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Background Methods Results Conclusions Emergency department (ED) visits at end‐of‐life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end‐of‐life ED use, total healthcare spending, and out‐of‐pocket spending in a nationally representative sample.Using Medicare Current Beneficiary Survey data, we conducted a pooled cross‐sectional analysis of Medicare beneficiaries aged 65+ years with a date of death between July 1, 2015 and December 31, 2021. Our primary outcomes were ED visits, total healthcare spending, and out‐of‐pocket spending in the 7, 30, 90, and 180 days preceding death. We estimated a series of zero‐inflated negative binomial models identifying patient characteristics associated with the primary outcomes.Among 3812 older adult decedents, 610 (16%), 1207 (31.7%), 1582 (41.5%), and 1787 (46.9%) Medicare beneficiaries had ED visits in the final 7, 30, 90, and 180 days, respectively, of life. For Medicare beneficiaries with at least one ED visit in the final 30 days of life, the median total and out‐of‐pocket costs were, respectively, $12,500 and $308, compared, respectively, with $278 and $94 for those without any ED visits (p < 0.001 for both comparisons). Having a diagnosis of dementia (odds ratio [OR] 0.71; 95% confidence interval [CI] 0.51–0.99; p = 0.04) and being on hospice status during the year of death (OR 0.56; 95% CI 0.48–0.66; p = <0.001) were associated with a decreased likelihood of having an ED visit. Having dementia was associated with a decreased likelihood of having any healthcare spending (OR 0.50; 95% CI 0.36–0.71; p = 0.001) and any out‐of‐pocket spending (OR 0.51; 95% CI 0.36–0.72; p = <0.001).One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half‐year of life, with evidence of associated considerable total and out‐of‐pocket spending. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion A prescribing cascade occurs when medication causes an adverse drug reaction (ADR) that leads to the prescription of additional medication. Prescribing cascades can cause excess medication burden, which is of particular concern in older adults. This study aims to identify and quantify potentially problematic prescribing cascades relevant for clinical practice.A mixed‐methods study was conducted. First, prescribing cascades were identified through literature search. An expert panel (n = 16) of pharmacists and physicians assessed whether these prescribing cascades were potentially problematic. Next, a cohort study quantified potentially problematic prescribing cascades in adults using Dutch community pharmacy data for the period 2015–2020. Additionally, the influence of multiple medications potentially causing the same ADR was evaluated. Prescription sequence symmetry analysis was used to calculate adjusted sequence ratios (aSRs), adjusting for temporal prescribing trends. An aSR >1.0 indicates the occurrence of a prescribing cascade. In a subgroup analysis, aSRs were calculated for older adults.Seventy‐six prescribing cascades were identified in literature and three were provided by experts. Of these, 66 (83.5%) were considered potentially problematic. A significant positive aSR for the medication sequence was found for 41 (62.1%) of these prescribing cascades. The highest aSR was found for amiodarone potentially causing hypothyroidism treated with thyroid hormones (4.63 [95% confidence interval 4.40–4.85]), based on 565 incident users. The biggest population (n = 34,645) was found for angiotensin converting enzyme‐inhibitors potentially causing urinary tract infections treated with antibiotics. Regarding four potential ADRs, the aSRs were higher for people using multiple medications that cause the same ADR as compared to people using only one of those medications. Among older adults the aSRs remained significant for 37 prescribing cascades.An overview was generated of potentially problematic prescribing cascades relevant for clinical practice. These results can support healthcare providers to intervene and reduce medication burden for older adults. [ABSTRACT FROM AUTHOR]

This research letter explores the concept of "clinical momentum" in the care of older adults with advanced dementia. Clinical momentum refers to the tendency for interventions to be performed near the end of life, often resulting in excessive treatment. The study specifically focuses on the use of feeding tubes in patients with advanced dementia as an example of overtreatment. The researchers conducted a retrospective case-control study using electronic health records to identify patients with dementia who received a permanent feeding tube and compared them to controls who did not receive a feeding tube. The study aims to identify markers of clinical momentum in the medical records. The findings indicate that patients with advanced dementia who received a permanent feeding tube had longer hospital stays and more events such as discussions about goals of care and consultations for palliative care. The study suggests that prolonged exposure to a healthcare system that prioritizes interventions for isolated problems can result in care that does not align with guidelines. However, it is important to note that the study has limitations, including a small and nondiverse sample. [Extracted from the article]

Background Methods Results Conclusions Frailty is common in people with cardiovascular disease. Worse left atrial (LA) function is an independent risk factor for cardiovascular disease. However, whether worse LA function is associated with frailty is unclear.We included 3292 older adults from the Atherosclerosis Risk in Communities study who were non‐frail at baseline (visit 5, 2011–2013) and had LA function (reservoir, conduit, and contractile strain) measured from two‐dimensional speckle‐tracking echocardiography. LA stiffness index was calculated as a ratio of E/e′ to LA reservoir strain. Frailty was defined using the validated Fried frailty phenotype. Incident frailty was assessed between 2016 and 2019 during two follow‐up visits. LA function was analyzed as quintiles. Multivariable logistic regression examined odds of incident frailty.Median (interquartile range [IQR]) age was 74 (71–77) years, 58% were female, and 214 (7%) participants developed frailty during a median (IQR) follow‐up of 6.3 (5.6–6.8) years. After adjusting for baseline confounders and incident cardiovascular events during follow‐up, the odds of developing frailty was 2.42 (1.26–4.66) times greater among participants in the lowest (vs highest) quintile of LA reservoir strain and 2.41 (1.11–5.22) times greater among those in the highest (vs lowest) quintile of LA stiffness index. Worse LA function was significantly associated with the development of exhaustion, but not the other components of the Fried frailty phenotype.Worse LA function is associated with higher incidence of frailty and exhaustion component independent of LA size and left ventricular function. Future studies are needed to elucidate the underlying mechanisms that drive the observed association. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best‐practice hearing intervention on cognitive decline among community‐dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self‐reported communicative function.The ACHIEVE Study is a parallel‐group, unmasked, randomized controlled trial of adults aged 70–84 years with untreated mild‐to‐moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self‐reported communicative function was measured with the Hearing Handicap Inventory—Elderly Screening version (HHIE‐S, range 0–40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE‐S was analyzed through an intention‐to‐treat model controlling for known covariates.HHIE‐S improved after 6‐months with hearing intervention compared to control, and continued to be better through 3‐year follow‐up. We estimated a difference of −8.9 (95% CI: −10.4, −7.5) points between intervention and control groups in change in HHIE‐S score from baseline to 6 months, −9.3 (95% CI: −10.8, −7.9) to Year 1, −8.4 (95% CI: −9.8, −6.9) to Year 2, and − 9.5 (95% CI: −11.0, −8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.Hearing intervention improved self‐reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Delirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one‐third of cases. Evidence‐based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake. Early adopters of ED delirium screening can offer valuable lessons about successful implementation.We conducted semi‐structured interviews with clinician‐administrators leading ED delirium screening initiatives from 20 EDs in the United States and Canada. Interviews focused on experiences of planning and implementing ED delirium screening. Interviews lasted 15 to 50 minutes and were digitally recorded and transcribed. To identify factors that commonly impacted implementation of ED delirium screening, we used constructs from the Consolidated Framework for Implementation Research (CFIR), an Implementation Science framework widely used to evaluate healthcare improvement initiatives.Overall, notable facilitators of successful implementation were having institutional and ED leadership support and designated clinical champions to longitudinally engage and educate frontline staff. We found specific examples of factors affecting implementation drawn from the following seven CFIR constructs: (1) intervention complexity, (2) intervention adaptability, (3) external policies and incentives, (4) peer pressure from other institutions, (5) the implementation climate of the ED, (6) staff knowledge and beliefs, and (7) engaging deliverers of intervention, that is, frontline ED staff.Implementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Appropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.We conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post‐acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g‐formula to standardize for age and sex.We identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).Racial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short‐ and long‐term health outcomes. [ABSTRACT FROM AUTHOR]

Background Objective of the Study Materials and Methods Results Conclusions Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post‐cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.One hundred and thirty‐three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (p < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (p < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (p = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, p < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, p = 0.016) and pericardiocentesis (16.5% vs 8.5%, p = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm3 vs 11,208 + 285/mm3, p = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (p = 0.003), colchicine in 76.7% versus 87.3% (p = 0.023), corticosteroids in 49.6% versus 26.8% (p < 0.001), and anakinra in 14.3% versus 23.9% (p = 0.044).Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely due to comorbidities; they were also treated less commonly with anti‐IL1 agents, and more frequently with corticosteroids. [ABSTRACT FROM AUTHOR]

This article highlights the significance of involving older individuals in the creation of core outcome sets (COS) for clinical trials. COS is a standardized collection of outcomes that should be reported in all trials within a specific clinical field. The authors share their experiences in ensuring meaningful participation of older people in the selection of outcomes for a COS related to hospital deprescribing trials. They propose strategies such as simplifying the number of outcomes presented, providing alternative methods of participation, and utilizing ranking exercises to support participants. The article underscores the value of workshops and discussions in the development of COS. [Extracted from the article]

Background Methods Results Conclusions Antipsychotic and other psychotropic medication use is prevalent among community‐dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.Among community‐dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee‐for‐service claims using interrupted time series analyses across three periods (“Pre‐Partnership”: July 1, 2010 to March 31, 2012; “Post‐Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).We included 1,289,401 community dwellers with dementia contributing 26,609,697 person‐months. The mean age was 80 years, most were female (70%), approximately 80% were non‐Hispanic Whites, 10% were non‐Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre‐Partnership (β = −0.06, 95% CI: −0.08, −0.05) and post‐Partnership (β = −0.02, 95% CI: −0.02, −0.01). Post‐Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community‐dwelling older adults with dementia.These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community‐dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community‐dwellers with dementia. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.This was a cross‐sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation‐adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$.Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Discussion The number of older adults struggling to maintain adequate housing is growing. Prior studies have used various criteria to measure housing insecurity; however, no standardized definition exists to date. Using a multidimensional approach, our study sought to calculate population‐based estimates of various forms of housing insecurity among community‐living older Americans and determine how these estimates differ across key characteristics.This study utilized data from the 2011 round of the National Health and Aging Trends Study (NHATS), a prospective longitudinal study of Medicare beneficiaries aged 65 years or older. Three key forms of housing insecurity were operationalized: poor housing affordability (PHA), poor housing quality (PHQ), and poor neighborhood quality (PNQ). Population‐based estimates of these forms of housing insecurity were calculated using analytic sampling weights and stratified by age, gender, race and ethnicity, frailty status, and dementia status.Totally 6466 participants were included in the analysis, representing 29,848,119 community‐living older Americans. The mean (standard deviation) age was 77.3 (7.7) years; by weighted percentages, 56.0% identified as female, 81.3% as White, 8.2% Black, and 7.1% Hispanic. At least one form of housing insecurity was identified in 38.5% of older Americans. Individually, the prevalence of PHA was 14.8%, PHQ 24%, and PNQ 12.5%. The prevalence of at least one form of housing insecurity was higher among persons of color (62.9% Black and 66% Hispanic vs White; p < 0.001), those with frailty (40.9% pre‐frail and 49.4% frail vs robust; p < 0.001), and those with cognitive impairment (48.1% possible and 51% probable dementia vs no dementia; p < 0.001).Nearly one in three community‐living older Americans experience at least one form of housing insecurity. This was most common among vulnerable subgroups. Our multidimensional approach to defining various forms of housing insecurity can be used for future studies focused on improving social determinants of health among high‐risk older adults. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Influenza vaccines are available to help protect persons aged ≥65 years, who experience thousands of influenza hospitalizations annually. Because some influenza vaccines may work better than others, we sought to assess benefit of high‐dose (HD), adjuvanted (ADJ), and recombinant (RIV) influenza vaccines (“enhanced influenza vaccines”) compared with standard‐dose unadjuvanted influenza vaccines (SD) and with one another for prevention of influenza‐associated hospitalizations among persons aged ≥65 years.We searched MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library to identify randomized or observational studies published between January 1990 and October 2023 and reporting relative vaccine effectiveness (rVE) of HD, ADJ, or RIV for prevention of influenza‐associated hospitalizations among adults aged ≥65 years. We extracted study data, assessed risk of bias, and conducted random‐effects network meta‐analysis and meta‐regression.We identified 32 studies with 90 rVE estimates from five randomized and 27 observational studies (71,459,918 vaccinated participants). rVE estimates varied across studies and influenza seasons. Pooled rVE from randomized studies was 20% (95% CI −54 to 59) and 25% (95% CI −19 to 53) for ADJ and HD compared with SD, respectively; rVE was 6% (95% CI −109 to 58) for HD compared with ADJ; these differences were not statistically significant. In observational studies, ADJ, HD, and RIV conferred modestly increased protection compared with SD (rVE ranging from 10% to 19%), with no significant differences between HD, ADJ, and RIV. With enhanced vaccines combined, rVE versus SD was 18% (95% CI 3 to 32) from randomized and 11% (95% CI 8 to 14) from observational evidence. Meta‐regression of observational studies suggested that those requiring laboratory confirmation of influenza reported greater benefit of enhanced vaccines.HD, ADJ, and RIV provided stronger protection than SD against influenza hospitalizations among older adults. No differences in benefit were observed in comparisons of enhanced influenza vaccines with one another. [ABSTRACT FROM AUTHOR]

Background Objective Design Setting Participants Results Conclusions Implications Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well‐being and independence.To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: Empowering People to Independence in COPD).Multiphase study guided by Baltes Theory of Successful Aging and the 5Ms Framework: Phase 1: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. Phase 2: Rapid qualitative analysis. Phase 3: Intervention mapping and refinement.Ambulatory, virtual.Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders.NGT sessions were conducted by constituency group with 37 participants (n = 7 patients, n = 6 family caregivers, n = 8 clinic staff, n = 9 clinicians, n = 7 health system leaders) (Phase 1). Participants generated 92 statements across five themes (Phase 2): (1) “Barriers to care”, (2) “Family caregiver needs”, (3) “Functional status and mobility issues”, (4) “Illness understanding”, and (5) “COPD care complexities”. Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized “Functional status and mobility issues”, family caregivers prioritized “Family caregiver needs”, and clinicians and health system leaders prioritized “COPD care complexities”. Intervention mapping (Phase 3) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities.Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, emerged as patient prioritized challenges.Patient‐centered interventions for older adults with COPD must account for their prioritized functional and supplemental oxygen needs and explore diverse constituent perspectives to facilitate intervention enrichment. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions High‐risk medication use is associated with an increased risk of adverse events, but little is known about its chronic utilization by key demographic groups. We aimed to study the associations between age, sex, and race/ethnicity with new chronic use of high‐risk medications in older adults.In this retrospective cohort study, we analyzed data from older adults aged ≥65 years enrolled in a national health insurer who started a high‐risk medication between 2017 and 2022 across 16 high‐risk medication classes. We used generalized estimating equations to estimate the associations between sociodemographic classifications and the onset of chronic high‐risk medication use after initiation (≥90 days' supply across ≥2 fills within 180 days). We adjusted the analyses for sociodemographic and clinical patient characteristics and added three‐way interaction terms for race/ethnicity, sex, and age to explore whether the outcome varied across different subgroups of race/ethnicity, age, and sex.Across 2,751,069 patients (mean age: 74 years [SD = 7], 72% White, 60% Female), 406,075 (15%) became new chronic users of ≥1 high‐risk medication. Compared to White older adults, Asian (RR = 0.81, 95% CI: 0.79–0.84), Black (RR = 0.92, 95% CI: 0.90–0.94), and Hispanic (RR = 0.85, 95% CI: 0.83–0.86) older adults had a lower risk of becoming new chronic users. Men had a higher risk compared to women (RR = 1.09, 95% CI: 1.08–1.10). Age was not significantly associated with new chronic high‐risk medication use (≥75 years: RR = 1.00, 95% CI: 1.00–1.01). We observed differences across some medication classes, like benzodiazepines, first‐generation antihistamines, and antimuscarinics for which non‐White older adults were at a higher risk. The joint presence of specific age, sex, and race/ethnicity characteristics decreased the risk of becoming a new chronic user (e.g., Hispanic/Female/65–74 years: RR = 0.96, 95% CI: 0.94–0.99).New chronic high‐risk medication use varied across older adults by sociodemographic characteristics, suggesting the need to individualize medication optimization approaches and better understand how systematic barriers in access to health care may influence differences in high‐risk medication use in older adults. [ABSTRACT FROM AUTHOR]

Background Method Results Conclusions Primary care can be an important setting for communication and advance care planning (ACP), including for those with dementia and their families. The study objective was to explore experiences with a pragmatic trial of a communication and ACP intervention, SHARING Choices, in primary care for older adults with and without dementia.We conducted qualitative interviews using tailored semi‐structured guides with three groups: ACP facilitators who conducted the intervention; clinicians, managers, and administrators from sites randomized to the intervention; and patients and families who met with ACP facilitators. We used thematic analysis to identify and synthesize emergent themes based on key Consolidated Framework for Implementation Research concepts and Proctor's Implementation Outcomes, triangulating the three groups' perspectives.We identified five key themes. For acceptability, perceptions of the intervention were mostly positive, although some components were not generally implemented. For adoption, respondents perceived that ACP facilitators mainly focused on conducting ACP, although facilitators often did not implement the ADRD and family engagement aspects with the ACP. For relational connections, ACP facilitator—practice and clinician communication and engagement were key to how the intervention was implemented. For adaptability, ACP facilitators and health systems adapted how the ACP facilitation component was implemented to local preferences and over time, given the pragmatic nature of the trial. And, for sustainability, ACP facilitators and clinicians/managers/facilitators were positive that the intervention should be continued but noted barriers to its sustainability. Patients and families generally did not recall the intervention.ACP facilitators and clinicians, managers, and administrators had positive perceptions of the ACP facilitator component of the intervention in this pragmatic trial with adaptation to local preferences. However, engaging those with dementia and families was more challenging in the implementation of this intervention. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Among older persons, neighborhood disadvantage is a granular and increasingly used social determinant of health and functional well‐being. The frequency of transitions into or out of a disadvantaged neighborhood over time is not known. These transitions may occur when a person moves from one location to another or when the Neighborhood Atlas, the data source for the area deprivation index (ADI) that is used to identify disadvantaged neighborhoods at the census‐block level, is updated.From a prospective longitudinal study of community‐living persons, aged 70 years or older in South Central Connecticut, neighborhood disadvantage was ascertained every 18 months for 22 years (from March 1998 to March 2020). ADI scores higher than the 80th state percentile were used to distinguish neighborhoods that were disadvantaged (81–100) from those that were not (1–80).At baseline, 205 (29.3%) of the 699 participants were living in a disadvantaged neighborhood. Changes in neighborhood disadvantage during 14 consecutive 18‐month intervals were relatively uncommon, ranging from 1.5% to 11.8%. Nearly 80% of participants had no change in neighborhood disadvantage and less than 4% had more than one change over a median follow‐up of more than 9 years. Overall, the rate of transitions into or out of neighborhood disadvantage was only 2.7 per 100 person‐years. These transitions were most common when the Neighborhood Atlas was updated (2013, 2015, 2018, and 2020). Comparable results were observed when decile changes in ADI scores during the 18‐month intervals were evaluated.In longitudinal studies of older persons with extended follow‐up, it may not be necessary to update information on disadvantaged neighborhoods in circumstances when it is possible, and the degree of misclassification of neighborhood disadvantage should be relatively low in circumstances when updated information cannot be obtained. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Gait performance can provide valuable insights into cognitive functioning in older adult and may be used to screen for cognitive impairment. However, the optimal test condition and spatiotemporal parameter for accuracy have not yet been determined. This study aims to determine the gait measure with the highest accuracy identifying cognitive decline.A total of 711 participants were recruited, including 332 cognitively healthy individuals, 264 with mild cognitive impairment (MCI), and 115 with dementia, with a mean age of 72 years (interquartile range 69–76), and 43% (n = 307) of women. The participants underwent gait assessment in three different conditions, including a single task and dual tasks of counting backward by ones and naming animals.Gait performance was deteriorated as cognitive impairment progressed. The gait test performed during naming animals condition was the most accurate in differentiating between cognitive groups. Specifically, the naming animals gait speed was more accurate in discriminating control participants from those with cognitive impairment (area under the curve [AUC] = 76.9% for MCI and 99.7% for people with dementia with control group as reference). The coefficient of stride length variability while naming animals was the most effective parameter in discriminating between MCI and dementia groups (AUC = 96.7%).The naming animals dual‐task gait test can be a valuable assessment for screening cognitive impairment in older adults, regardless of their cognitive abilities. The test is useful in clinical settings for subjects with a range of cognitive profiles. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions There are likely many contributors to variation in the rate of cognitive decline in middle and late adulthood, including individual and neighborhood socio‐economic factors. This study examines whether individual socio‐economic factors, namely income and wealth, correlate with cognitive decline, in part, through neighborhood‐level social and material disadvantage.Using the three waves of data collection from the Canadian Longitudinal Study on Aging (CLSA), this study included 51,338 participants between the age of 45 and 85 years at baseline (51% female). Individual socio‐economic status (SES) was assessed by annual household income and by the current value of savings and investments. Neighborhood disadvantage was measured by area‐based material and social deprivation indices. Cognition was measured at each wave using verbal fluency, mental alternations, and delayed word recall. Latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of individual SES on cognitive change through area‐level disadvantage. Multi‐group models were constructed on the basis of age‐group (45–64 years; 65–74 years; or 75+ years) to allow for varying estimates across age.Among 45–64‐year‐olds, income and wealth had indirect effects on initial cognitive level and on rate of cognitive decline through material disadvantage (standardized indirect effects = 0.01, p < 0.001), but only wealth had an indirect effect through social disadvantage (p = 0.019). Among 65‐74‐year‐olds, income and wealth had indirect effects on initial cognitive level (p < 0.01) but not on rate of cognitive decline (p > 0.05), and among 75+ year‐olds, no indirect effects were observed (p > 0.05). Wealth and income had direct effects, independent of neighborhood disadvantage, on cognition in all age groups (p < 0.05).Among middle‐aged adults, greater individual SES may mitigate cognitive decline, in part, by allowing individuals to live in more materially and socially advantaged neighborhoods. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Spousal loss is a stressful life event that is associated with loneliness and social isolation, both of which affect mental and physical health. The primary objective of this paper was to synthesize longitudinal studies that investigated loneliness and social isolation in widowhood.A systematic search of the literature was conducted using three electronic databases. 26 longitudinal studies published through June 2024 were included for further analysis. Participant characteristics, study design, and key findings were extracted.Most studies were from the United States or Europe, included more widows than widowers, and assessed loneliness in older adults aged >60 years. Loneliness peaked directly following spousal death, but findings were inconsistent regarding the lasting effects of widowhood. Heterogeneity in the longitudinal trajectories of loneliness was noted, with studies showing linear increases, decreases, or curvilinear relationships over time. Several factors modified the relationship between widowhood and loneliness, including volunteerism, military experience, income, and age. Widowers consistently reported greater loneliness and worse social isolation when compared with widows. Few studies investigated social isolation specifically, but those that did found that social isolation may decrease in widowhood.As the world grapples with a social pandemic of loneliness and social isolation, widowed adults may be uniquely affected. Few studies investigated the longitudinal trajectory of loneliness and especially social isolation in widowhood, and those that did found heterogenous results. Future work is needed to understand why some widowed adults are uniquely affected by feelings of loneliness and social isolation while others are not, and whether potentially modifiable factors that moderate or mediate this relationship could be leveraged by psychosocial interventions. [ABSTRACT FROM AUTHOR]

Background Objective Design Setting Participants Measurements Results Conclusions Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer's disease related dementias (ADRD) has not been examined.To compare change in cognition and function among short‐stay SNF patients with delirium, ADRD, or both.Retrospective cohort study using claims data from 2011 to 2013.Centers for Medicare and Medicaid certified SNFs.A total of 740,838 older adults newly admitted to a short‐stay SNF without prevalent ADRD who had at least two assessments of cognition and function.Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD‐9 codes, and incident ADRD by ICD‐9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale.Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD‐only and delirium‐only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD.Among older adults without dementia admitted to SNF for post‐acute care following hospitalization, a positive screen for delirium and a new diagnosis of ADRD, within 7 days of SNF admission, were both significantly associated with worse cognitive and functional recovery. Patients with both delirium and new ADRD had the worst cognitive and functional recovery. [ABSTRACT FROM AUTHOR]

This document discusses the perception that geriatric medicine is declining and proposes new metrics to assess the health of the profession. It acknowledges the low number of practicing geriatricians but argues that this does not accurately reflect the advancements and vitality of geriatric medicine. The document highlights the importance of geriatrics care models, the age-friendly health systems movement, leadership training, innovative educational programs, and practice and leadership opportunities in geriatrics. It suggests that increasing the supply of geriatricians requires a multifaceted approach that includes interprofessional training and support for early-career clinicians. The document emphasizes the importance of evidence-based, safe, and reliable care for older adults and the need for creative strategies to ensure that older adults receive the care they need and deserve. [Extracted from the article]

Introduction Methods Results Discussion Racial and ethnic disparities in potentially inappropriate medication (PIM) use among older adults with dementia are unclear.Data were drawn from the baseline visits of participants who were ≥60 years old and diagnosed with dementia in the National Alzheimer's Coordinating Center Uniform Data Set (NACCUDS) recruited from National Institute on Aging (NIA)‐funded Alzheimer's Disease Research Centers (ADCs) throughout the United States. PIM utilization was evaluated using the 2019 American Geriatrics Society Beers Criteria for PIM Use in Older Adults. We estimated the association between race and ethnicity and the following outcomes and estimation models: (1) any PIM use, any PIM in each drug class, and any PIM best avoided in dementia patients using logistic regression models, (2) total number of medications, total number of PIMs, and anticholinergic burden scale (ACBS) using Poisson or negative binomial regression models, and (3) proportion of total medications that were PIMs using generalized linear models (GLM).Compared to White participants, Black, Hispanic, and Asian participants reported taking fewer total medications (incidence rate ratio [IRR] ± standard error[SE] = 0.903 ± 0.017, 0.875 ± 0.021, and 0.912 ± 0.041, respectively, all p < 0.01). Asian participants were less likely to be exposed to any PIM (odds ratio [OR] ± SE = 0.619 ± 0.118, p < 0.05). Compared to White participants, Black participants were less likely to be exposed to benzodiazepine (OR ± SE = 0.609 ± 0.094, p < 0.01) and antidepressant (OR ± SE = 0.416 ± 0.103, p < 0.001) PIMs, but greater antipsychotic (OR ± SE = 1.496 ± 0.204, p < 0.01), cardiovascular (OR ± SE = 2.193 ± 0.255, p < 0.001), and skeletal muscle relaxant (OR ± SE = 2.977 ± 0.860, p < 0.001) PIMs. Hispanic participants were exposed to greater skeletal muscle relaxant PIMs and had lower anticholinergic burden. Asian participants were exposed to fewer benzodiazepine PIMs.Significant racial and ethnic disparities in exposure to PIMs and PIMs by medication category in dementia research participants who have access to dementia experts found in the study suggest that disparities may be wider in the larger community. [ABSTRACT FROM AUTHOR]

This research letter discusses the use of technology for health-related purposes among older adults (65+ years) in the United States. The study aimed to evaluate the impact of the COVID-19 pandemic on digital health utilization among older adults and assess whether there were any disparities in technology uptake across different sociodemographic groups. The findings showed that older adults increased their utilization of technology for health-related purposes following the pandemic, challenging the belief that this age group is uninterested in digital health. However, there were variations in adoption trends among different racial and educational groups. The study emphasizes the importance of providing equitable digital support and representation for older adults in medical settings and digital health research. [Extracted from the article]

This commentary explores the role of science communication in advancing translational gerontology, specifically in relation to the Geroscience Hypothesis. It acknowledges the challenges faced in effectively communicating the potential benefits of translational gerontology, including the media's negativity bias and concerns about increasing health disparities. The article emphasizes the importance of engaging different stakeholders and using effective communication strategies to promote support for geriatric innovations. It suggests a dualistic frame that focuses on the diminishing health dividends of the "War Against Disease" paradigm and the advances made in research on the biology of aging. The text discusses the research conducted on caloric restriction (CR) and fasting in rodents, which demonstrated significant impacts on aging by preventing or delaying age-related diseases. However, the impact of CR and fasting on human health is still being explored. The text also highlights the challenges of communicating the potential benefits and risks of dietary interventions in the field of geroscience. It emphasizes the importance of developing drugs that mimic the effects of dietary restriction to delay the onset of disease in late life. Additionally, the text discusses the potential benefits of slowing aging for groups that are typically vulnerable to health disparities, such as women, those living in regions vulnerable to climate change, and the poor. It suggests that improving healthspan, rather than lifespan, should be a key part of a global health strategy. The text also mentions the importance of addressing socioeconomic disadvantage and promoting greater equality in public health efforts. [Extracted from the article]

The article explores different models of aging and introduces a new approach called "Surviving Aging." Unlike existing models that prioritize disease prevention and maintaining cognitive and physical function, Surviving Aging takes an assets-based approach that considers individual goals and values. It recognizes the diverse challenges and assets that older adults may have and aims to avoid stigmatization. The Surviving Aging Framework, which is still in development, emphasizes a shift from a deficit-based approach to a focus on strengths and assets. It also highlights the importance of considering the socio-environmental context and involving aging adults and their care systems in identifying relevant outcomes. The framework has the potential to inform research, practice, and policy related to aging. [Extracted from the article]

Background Methods Results Conclusions The COVID‐19 pandemic significantly affected the physical health of older adults around the world, causing day‐to‐day disruptions in routines and changes to usual patterns of mobility. Despite the passing of 2 years since vaccinations, older adults continue to experience detriments, including social isolation and reduced mobility. This study aims to understand how views of the COVID‐19 pandemic are associated with life‐space mobility—moving about the community. We hypothesize that endorsing stronger perspectives about the persistence of COVID‐19 is correlated with reduced life‐space mobility.Survey data were collected via online questionnaire in October and November of 2022. Linear regression models were used to examine the relationship between five perspectives on the COVID‐19 pandemic (e.g., agreeing that “I wish people would take COVID‐19 more seriously”) and life‐space mobility, measured using a modified version of the life space assessment, in older adults (n = 510). Analyses were adjusted for demographic factors and mental and physical health indicators, including depressive symptoms and number of chronic conditions.In fully adjusted models, the study found that endorsing a stronger lingering impact of the COVID‐19 pandemic across any of the five perspectives was associated with significantly lower life‐space mobility.The results of this study show that endorsing a stronger lingering impact of the COVID‐19 pandemic is associated with reduced life‐space mobility, which underscores the importance of designing public health strategies that carefully balance the safety concerns of older adults with opportunities for physical activity and social interaction. [ABSTRACT FROM AUTHOR]

This is an exciting time in Geriatrics, with numerous opportunities in health care for Geriatrics specialists to innovate and lead. Geriatrics specialists should know how to implement innovative care models to lead healthcare changes in their organizations and effectively facilitate change management. We highlight a 10‐step framework that Geriatrics specialists can leverage to quickly move their ideas from development to implementation at a system level. This framework adapts concepts from business management to provide a step‐by‐step guide to move from idea generation to implementation. We provide different practical examples that a Geriatrician can correlate to in their practice, including value proposition and business canvas model. Though small components of the business canvas model may vary based on organization and program/idea‐specific needs, the outlined skills will establish Geriatrics specialists as leaders of change, a resource for education, and valued consultants to a health system that is in dire need of direction to improve the quality of care, and health outcomes, for older adults. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Advance care planning (ACP) has been reconceptualized as a health behavior. Action plans (APs), or patient‐directed mini contracts, improve behavior change. However, no prior studies have assessed whether APs can increase ACP documentation and engagement.We included English and Spanish‐speaking primary care patients from San Francisco, ≥55 years of age, with ≥2 serious or chronic illnesses. Participants were in the intervention arm of the PREPAREforYOURcare.org trial and asked at baseline to choose 1 of 5 actions (e.g., choose a surrogate). At 6 months, we assessed whether participants completed their AP and if completion was associated with demographics, electronic health record (EHR) ACP documentation, and five‐point ACP Engagement Survey scores. We used t‐tests, chi‐squared, multivariate analysis adjusted for baseline ACP and clustering by physician, and qualitative thematic analysis to explore reasons for non‐completion.The mean age of 586 participants was 65 ± 10 years; 44.0% women, 45.9% Spanish‐speaking, 31.4% had limited health literacy, and 43% completed an AP at 6 months; surrogate‐related (47.4%), tell others about medical wishes (33.7%), ask clinicians questions (13.7%), and decide what matters most in life (5.2%). Participants with limited versus adequate health literacy were less likely to complete an AP (25.4% vs 35.9%, p = 0.01). Completing an AP was associated with greater ACP EMR documentation 49.8% vs 35.6%, p < 0.001 (adjusted odds ratio: 2.06; 95% CI [1.43–2.97]) and engagement (adjusted five‐point scores [3.69; 95% CI 3.57–3.81 vs 3.10; 95% CI: 2.98–3.21], p < 0.001). Themes for non‐completion included not being ready and logistical issues (e.g., surrogate deceased).Among English and Spanish‐speaking older adults, creating an ACP AP resulted in greater documentation and engagement. APs may help facilitate ACP behavior change as part of effective ACP interventions. Additional support may be needed for patients with limited health literacy and those facing logistical barriers. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Some vaccines have a small risk of triggering Guillain–Barré syndrome (GBS), an autoimmune disorder where nerve damage leads to paralysis. There is a CDC precaution for patients whose GBS was associated with an influenza or tetanus toxoid‐containing vaccine (GBS occurring within 42 days following vaccination).We described vaccine patterns before and after a GBS diagnosis with a matched cohort design in a 20% random sample of fee‐for‐service Medicare enrollees. We defined the index date as an ICD‐9‐CM or ICD‐10‐CM GBS diagnosis code in the primary position of an inpatient claim. We matched each GBS patient to five non‐GBS comparators on sex, exact age, racial and ethnic category, state of residence and the month of preventive health visits during baseline; used weighting to balance covariates; and measured frequency of vaccines received per 100 people during year before and after the index date using the weighted mean cumulative count (wMCC).We identified 1567 patients with a GBS diagnosis with at least 1 year of prior continuous enrollment in Medicare A and B that matched to five comparators each. The wMCCs in the 1 year before the index date were similar for both groups, with a wMCC of 74 vaccines/100 people in the GBS group (95% CI 71, 77). Within 1 year after the index date, patients with GBS had received 26 vaccines/100 people (95% CI 23, 28), which was 41 fewer vaccines than matched non‐GBS comparators (95% CI −44, −38). Among GBS patients, 11% were diagnosed with GBS within 42 days after a vaccine.GBS diagnosis has a strong impact on reducing subsequent vaccination even though there is no warning or precaution about future vaccines for most patients diagnosed with GBS. These data suggest discordance between clinical practice and current vaccine recommendations. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions High‐intensity end‐of‐life (EOL) care, marked by admission to intensive care units (ICUs) or in‐hospital death, can be costly and burdensome. Recent trends in use of ICUs, life‐sustaining treatments (LSTs), and noninvasive ventilation (NIV) during EOL hospitalizations among older adults with advanced cancer and patterns of in‐hospital death are unknown.We used SEER‐Medicare data (2003–2017) to identify beneficiaries with advanced solid cancer (summary stage 7) who died within 3 years of diagnosis. We identified EOL hospitalizations (within 30 days of death), classifying them by increasing intensity of care into: (1) without ICU; (2) with ICU but without LST (invasive mechanical ventilation, tracheostomy, gastrostomy, acute dialysis) or NIV; (3) with ICU and NIV but without LST; and (4) with ICU and LST use. We constructed a multinomial regression model to evaluate trends in risk‐adjusted hospitalization, overall and across hospitalization categories, adjusting for sociodemographics, cancer characteristics, comorbidities, and frailty. We evaluated trends in in‐hospital death across categories.Of 226,263 Medicare beneficiaries with advanced cancer, 138,305 (61.1%) were hospitalized at EOL [Age, Mean (SD):77.9(7.1) years; 45.5% female]. Overall, EOL hospitalizations remained high throughout, from 78.1% (95% CI: 77.4, 78.7) in 2004 to 75.5% (95% CI: 74.5, 76.2) in 2017. Hospitalizations without ICU use decreased from 49.3% (95% CI: 48.5, 50.2) to 35.0% (95% CI: 34.2, 35.9) while hospitalizations with more intensive care increased, from 23.7% (95% CI: 23.0, 24.4) to 28.7% (95% CI: 27.9, 29.5) for ICU without LST or NIV, 0.8% (95% CI: 0.6, 0.9) to 3.8% (95% CI: 3.4, 4.1) for ICU with NIV but without LST, and 4.3% (95% CI: 4.0, 4.7) to 8.0% (95% CI: 7.5, 8.5) for ICU with LST use. Among those who experienced in‐hospital death, the proportion receiving ICU care increased from 46.5% to 65.0%.Among older adults with advanced cancer, EOL hospitalization rates remained stable from 2004–2017. However, intensity of care during EOL hospitalizations increased as evidenced by increasing use of ICUs, LSTs, and NIV. [ABSTRACT FROM AUTHOR]

Since their inception in 1975, the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers (GRECCs) have served as incubators of innovation in geriatrics. Their contributions to the VA mission were last reviewed in 2012. Herein, we describe the continuing impact of GRECCs in research, clinical, and educational areas, focusing on the period between 2018 and 2022. GRECC research spans the continuum from bench to bedside, with a growing research portfolio notable for highly influential publications. GRECC education connects healthcare professions trainees and practicing clinicians, as well as Veterans and their caregivers, to engaging learning experiences. Clinical advancements, including age‐friendly care, span the continuum of care and leverage technology to link disparate geographical sites. GRECCs are uniquely positioned to serve older adults given their alignment with the largest integrated health system in the United States and their integration with academic health centers. As such, the GRECCs honor Veterans as they age by building VA capacity to care for the increasing number of aging Veterans seeking care from VA. GRECC advancements also benefit non‐VA healthcare systems, their academic affiliates, and non‐Veteran older adults. GRECCs make invaluable contributions to advancing geriatric and gerontological science, training healthcare professionals, and developing innovative models of geriatric care. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions More than one‐fourth of older adults with cognitive impairment (CI) live alone; these individuals often lack support for medication management and face a high risk of adverse drug events. We characterized the frequency and types of high‐risk medications used by older adults with CI living alone and, for context, compared patterns with those in older adults with CI living with others.This was a cross‐sectional study of National Health and Aging Trends Study (NHATS) data and Medicare claims (2015–2017). We ascertained cognitive status from NHATS and medication use with Part D claims. We compared high‐risk medication use (those with adverse cognitive effects or low tolerance for misuse) among older adults with CI living alone versus living with others using logistic regression models adjusted for demographic/clinical factors.The unweighted sample included 1569 older adults with CI, of whom 491 (weighted national estimate, 31%) were living alone. In the living‐alone group, the mean age was 79.9 years and 66% were female, 64% reported managing medications on their own without difficulty, 14% reported managing medications on their own with difficulty, and 18% received total support with medication management. Older adults with CI living alone used a median of 5 medications (IQR, 3–8), 16% took ≥10 medications, and 46% took ≥1 high‐risk medication (anticholinergic/sedating: 24%; opioid: 13%; anticoagulant: 10%; sulfonylurea: 10%; insulin: 9%). Compared with those living with others, the use of high‐risk medications was similar (p > 0.05 for unadjusted/adjusted comparisons). Those living alone were more likely both to take at least one high‐risk medication and not receive help with medication management: 34% in those living alone versus 23% living with others (p < 0.05 for unadjusted/adjusted comparisons).Older adults with CI living alone use many medications; nearly half use high‐risk medications. Our findings can inform medication optimization interventions supporting this vulnerable population. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Social isolation and loneliness are pervasive issues among older adults in the United States, carrying significant health risks. Low‐income older adults are particularly vulnerable to these challenges compared with their higher‐income counterparts due to their limited access to resources and social networks. Many low‐income older adults live in subsidized housing, which has the potential to offer unique support tailored to their needs. The intersection of aging and the unique social circumstances faced by low‐income older adults significantly influences how they navigate crises.We conducted semi‐structured interviews with 24 older adults aged 63–86 residing in subsidized housing communities in the United States. The data were collected from August 2021 to November 2022 and subsequently analyzed using a thematic constant comparison analysis approach.Many participants felt connected to their housing community. Participants reported that their lives changed substantially due to the pandemic: communal activities ceased leading to isolation and feelings of loneliness. Amid this challenge, participants were resourceful and found creative ways to manage. Many emphasized the crucial role of technology in maintaining emotional support despite physical separation.Participants in subsidized housing shared their experiences before and during this unique crisis highlighting the challenges they face, as well as their resilience and adaptability when facing challenges. Our findings underscore the significance of community activation, demonstrating that activities motivated older adults to improve their well‐being. Additionally, the role of technology in maintaining connections proved to be crucial. [ABSTRACT FROM AUTHOR]

This research letter presents a study conducted in Norway that examines the connection between cognitive function and oral health in older adults. The study reveals that there may be a potential link between cognitive function and the number of decayed teeth, as participants with neurocognitive disorders (NCDs) had a slightly higher average number of decayed teeth compared to those with normal cognitive function. However, this association was not statistically significant. The study emphasizes the need for further research to gain a better understanding of the relationship between cognitive function and oral health in older adults. It also suggests that poor cognitive function may contribute to neglected self-care, resulting in poorer oral hygiene and oral health in older individuals. However, it is important to note that the sample size of the study was small, which may have led to less precise estimates. The study underscores the importance of improving oral health care for older adults with NCDs. [Extracted from the article]

This article explores the use of precision medicine and patient-centered outcomes in prevention clinical trials for older adults. It specifically focuses on the association between apolipoprotein E (APOE) genotypes and the incidence of dementia, disability, and all-cause mortality in older adults. The study finds that carrying the APOE ε4 allele is associated with an increased risk of developing dementia and disability, while carrying the APOE ε2 genotype is associated with a non-significant decrease in risk. The article emphasizes the importance of considering broader genetic risk factors, like APOE, in trials aimed at preventing dementia and disability in older adults, and suggests that future trials should consider multi-domain interventions. Overall, the study supports the evaluation of APOE and genetics in maintaining functional independence and highlights the complexity of designing trials with composite outcomes. [Extracted from the article]

Background Methods Results Conclusions With changing cognitive abilities, individuals with mild cognitive impairment (MCI) and dementia face challenges in successfully managing multidrug regimens. We sought to understand how individuals with MCI or dementia and their family caregivers manage multidrug regimens and better understand patient‐to‐caregiver transitions in medication management responsibilities.We conducted qualitative interviews among patient–caregiver dyads. Eligibility included: patients with a diagnosis of MCI, mild or moderate dementia, managing ≥3 chronic conditions, ≥5 prescription medications, who also had a family caregiver ≥18 years old. Semi‐structured interview guides, informed by the Medication Self‐Management model, ascertained roles and responsibilities for medication management and patient‐to‐caregiver transitions in medication responsibilities.We interviewed 32 patient–caregiver dyads. Older adults and caregivers favored older adult autonomy in medication management, and individuals with MCI and mild dementia largely managed their medications independently using multiple strategies (e.g., establishing daily routines, using pillboxes). Among individuals with moderate dementia, caregivers assumed all medication‐related responsibilities except when living separately. In those scenarios, caregivers set up organizers and made reminder calls, but did not observe family members taking medications. Patient‐to‐caregiver transitions in medication responsibilities frequently occurred after caregivers observed older adults making errors with medications. As caregivers sought to assume greater responsibilities with family members' medicines, they faced multiple barriers. Most barriers were dyadic; they affected both the older adult and the caregiver and/or the relationship. Some barriers were specific to caregivers; these included caregivers' competing responsibilities or inaccurate perceptions of dementia, while other barriers were related to the healthcare system.To ease medication management transitions, balance must be sought between preservation of older adult autonomy and early family caregiver involvement. Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion The intersection of ageism and racism is underexplored in geriatric emergency medicine (GEM) research.We performed a scoping review of research published between January 2016 and December 2021. We included original emergency department‐based research focused on falls, delirium/dementia, medication safety, and elder abuse. We excluded manuscripts that did not include (1) original research data pertaining to the four core topics, (2) older adults, (3) subjects from the United States, and (4) for which full text publication could not be obtained. The primary objective was to qualitatively describe reporting about older adults' social identities in GEM research. Secondary objectives were to describe (1) the extent of inclusion of minoritized older adults in GEM research, (2) GEM research about health equity, and (3) feasible approaches to improve the status quo of GEM research reporting.After duplicates were removed, 3277 citations remained and 883 full‐text articles were reviewed, of which 222 met inclusion criteria. Four findings emerged. First, race and ethnicity reporting was inconsistent. Second, research rarely provided a rationale for an age threshold used to define geriatric patients. Third, GEM research more commonly reported sex than gender. Fourth, research commonly excluded older adults with cognitive impairment and speakers of non‐English primary languages.Meaningful assessment of GEM research inclusivity is limited by inconsistent reporting of sociodemographic characteristics, specifically race and ethnicity. Reporting of sociodemographic characteristics should be standardized across different study designs. Strategies are needed to include in GEM research older adults with cognitive impairment and non‐English primary languages. [ABSTRACT FROM AUTHOR]

This article explores the connection between peripheral neuropathy (PN), gait speed, and lower extremity function in older adults, both with and without diabetes. The study reveals that PN is linked to slower gait speed and impaired lower extremity function in both groups. These findings indicate the importance of screening for PN to identify individuals at risk for negative outcomes, even in older adults without diabetes. The study emphasizes the need for additional research on the impact of PN on lower extremity function in older adults. [Extracted from the article]

Background Methods Results Conclusion Pain is ubiquitous, yet understudied. The objective of this study was to analyze inequities in pain assessment and management for hospitalized older adults focusing on demographic and geriatric‐related variables.This was a retrospective cohort study from January 2013 through September 2021 of all adults 65 years or older on the general medicine service at UCSF Medical Center. Primary exposures included (1) demographic variables including race/ethnicity and limited English proficiency (LEP) status and (2) geriatric‐related variables including age, dementia or mild cognitive impairment diagnosis, hearing or visual impairment, end‐of‐life care, and geriatrics consult involvement. Primary outcomes included (1) adjusted odds of numeric pain assessment versus other assessments and (2) adjusted opioids administered, measured by morphine milligram equivalents (MME).A total of 15,809 patients were included across 27,857 hospitalizations with 1,378,215 pain assessments, with a mean age of 77.8 years old. Patients were 47.4% White, 26.3% with LEP, 49.6% male, and 50.4% female. Asian (OR 0.75, 95% CI 0.70–0.80), Latinx (OR 0.90, 95% CI 0.83–0.99), and Native Hawaiian or Pacific Islander (OR 0.77, 95% CI 0.64–0.93) patients had lower odds of a numeric assessment, compared with White patients. Patients with LEP (OR 0.70, 95% CI 0.66–0.74) had lower odds of a numeric assessment, compared with English‐speaking patients. Patients with dementia, hearing impairment, patients 75+, and at end‐of‐life were all less likely to receive a numeric assessment. Compared with White patients (86 MME, 95% CI 77–96), Asian patients (55 MME, 95% CI 46–65) received fewer opioids. Patients with LEP, dementia, hearing impairment and those 75+ years old also received significantly fewer opioids.Older, hospitalized, general medicine patients from minoritized groups and with geriatric‐related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment. [ABSTRACT FROM AUTHOR]

Background Design and Setting Participants and Methods Results Conclusion Older women experience more adverse drug reactions (ADRs) than older men. However, the underlying basis for this sex difference is unclear. Sex (biological status) and/or gender (sociocultural constructs) influences on patterns of inappropriate prescribing in multimorbid older adults may be one reason for this ADR sex difference. In this secondary analysis, we examined whether incident ADR sex differences could be related to concurrent sex differences in potentially inappropriate prescribing.A retrospective secondary analysis of sex differences in the prevalence of potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs), and ADRs among the 1537 participants (47.2% female, median [IQR] age 78 [72–84] years) was undertaken in the SENATOR clinical trial database, conducted in six large European medical centers.We looked specifically for male/female differences relating to PIMs and PPOs (defined by STOPP/START version 2 criteria) identified within 48 h of acute hospitalization. We also assessed sex differences for ADRs identified at 14 days from admission or discharge, whichever came first. ADRs were assessed by blinded endpoint adjudication panel consensus.During hospitalization, significantly more females experienced ≥1 ADR compared to males (28% and 21%, respectively; odds ratio 1.40, 95% CI 1.10–1.78, p < 0.005). Nine of the 11 STOPP‐criteria PIMs showing a significant sex difference occurred more often in females. Of the four START‐criteria PPOs showing a significant sex difference, all occurred more often in females. Some sex‐associated PIMs reflect higher prevalence of related conditions in older women.We conclude that specific STOPP‐criteria PIMs and START‐criteria PPOs were identified more frequently in older women than older men during acute hospitalization, possibly contributing to higher ADR incidence in older women. Prescribers should appreciate sex differences in exposure to potentially inappropriate prescribing and ADR risk, given the preponderance of older women over older men in most clinical settings. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Sleep aids are commonly prescribed to treat sleep disturbance, a modifiable risk factor for postoperative delirium in older patients. The use of melatonin receptor agonists in the postoperative period has been increasing. The comparative safety of melatonin receptor agonists, zolpidem, and temazepam remains uncertain.This retrospective study included 22,083 patients ≥65 years old who initiated melatonin receptor agonists, zolpidem, or temazepam after major surgery in the Premier Healthcare Database 2009–2018. We performed propensity score‐based overlap weighting and estimated the risk ratio (RR) and risk difference (RD) of postoperative delirium as the primary outcome and a composite of delirium or new antipsychotic initiation, pneumonia, and in‐hospital mortality as secondary outcomes.The mean age of the study population was 78 (SD, 7) years and 50% were female. There was no significant difference in the risk of postoperative delirium among patients treated with melatonin receptor agonists (3.4%, reference group), zolpidem (2.9%; RR [95% CI], 0.9 [0.7–1.2]; RD [95% CI] per 100 persons, −0.3 [−1.1 to 0.6]), and temazepam (3.1%; 0.9 [0.7–1.1]; RD [95% CI] per 100 persons, −0.5 [−1.2 to 0.3]). The risks of delirium or new antipsychotic initiation, pneumonia, and in‐hospital mortality were also similar among all groups.Melatonin receptor agonists were not associated with a lower risk of postoperative delirium and other adverse outcomes compared with zolpidem and temazepam in older adults after major surgery. [ABSTRACT FROM AUTHOR]

This article emphasizes the importance of recognizing and supporting family caregivers in the United States. It discusses the challenges faced by caregivers and the need for healthcare systems and clinicians to address their needs. The article suggests different approaches to geriatric care, such as person-centered and caregiver-centered care, and highlights the need for cultural change in the healthcare system to better support caregivers. It concludes by suggesting ways to incorporate these approaches into evaluation and treatment plans. [Extracted from the article]

This research letter summarizes a study that investigates the connection between cerebrovascular function and cognitive-balance dual-task behavior in older adults. The study reveals that maintaining higher cerebral blood flow velocity (CBFv) is associated with better cognitive and balance function in older adults. Furthermore, individuals with higher CBFv prioritize balance control over cognitive performance. These findings suggest that cerebrovascular health may be important for maintaining cognitive and balance abilities in older adults. Further research is needed to fully understand the impact of aging on the relationship between cerebrovascular function and dual-task performance. [Extracted from the article]

Background: Multiple short delirium detection tools have been validated in research studies and implemented in routine care, but there has been little study of these tools in real‐world conditions. This systematic review synthesized literature reporting completion rates and/or delirium positive score rates of detection tools in large clinical populations in general hospital settings. Methods: PROSPERO (CRD42022385166). Medline, Embase, PsycINFO, CINAHL, and gray literature were searched from 1980 to December 31, 2022. Included studies or audit reports used a validated delirium detection tool performed directly with the patient as part of routine care in large clinical populations (n ≥ 1000) within a general acute hospital setting. Narrative synthesis was performed. Results: Twenty‐two research studies and four audit reports were included. Tools used alone or in combination were the Confusion Assessment Method (CAM), 4 'A's Test (4AT), Delirium Observation Screening Scale (DOSS), Brief CAM (bCAM), Nursing Delirium Screening Scale (NuDESC), and Intensive Care Delirium Screening Checklist (ICDSC). Populations and settings varied and tools were used at different stages and frequencies in the patient journey, including on admission only; inpatient, daily or more frequently; on admission and as inpatient; inpatient post‐operatively. Tool completion rates ranged from 19% to 100%. Admission positive score rates ranged from: CAM 8%–51%; 4AT 13%–20%. Inpatient positive score rates ranged from: CAM 2%–20%, DOSS 6%–42%, and NuDESC 5–13%. Postoperative positive score rates were 21% and 28% (4AT). All but two studies had moderate–high risk of bias. Conclusions: This systematic review of delirium detection tool implementation in large acute patient populations found clinically important variability in tool completion rates, and in delirium positive score rates relative to expected delirium prevalence. This study highlights a need for greater reporting and analysis of relevant healthcare systems data. This is vital to advance understanding of effective delirium detection in routine care. [ABSTRACT FROM AUTHOR]

The article discusses the increased risk of medication nonadherence and administration errors among older adults living alone with cognitive impairment. It highlights that one quarter of older adults with cognitive impairment live alone, mostly women without support for medication management. The study compares high-risk medication use among older adults living alone versus those living with others and finds that living alone is associated with being prescribed high-risk medication and not receiving help with medication management. The study emphasizes the need for support and interventions to improve medication adherence and administration in this population. The document also includes references to three different studies related to medication adherence in the elderly, assistive technology and telecare for people with dementia, and dementia care, providing valuable insights into these topics for library patrons conducting research. [Extracted from the article]

A systematic review of studies on the effects of discontinuing statin medication on clinical outcomes found limited evidence and a high degree of uncertainty. While one randomized trial conducted in people near the end of life showed no difference in mortality rates between those who discontinued statins and those who continued, nonrandomized studies in people not near the end of life showed a higher risk of mortality and cardiovascular events with statin discontinuation. However, there were concerns about bias and the quality of the studies. The review also highlighted the discordance among guidelines on the benefit of statins in older adults and the lack of evidence on potential harms and patient-centered outcomes. The authors emphasized the need for robust observational studies using state-of-the-art design and statistical methods to inform shared decision-making on statin discontinuation. [Extracted from the article]

The article titled "A single item screen for clinically significant insomnia symptoms in community-living older adults" discusses a study that developed a screening tool for identifying clinically significant insomnia symptoms in older adults. The study found that a single question about sleep quality was effective in identifying those with insomnia symptoms. This information is valuable for researchers and healthcare professionals working with older adults and insomnia. [Extracted from the article]

This research letter discusses the care settings for older adults after participating in a transitional care model program in a fully integrated healthcare system. The study found that about half of the participants who received services in the program returned to care with their primary care provider in an office setting, while the other half transitioned to different care settings. Some participants went to home-based primary care, hospice, or long-term care facilities. These findings are important for fully integrated healthcare systems to effectively plan for the needs of high-risk older adults and control healthcare costs. [Extracted from the article]

Background: Blood pressure (BP) postural changes, both orthostatic hypotension (OHYPO) and orthostatic hypertension (OHYPER) are common in older adults. Few studies have investigated their association with cognition, particularly for OHYPER, an emerging cardiovascular risk factor. We aimed to assess the association between OHYPO, OHYPER and cognition in non‐institutionalized older subjects. Methods: The S.AGES (Sujets ÂGES, Aged Subjects) cohort followed every 6 months for 3 years non‐institutionalized subjects aged ≥65 years without dementia at inclusion, in France. OHYPO and OHYPER were respectively defined as a fall or an increase of ≥20 mmHg in systolic BP and/or ≥10 mmHg in diastolic BP after standing from a sitting position. Cognition was assessed using the Mini‐Mental State Examination (MMSE). Linear mixed models were used for the analyses. Results: Among the 3170 subjects included (mean age 78 years, 56% women), 209 (6.5%) had OHYPO and 226 (7.1%) had OHYPER at baseline. After adjustment for demographics, cardiovascular risk factors and disease, seated SBP/DBP and BP lowering treatment, mean MMSE was 0.52 point lower in participants with OHYPER compared to those with normal BP postural changes (β adjusted [95% CI] = −0.52 [−0.96; −0.09], p = 0.02) and 0.50 point lower in participants with OHYPO compared to those with normal BP postural changes (β adjusted [95% CI] = −0.50 [−0.95; −0.06], p = 0.03). Sensitivity analyses showed a dose–response relationship between OHYPO and cognition. Conclusion: Although the absolute differences in MMSE were small, both OHYPO and OHYPER were associated with lower cognition. Orthostatic BP measurements could help identify patients with risk of cognitive impairment. Further studies are needed to assess whether controlling orthostatic BP could be a promising interventional target in preserving cognition among older adults. [ABSTRACT FROM AUTHOR]