event (acute/unknown cause vs. chronic/known or suspected cause).

Conclusion: Findings suggest that interpersonal interactions, including being informed about care and involved in decisions, strongly influence the evaluation of ED visits for PLWD. These findings can support the development of person-centered outcome measures capable of evaluating these priorities.

Objective: The COVID-19 pandemic prompted a rapid shift to remote healthcare. In response, the Veteran Health Administration's (VHA) Gerofit clinical exercise program began providing supervised, group-based exercise sessions three times weekly via real-time video for older Veterans. The longer-term benefits of such remote programs, particularly their impact on mobility and physical function, remain unclear. This analysis evaluates whether the Gerofit to Home (GTH) model of care improves physical performance in older veterans with multiple chronic conditions.

Design: This is a retrospective, quality improvement analysis of national data collected in the VHA GTH program from April 2020 to December 2022. Physical function assessments (PFA) including the 2-min step test, 30-s chair stand test, 5 times sit to stand, and the 30-s arm curl test were completed at baseline, 3 months, 6 months, and 1 year time points. To assess functional trajectories for the PFAs, repeated measures ANCOVA, as implemented under mixed models, was applied, adjusting for age, gender, and race.

Results: The overall GTH sample included 626 older veterans (mean age of 75 ± 6.8 years). All PFA measures showed similar longitudinal trajectories, with significant improvements from baseline to 1 year (p < 0.01). Each follow-up differed significantly from baseline (ps < 0.01), and clinically meaningful gains were achieved and sustained across all assessments.

Conclusion: The GTH program demonstrates that remotely delivered, medically supervised group exercise-integrated within a national healthcare system-can produce and sustain meaningful improvements in physical function for older adults. As one of the first large-scale, health care system-supported remote exercise programs for older adults, GTH offers a novel, scalable model for delivering effective, accessible care to high-risk populations.