Journal of the American Geriatrics Society最新文献

Background: Millions of older adults (≥65) present to emergency departments for injury annually. As the population increases, so will the number of older adults admitted for trauma. Although treatment guidelines for older adults who sustain trauma exist, the evidence for quality improvement is limited. The purpose of this scoping review was to identify hospital-based geriatric-centered interventions that improve care for older adults admitted to trauma services.

Methods: We searched MEDLINE, EMBASE, and CINAHL to identify studies related to geriatric-centered interventions on trauma surgery services (1993-2023). Five reviewers screened studies for full-text review based on these inclusion criteria: (1) older injured adults and/or their caregivers; (2) hospital-based clinical interventions directed to geriatric trauma patients (e.g., frailty assessments, geriatric co-management, triage criteria); and (3) measuring outcomes associated with geriatric trauma. We used the Donabedian quality improvement framework to categorize interventions as structures or processes.

Results: Of 2243 abstracts, 66 studies met the criteria for full-text review, and 47 were included in the analysis. Most (64%) were single-site retrospective cohort studies at Level 1 trauma centers. The most frequent interventions (not mutually exclusive) included geriatric-centered teams (26%), geriatric consultation (23%), interdisciplinary rounds (17%), and medication review (11%). The most frequently measured clinical outcomes were length of stay (47%), discharge location (26%), and in-hospital mortality (21%). Two studies (4%) measured outcomes beyond 3 months. Patient-reported outcomes were rarely included (4%), and caregiver-specific outcomes were not measured.

Conclusions: This scoping review demonstrates the variability in the types of geriatric-centered interventions on trauma surgery services and their associated outcome measures. Furthermore, this review highlights evidence gaps in existing long-term, post-discharge outcomes and patient-/caregiver-reported outcomes. Given the increasing demand for high-quality geriatric trauma care, our findings emphasize the need for evidence-based national standards for geriatric trauma care and targeted study of outcomes germane to older adults and their caregivers.

Background: Improved health outcomes and lower costs have been reported with pharmacist-led patient-centered approaches to medication optimization in older adults, but heterogeneity in studies has complicated assessments of how well these approaches have worked. Among the challenges in advancing care from patient-centered research is uncertainty in how well research questions have matched patients' care needs. One strategy is to engage patients, ideally as equal partners, in the preparation, execution, and dissemination of research. The objective of this study was to survey older adults, caregivers, researchers, and pharmacists to better understand the needs for training on patient-centered outcomes research (PCOR) focusing on medication optimization in older adults.

Methods: A 12-member Community Council was formed to guide the project and to build capacity for engaging older adults, caregivers, researchers, and pharmacists in medication-related patient-centered outcomes research. The Community Council consisted of individuals from three regions: Hawaii, Midwest, and Mid-Atlantic. The Council created a needs assessment survey that was deployed electronically.

Results: There were 93 Elder Care Network participants who were asked to complete the needs assessment survey and 74 surveys were received resulting in a response rate of 80% but only 68 were completed and included in the analysis. Explaining what PCOR is, sharing examples of how members of the community can participate in research, discussing how community members can work with research teams to answer questions, and helping respondents understand how research can affect them were the top responses.

Conclusions: Work of the Elder Care Medicine Network illustrates the importance of understanding the ongoing needs for education that are customized to meet the needs and preferences reported by older adults, caregivers, compared to clinicians and researchers.

Objective: While emergency departments (EDs) are crucial for identifying patients at risk for falls, existing fall risk measures are often inaccurate. This study aimed to assess whether iPhone sensor-based mobility measures collected after ED discharge can improve fall prediction compared with traditional ED-based screening measures.

Methods: This single-center, observational cohort study recruited ED patients aged 60 or older who owned an iPhone. Participants completed baseline assessments, downloaded a custom app to track mobility measures from the iPhone, and were followed for 90 days post-discharge. Fall outcomes were self-reported via the app or follow-up phone calls. Logistic regression and the LASSO technique were employed to identify significant predictors. The discriminative ability of the models was assessed by comparing the C-statistics.

Results: Of the 149 participants enrolled, 76.5% (N = 114) provided at least 7 days of post-discharge iPhone sensor-based mobility data. The cohort had a mean age of 73 years, with 16.7% (N = 19) experiencing a fall. Participants who fell showed a significantly greater increase in daily steps over time compared with those who did not (p = 0.002). The extended logistic regression model, by incorporating mean gait asymmetry and change in step count, demonstrated a higher but nonsignificant improvement in discriminative ability (C-statistic = 0.84) compared with the base model (C-statistic = 0.79).

Conclusions: This study demonstrates that iPhone mobility measures collected after ED discharge can enhance fall prediction relative to self-reported fall risk screening questions in older adults. The strongest mobility predictors were gait asymmetry and changes in step count. While the findings suggest that post-discharge mobility monitoring could improve fall prevention strategies, further validation in diverse populations is necessary.

Background: Visual impairment (VI) is common in older adults and is associated with adverse health outcomes. However, the association between objectively assessed VI and recurrent hospitalization remains unclear.

Objective: To investigate the association of different domains of visual function with recurrent hospitalization in older adults in the United States.

Methods: We used data from Round 11 of the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries, which included objective measures of distance and near visual acuity and contrast sensitivity. Using multivariable logistic regression models, we analyzed the association between VI (distance and near acuity <20/40, contrast sensitivity <1 SD below the sample mean) and prior year hospitalization and estimated marginal predicted probabilities of any (≥1) and recurrent (>1) hospitalization. Models were adjusted for demographic factors and comorbid medical conditions and accounted for NHATS complex survey design.

Results: The sample included 2960 respondents aged 71 and older (median age 81 years; 45% male, 82% non-Hispanic White). The predicted probability of hospitalization for those with any type of VI was 19.2% (15.9-22.6) versus 16.7% (14.9-18.6) for those without VI. The predicted probability of recurrent hospitalization for those with any type of VI was 7.2% (4.8-9.7) versus 4.1% (3.1-5.2) for those without VI. Near VI was significantly associated with recurrent hospitalization (OR = 2.04 [1.6, 3.61], p = 0.02), independent of other visual function measures, while other types of VI were not.

Conclusion: Near VI is significantly associated with recurrent hospitalization in older US adults. Future studies should determine whether improving near vision affects the likelihood of recurrent hospitalization.

Background: Aging populations worldwide face a substantial burden of psychological distress that affects their quality of life and overall health. Oral health is associated with psychological distress; however, the effect of changes in the number of teeth on psychological distress remains unknown. This study aimed to evaluate the association of changes in the number of teeth with the development of psychological distress among community-dwelling older adults in Taipei City.

Methods: From 2005 to 2013, 62,119 community-dwelling individuals aged 65 years and older participated in the physical examination program in Taipei. We collected data on the number of teeth during each examination. Psychological distress was defined as a score of ≥6 on the Brief Symptoms Rating Scale. A generalized estimating equation (GEE) model was used to examine the longitudinal relationship between changes in the number of teeth and the development of psychological distress.

Results: The participants lost an average of 6.6 teeth during the follow-up, with 9.9% of oral examination records showing the loss of ≥5 teeth compared with the previous examination. After GEE analysis with adjustment for multiple covariates, participants were at higher risk of developing psychological distress if they lost 1-4 teeth, 5-9 teeth, or ≥10 teeth compared to that at their previous oral examination. Subgroup analysis revealed that participants with ≥20 teeth at baseline and those who used dentures to compensate for the tooth loss had a lower risk of developing psychological distress than those who experienced tooth loss and did not use dentures.

Conclusion: A rapid decrease in the number of teeth is associated with an increased risk of psychological distress in older adults. Regular dental checkups, nutritional counseling, and the use of dentures are critical in mitigating the adverse psychological effects of the tooth loss.

Background: This program evaluation was conducted to assess the effectiveness of a community memory screening initiative across 25 Aging and Disability Resource Centers, spanning 39 counties and 5 tribal communities in the state of Wisconsin.

Methods: We evaluated the screened individuals' characteristics and reasons for screening, the screen results and topics addressed during screening, the rate of sending positive screens to primary care providers, and the incidence of subsequent dementia diagnosis as well as health behavior changes.

Results: Program evaluation results showed 791 completed surveys from individuals, indicating the program's accessibility and potential to reach populations in both urban and rural counties across Wisconsin. Evaluation results also showed that brain health was the most frequently discussed topic during memory screens (discussed during 689 screens, 87.1%), along with other topics such as potential causes of dementia symptoms (670 screens, 84.5%), dementia warning signs (656, 83%), the importance of early detection (605 screens, 76.5%), and caregiver support (106 screens, 13.4%). Of all 791, a total of 273 (34.5%) individuals had screen results sent to a primary care provider. Follow-up surveys completed with a subset of individuals (n = 49) who had their results sent to a primary care provider indicated that 10 (20%) received a diagnosis of dementia and over half made a health behavior change to improve brain health.

Conclusions: The evaluation results presented herein highlight the program's success in addressing the critical need for accessible dementia-related services. Overall, our evaluation results underscore the importance of community-based initiatives in promoting early dementia detection and intervention, which are crucial for disease management.

Background: Randomized controlled trials (RCTs) of complete revascularization (CR) versus culprit-only revascularization (COR) in patients with ST-elevation myocardial infarction (STEMI) have shifted the recommendation for CR from class III to class I in the AHA/ACC/SCAI guidelines, but it remains unclear if the benefit of CR over COR extends to older adults, who have greater bleeding risk, comorbidity burden, and complexity of lesions. We performed a meta-analysis to place the results of the previous RCTs in the context of the recently published FIRE trial and the subgroup analysis of the COMPLETE trial in adults ≥75 years old.

Methods: We searched the literature from inception to October 21, 2023. RCTs of CR versus COR in STEMI were selected if it reported results for older adults, defined as either age > 65 years or > 75 years. Integrated hazard ratios (HRs) were calculated using random effects models. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes were major bleeding and contrast-associated acute kidney injury (CA-AKI).

Results: In this meta-analysis of 5 RCTs including 3513 older adults, CR was associated with a lower hazard of MACE than COR (HR 0.60, 95% CI 0.37-0.99, p = 0.047). Sensitivity analysis including trials that defined older adults as age > 65 years resulted in a lower hazard of MACE with CR versus COR, but not in trials that defined older adults as age > 75 years. There was no difference in the hazard of major bleeding or CA-AKI between CR and COR.

Conclusions: In this largest meta-analysis to date investigating CR compared with COR in older adults with STEMI, CR was associated with reduced MACE without a concomitant increase in major bleeding or CA-AKI compared with COR. These results can help cardiologists and geriatricians involved in shared decision-making with patients and caregivers when contemplating whether to pursue CR in older adults.