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OBJECTIVES: Decline in physical function is associated with older age. Healthcare utilization and expenditures related to physical functioning declines will likely increase as the proportion of the population of older adults rises. This study evaluated resource utilization associated with differences in physical functioning in a nationally representative sample of older adults. DESIGN: A retrospective panel study nationally representative for 26 809 552 older adults in the United States. SETTING: Medical Expenditure Panel Survey (MEPS) data from 2013 to 2014. PARTICIPANTS: Adults aged 70 years or older who completed both rounds of the Self‐Administered Questionnaire in MEPS. MEASUREMENTS: Physical Component Score (PCS) from the Short‐Form Health Survey as a measure of physical functioning was stratified into quartiles. Healthcare utilization (count of medical visits by setting) and total expenditures were assessed during and after the PCS measurements. Generalized linear mixed models, adjusted for demographic and clinical covariates, estimated the relationship between healthcare utilization and physical functioning. RESULTS: The lowest functional status (Q1) was associated with significantly increased healthcare utilization of emergency department, inpatient, home health, outpatient, and total medical visits compared with the three higher quartiles groups (P <.001, all). When compared with the lowest functioning group (Q1), the percentage savings for direct healthcare expenditures were 26.7% (95% confidence interval [CI] = 7.8‐41.7) in Q2, 50.1% (95% CI = 35.6‐61.4) in Q3, and 65.2% (95% CI = 54.7‐73.2) in Q4. Similarly, there were 10.4% (95% CI = 9.2‐11.7), 11.9% (95% CI = 10.5‐13.6), and 14.0% (95% CI = 2.2%‐15.9%) reductions in total medical visits, respectively. CONCLUSION: Lower physical functioning was associated with higher healthcare utilization and expenditures. These estimates are conservative because they do not capture long‐term care utilization due to the nature of MEPS. These results can be used to benchmark other healthcare resource benefits of interventions to maintain or improve physical functioning in older adults in noninstitutionalized settings. J Am Geriatr Soc 68:266–271, 2020 See related editorial by Resnick et al. in this issue. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hospital‐acquired disability (HAD) is common and often related to low physical activity while in the hospital. OBJECTIVE: To examine whether wearable hospital activity trackers can be used to predict HAD. DESIGN: A prospective observational study between January 2016 and March 2017. SETTING: An academic medical center. PARTICIPANTS: Community‐dwelling older adults, aged 60 years or older, enrolled within 24 hours of admission to general medicine (n = 46). MAIN MEASURES: Primary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late‐Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle‐mounted accelerometers. The association of the literature‐based threshold of 900 steps/day with HAD was also evaluated. RESULTS: Mean age was 73.2 years (SD = 9.5 years), 48% were male, and 76% were white. Median length of stay was 4 days (interquartile range [IQR] = 2.0‐6.0 days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7‐1.7 h/d) and 1455.7 steps/day (IQR = 908.5‐2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P =.04) and fewer step counts (1186 vs 1808 steps/day; P =.04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD. CONCLUSIONS: Low hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs. J Am Geriatr Soc 68:261–265, 2020 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Data on the virologic response and tolerability of direct‐acting antivirals (DAAs) are lacking in older people because these individuals are underrepresented in clinical trials. This study aimed to assess the effectiveness and tolerability of DAA regimens in older individuals in a large cohort of real‐life clinical practice. METHODS: In this retrospective study, patients with chronic hepatitis C infection between 2017 and 2018 were divided into patients aged 65 years and older and those younger than 65 years. We evaluated the sustained virologic response rates (SVRs) in both groups. Further subgroup analyses on the SVRs for patients aged 65 to 74, 75 to 84, and 85 years and older were performed. We also analyzed the predictors of treatment response in older individuals. RESULTS: Among 1151 eligible patients, 516 were in the older group and 635 were in the younger group. The overall treatment response in the entire cohort was 97.7%. A significantly higher percentage of patients presented with advanced stages of fibrosis in the older group (53.1% vs 39.5%; P = <.001). The SVR rates were similar between the two groups (98.3% vs 97.7%; P =.18). In multivariate models, age was not predictive of SVR after adjusting for confounders. Subgroup analyses in the age groups of 65 to 74, 75 to 84, and older than 85 years showed similar treatment response rates (97.4%, 97.2%, and 86.7, respectively; P =.06) and advanced fibrosis (50.8%, 61.5%, and 53.3%, respectively; P =.14). CONCLUSION: Although older people exhibit a significantly higher frequency of fibrosis, DAAs produce high rates of SVR in all age groups, and the age of the patient does not seem to have a significant impact on the efficacy of DAAs including patients in the oldest age category (≥75 y). Treatment should not be withheld in older individuals. J Am Geriatr Soc 68:379–387, 2020 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Neuropsychiatric symptoms are common in dementia. Limited data are available concerning their association with dementia in developing countries. Our aim was to describe the severity of neuropsychiatric symptoms among older people, evaluate the distress experienced by caregivers, and assess which neuropsychiatric symptoms were specifically associated with dementia among older adults in Central Africa. DESIGN: This study is part of the EPIDEMCA program, a cross‐sectional multicenter population‐based study. SETTING: The EPIDEMCA program was conducted from November 2011 to December 2012 in urban and rural areas of the Central African Republic and the Republic of the Congo. PARTICIPANTS: Participants were older people (≥65 y) included in the EPIDEMCA program who underwent a neuropsychiatric evaluation. The sample included overall 532 participants, of whom 130 participants had dementia. MEASUREMENTS: Neuropsychiatric symptoms were assessed with the brief version of the Neuropsychiatric Inventory including the evaluation of severity and associated distress. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, criteria were followed to diagnose dementia. A logistic regression model was used to identify associated neuropsychiatric symptoms. RESULTS: The prevalence of neuropsychiatric symptoms was 89.9% (95% confidence interval = 84.6‐95.1) among people living with dementia. The overall median severity score for neuropsychiatric symptoms was 9 [interquartile range [IQR] = 6‐12], and the overall median distress score was 7 [IQR = 4‐10]. Overall median scores of both severity and distress were significantly increased with the number of neuropsychiatric symptoms, the presence of dementia, and dementia severity. Depression, delusions, apathy, disinhibition, and aberrant motor behavior were associated with dementia after multivariate analysis. CONCLUSION: This report is one of the few population‐based studies on neuropsychiatric symptoms among older people with dementia in Sub‐Saharan Africa and the first one evaluating the severity of those symptoms and distress experienced by caregivers. Individual neuropsychiatric symptoms were strongly associated with dementia in older people and require great attention considering their burden on populations. J Am Geriatr Soc 68:180–185, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Use of objectively measured physical activity (PA) in older adults to assess relationship between PA and risk of all‐causes mortality is scarce. This study evaluated the associations of PA based on accelerometry and a questionnaire with the risk of mortality among older adults from a city in Southern Brazil. DESIGN: A cohort study. SETTING: Urban area of Pelotas, Southern Brazil. PARTICIPANTS: A representative sample of older adults (≥60 y) from Pelotas, enrolled in 2014. MEASUREMENTS: Overall physical activity (mg), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were estimated by raw accelerometer data. The International Physical Activity Questionnaire estimated leisure time and commuting PA. Hazard ratios (excluding deaths in the first 6 mo) stratified by sex were estimated by Cox regression analysis considering adjustment for confounders. RESULTS: From the 1451 older adults interviewed in 2014, 145 died (10%) after a follow‐up of an average 2.6 years. Men and women in the highest tertile of overall PA had on average a 77% and 92% lower risk of mortality than their less active counterparts (95% confidence interval [CI] =.06‐.84 and 95% CI =.01‐.65, respectively). The highest tertile of LPA was also related to a lower risk of mortality in individuals of both sexes (74% and 91% lower risk among men and women, respectively). MVPA statistically reduced the risk of mortality only among women (hazard ratio [HR] =.30 and HR =.07 in the second and third tertiles). Self‐reported leisure‐time PA was statistically associated with a lower risk of mortality only among men. Women in the highest tertiles of commuting PA showed a lower risk of mortality than those in the reference group. CONCLUSION: Accelerometry‐based PA was associated with a lower risk of mortality among Brazilian older adults. Older individuals should practice any type of PA. J Am Geriatr Soc 68:137–146, 2019 [ABSTRACT FROM AUTHOR]

Improving the quality of medication use and medication safety is an important priority for prescribers who care for older adults. The objective of this article was to identify key articles from 2018 that address these issues. In addition, we selected four of these articles to annotate, critique, and discuss their broader implications for clinical practice. The first study highlights a cluster‐randomized trial that utilized a pharmacist‐led education‐based intervention delivered to both patients and physicians to deprescribe four types of inappropriate medications (sedative‐hypnotics, first‐generation antihistamines, selective nonsteroidal anti‐inflammatory drugs, and glyburide). The second study, a nested case‐control study using data from within the UK Clinical Practice Research Datalink, examined the association between anticholinergic exposure, overall and by anticholinergic medication class, and dementia risk in 40 770 older adults. The third study, a longitudinal cohort study of 1028 Swedish older adults, examined the association between antihypertensive medications and incident dementia. The last study was a randomized, double‐blind, placebo‐controlled trial that investigated the effect of daily low‐dose aspirin (100 mg) for primary prevention on cardiovascular events and major hemorrhage in 19 144 community‐dwelling older adults. Collectively, this current article provides insight into the pertinent topics of medication use quality and safety in older adults and helps raise awareness about optimal prescribing in older adults. J Am Geriatr Soc 67:2458–2462, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: To estimate the rate of and risk factors associated with cost‐related medication nonadherence among older adults. DESIGN: Cross‐sectional analysis of the 2017 National Health Interview Survey (NHIS). SETTING: Nationally representative health interview survey in the United States. PARTICIPANTS: Survey respondents, aged 65 years or older (n = 5701 unweighted) in the 2017 wave of the NHIS. MEASUREMENTS: Self‐reported, cost‐related medication nonadherence (due to cost: skip dose, reduce dose, or delay or not fill a prescription) and actions taken due to cost‐related medication nonadherence (ask for lower‐cost prescription, use alternative therapy, or buy medications from another country) were quantified. We used a series of multivariable logistic regression analyses to identify factors associated with cost‐related medication nonadherence. We also reported analyses by chronic disease subgroups. RESULTS: In 2017, 408 (6.8%) of 5901 older adults, representative of 2.7 million older adults nationally, reported cost‐related medication nonadherence. Among those with cost‐related medication nonadherence, 44.2% asked a physician for lower‐cost medications, 11.5% used alternative therapies, and 5.3% bought prescription drugs outside the United States to save money. Correlates independently associated with a higher likelihood of cost‐related medication nonadherence included: younger age, female sex, lower socioeconomic levels (eg, low income and uninsured), mental distress, functional limitations, multimorbidities, and obesity (P < .05 for all). Similar patterns were found in subgroup analyses. CONCLUSION: Cost‐related medication nonadherence among older adults is increasingly common, with several potentially modifiable risk factors identified. Interventions, such as medication therapy management, may be needed to reduce cost‐related medication nonadherence in older adults. J Am Geriatr Soc 67:2463–2473, 2019 See related editorial by Claire Easthall [ABSTRACT FROM AUTHOR]

OBJECTIVES: Insomnia, especially difficulty maintaining sleep, is prevalent among older adults and increases the incidence of falls and fractures. Moreover, the drugs used to treat it exacerbate the risk. Yet current therapies fail to address one of its most common causes in older adults: nocturia and its primary contributor, nocturnal polyuria (NP), especially among the majority of individuals without lower urinary tract symptoms (LUTS). Therefore, we examined the factors associated with nocturia in two groups of such older women and the impact of nocturia on sleep. DESIGN: Secondary analysis of two observational studies of bladder function in carefully evaluated healthy older women. SETTING: Academic medical center. PARTICIPANTS: A total of 39 women without LUTS who had adequate fluid intake (ie, >1200 mL urine output/24 h recorded on their diary), normal videourodynamic testing, and normal daytime frequency (≤7 voids). MEASUREMENTS: Voided volumes and sleep duration obtained from subjects' 3‐day voiding diary, and sleep quality from the Center for Epidemiologic Studies Depression Scale. Nighttime excretion of more than 33% of 24‐hour urine volume was considered NP. RESULTS: Overall, 21 of these healthy subjects (54%) awakened at least once nightly to void, and 19 (90%) of them had NP. Compared with those without nocturia, participants with nocturia had shorter duration of the first uninterrupted sleep period (182 ± 100 vs 250 ± 60 min; P =.03), and they reported worse sleep quality. Two factors contributed independently to nocturia: (1) a larger proportion of 24‐hour urine output at night (43.4 ± 7.4% vs 25.4 ± 5.5%; P = <.001) and (2) smaller bladder capacity (484 ± 157 mL vs 608 ± 167 mL; P =.02). CONCLUSIONS: Nocturia, NP, and reduced bladder capacity are very common even in healthy older women without LUTS and are associated with impaired sleep. Thus applying currently available modalities to address both NP and reduced bladder capacity may effectively treat sleep disruption without incurring the complications of sedative‐hypnotics. J Am Geriatr Soc 67:2610–2614, 2019 [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Elevated low‐density lipoprotein cholesterol (LDL‐C) in early adulthood is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). The strength of the association between LDL‐C and ASCVD among older adults, however, is less understood. DESIGN: We examined individual‐level cohort data from the National Institutes of Health Pooled Cohorts (Framingham Study, Framingham Offspring Study, Multi‐Ethnic Study of Atherosclerosis, and Cardiovascular Health Study), which prospectively measured CVD risk factors and incident disease. SETTING: Prospective cohort study. PARTICIPANTS: Adults, aged 75 years or older, free of ASCVD. MEASUREMENTS: We evaluated the associations between LDL‐C and incident ASCVD (stroke, myocardial infarction, and cardiovascular death) in unadjusted analysis and in multivariable‐adjusted Cox proportional hazards models. We assessed 5‐year Kaplan‐Meier ASCVD event rates in patients with and without hyperlipidemia (LDL‐C ≥130 mg/dL or on lipid‐lowering medications), stratified by the number of other risk factors, including smoking, diabetes, and hypertension. RESULTS: We included 2667 adults, aged 75 years or older (59% female), free of ASCVD; median age was 78 years, with median LDL‐C of 117 mg/dL. In both unadjusted and adjusted analyses, there was no association between LDL‐C and ASCVD (adjusted hazard ratio = 1.022; 95% confidence interval = 0.998‐1.046; P =.07). Among adults without other risk factors (free of smoking, diabetes, and hypertension), event rates were similar between those with and without hyperlipidemia (Kaplan‐Meier rates = 5.8% and 7.0%, respectively). Among adults with one or two or more other risk factors, the presence of hyperlipidemia was also not associated with 5‐year CVD event rates (Kaplan‐Meier rates = 12.8% vs 15.0% [P =.44] for one other risk factor and 21.9% vs 24.0% [P =.59] for two or more other risk factors). CONCLUSION: Among a well‐characterized cohort, LDL‐C was not associated with CVD risk among adults aged 75 years or older, even in the presence of other risk factors. J Am Geriatr Soc 67:2560–2567, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Vision and hearing impairment may impact both life expectancy (LE) and health expectancy, that is, duration of life with and without health problems, among older adults. We examined the impact of self‐reported vision and hearing impairment on years of life with and without limitation in physical function and in activities of daily living (ADLs). DESIGN: Life table analysis, using a nationally representative longitudinal survey of community‐dwelling older adults aged 60 years or older, Panel on Health and Ageing of Singaporean Elderly. SETTING: Singapore. PARTICIPANTS: Survey participants (n = 3452) who were interviewed in 2009 and followed up in 2011‐2012 and 2015. MEASUREMENTS: Participants reporting difficulty with any of nine tasks involving upper or lower extremities were considered to have a limitation in physical function. Those reporting health‐related difficulty with any of six basic ADLs or seven instrumental ADLs were considered to have a limitation in ADLs. We used the multistate life table method with a microsimulation approach to estimate health expectancy, considering self‐reported sensory impairment status as time varying. RESULTS: Either or both impairments, vs neither, were associated with less years without limitation in physical function and in ADLs and more years with limitation in physical function and in ADLs, with the greatest impact on health expectancy among those with both impairments, who also had the lowest LE. For example, at age 60, those with both impairments, vs neither, could expect not only shorter LE (4.2 [95% confidence interval [CI] = 1.9‐5.7] less years; 20.7 [95% CI = 18.9‐22.5] vs 24.9 [95% CI = 23.8‐26.0]) but also more years of life with limitations in physical function (3.3 [95% CI =.9‐5.8] more years; 12.8 [95% CI = 10.7‐14.8] [about 61.7% of LE] vs 9.5 [95% CI = 8.4‐10.5] [about 38.0% of LE]). CONCLUSION: Timely and appropriate management of vision and hearing impairment, especially when coexisting, among older adults has the potential to reduce the years of life they live with limitation in physical function and in ADLs. J Am Geriatr Soc 67:2528–2536, 2019 [ABSTRACT FROM AUTHOR]

Objectives: Polypharmacy is associated with delirium, but the mechanisms for this connection are unclear. Our goal was to determine the frequency of supratherapeutic psychotropic drug levels (SPDLs) in older hospitalized patients and if it is associated with the duration of emergency department (ED) delirium. Design: Secondary analysis of a prospective cohort study. Setting: Tertiary care academic medical center. Participants: ED patients 65 years or older who were admitted to the hospital. Measurements: Delirium was assessed in the ED and during the first 7 days of hospitalization using the modified Brief Confusion Assessment Method. Drug concentrations were determined in serum samples collected at enrollment via a novel platform based on liquid chromatography–tandem mass spectrometry capable of identifying and quantitating 78 clinically approved medications including opioids, benzodiazepines, antidepressants, antipsychotics, and amphetamines. Patients with serum psychotropic drug concentrations above established reference ranges were considered supratherapeutic and have a SPDL. We performed proportional odds logistic regression to determine if SPDLs were associated with ED delirium duration adjusted for confounders. Medical record review was performed to determine if the doses of medications associated with SPDLs were adjusted at hospital discharge. Results: A total of 158 patients were enrolled; of these, 66 were delirious in the ED. SPDLs were present in 11 (17%) of the delirious and 4 (4%) of the non‐delirious ED patients. SPDLs were significantly associated with longer ED delirium duration (adjusted proportional odds ratio = 6.0; 95% confidence interval = 2.1‐17.3) after adjusting for confounders. Of the 15 medications associated with SPDLs, 9 (60%) were prescribed at the same or higher doses at the time of hospital discharge. Conclusion: SPDLs significantly increased the odds of prolonged ED delirium episodes. Approximately half of the medications associated with SPDLs were continued after hospital discharge at the same or higher doses. J Am Geriatr Soc 67:2387–2392, 2019 [ABSTRACT FROM AUTHOR]

Objectives: Long‐term acute care (LTAC) hospitals provide extended complex post–acute care to more than 120 000 Medicare beneficiaries annually, with the goal of helping patients to regain independence and recover. Because little is known about patients' long‐term outcomes, we sought to examine the clinical course after LTAC admission. Design: Nationally representative 5‐year cohort study using 5% Medicare data from 2009 to 2013. Setting: LTAC hospitals. Participants: Hospitalized Medicare fee‐for‐service beneficiaries 65 years of age or older who were transferred to an LTAC hospital. Measurements: Mortality, recovery (defined as achieving 60 consecutive days alive without inpatient care), time spent in an inpatient facility following LTAC hospital admission, receipt of an artificial life‐prolonging procedure (feeding tube, tracheostomy, hemodialysis), and palliative care physician consultation. Results: Of 14 072 hospitalized older adults transferred to an LTAC hospital, median survival was 8.3 months, and 1‐ and 5‐year survival rates were 45% and 18%, respectively. Following LTAC admission, 53% never achieved a 60‐day recovery. The median time of their remaining life a patient spent as an inpatient after LTAC admission was 65.6% (interquartile range = 21.4%‐100%). More than one‐third (36.9%) died in an inpatient setting, never returning home after the LTAC admission. During the preceding hospitalization and index LTAC admission, 30.9% received an artificial life‐prolonging procedure, and 1% had a palliative care physician consultation. Conclusion: Hospitalized older adults transferred to LTAC hospitals have poor survival, spend most of their remaining life as an inpatient, and frequently undergo life‐prolonging procedures. This prognostic understanding is essential to inform goals of care discussions and prioritize healthcare needs for hospitalized older adults admitted to LTAC hospitals. Given the exceedingly low rates of palliative care consultations, future research is needed to examine unmet palliative care needs in this population. J Am Geriatr Soc 67:2282–2288, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Valued life activities are those activities an individual deems particularly important or meaningful. Surgery in older adults can affect their ability to perform valued activities, but data are lacking. We characterized these activities and assessed performance of them following surgery. DESIGN: Retrospective observational study. SETTING: Preoperative program for older adults undergoing elective surgery at an academic hospital. PARTICIPANTS: Older adults (N = 194) in the program from February 2015 to February 2018. MEASUREMENTS: A preoperative written questionnaire asked, "What are the activities that are most important to you to be able to do when you return home from surgery?" Participants could list up to three activities. Content analysis was used to develop domains of valued life activities and categorize responses. Postoperative questionnaires and medical records were used to determine ability to perform activities 6 months after surgery. RESULTS: Of 194 participants (mean age = 74.9 ± 9.1 y), 57.7% were female; 33.5% had more than two comorbid conditions. We elicited 510 valued activities, with a mean of 2.6 (±.7) activities per participant. Content analysis revealed five categories: (1) recreational activities (28.9%); (2) mobility (24.9%); (3) activities of daily living (ADLs; 17.5%); (4) instrumental activities of daily living (IADLs; 16.9%); and (5) social activities (12.0%). Ultimately, 154 participants had surgery, of which 27.3% were unable to perform one of their valued activities at 6 months. Performance varied between activity categories; 91.9% of mobility activities, 90.8% of ADLs, 80.3% of IADLs, 77.3% of social activities, and 65.5% of recreational activities were able to be performed after surgery. CONCLUSION: Older adults expressed a wide range of valued life activities. More than one‐quarter were unable to engage in at least one valued life activity after surgery, with recreation the most commonly affected. Assessment of valued life activities should be incorporated into the perioperative management of older adults. J Am Geriatr Soc 67:2305–2310, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Prior studies of mortality following traumatic brain injury (TBI) have not focused specifically on older adults compared with a non‐TBI trauma cohort or included specific causes of death. The objectives of this study were, among adults aged 65 years and older, to (1) generate standardized mortality ratios (SMRs) by cause of death for TBI and a non‐TBI trauma cohort compared with a general population, and (2) assess risk of mortality associated with TBI compared with a non‐TBI trauma cohort. DESIGN: Retrospective cohort study of adults aged 65 years and older who were treated at an urban trauma center from 1997 to 2008. MEASUREMENTS: Data from the trauma registry were linked to the National Death Index through 2008 to obtain date and cause of death. We identified individuals with TBI and non‐TBI trauma and calculated age‐ and sex‐adjusted SMRs by comparing with the state general population. We next compared time to mortality between individuals with TBI (n = 852) and non‐TBI trauma (n = 1050), adjusting for potential confounders. RESULTS: Compared with the age‐ and sex‐adjusted state general population, older adults with TBI (SMR = 8.1; 95% confidence interval [CI] = 7.4‐9.0) and non‐TBI trauma (SMR = 6.7; 95% CI = 6.1‐7.4) were at a greatly increased risk of mortality. Highest SMRs in both cohorts were observed for accidents. In adjusted Cox regression models, TBI was not associated with increased risk of all‐cause mortality (hazard ratio = 1.03; 95% CI =.87‐1.23) compared with non‐TBI trauma. CONCLUSION: This study provides evidence that, over a 4‐year follow‐up of older adults, any moderate to severe injury is associated with increased mortality risk. Specifically, older injured adults are at high risk of death from accidental and therefore preventable causes, suggesting that intervention could reduce mortality. J Am Geriatr Soc 67:2382–2386, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Frailty places individuals at greater risk of adverse health outcomes. However, it is a dynamic condition and may not always lead to decline. Our objective was to determine the relationship between frailty status (at baseline and follow‐up) and mortality using both the frailty phenotype (FP) and frailty index (FI). DESIGN: Population‐based cohort. SETTING: Community‐dwelling older adults. PARTICIPANTS: A total of 909 individuals aged 65 years or older (55% female), mean age 74.4 (SD 6.2) years, had frailty measurement at baseline. Overall, 549 participants had frailty measurement at two time points. MEASUREMENTS: Frailty was measured using the FP and FI, with a mean 4.5 years between baseline and follow‐up. Mortality was matched to official death records with a minimum of 10 years of follow‐up. RESULTS: For both measures, baseline frailty was a significant predictor of mortality up to 10 years, with initially good predictive ability (area under the curve [AUC] =.8‐.9) decreasing over time. Repeated measurement at follow‐up resulted in good prediction compared with lower (AUC =.6‐.7) discrimination of equivalent baseline frailty status. In a multivariable model, frailty measurement at follow‐up was a stronger predictor of mortality compared with baseline. Frailty change for the Continuous FI was a significant predictor of decreased or increased mortality risk based on corresponding improvement or worsening of score (hazard ratio = 1.04; 95% confidence interval = 1.02‐1.07; P = .001). CONCLUSIONS: Frailty measurement is a good predictor of mortality up to 10 years; however, recency of frailty measurement is important for improved prediction. A regular review of frailty status is required in older adults. J Am Geriatr Soc 67:2311–2317, 2019 [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Implantable cardioverter‐defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are cardiac implantable electronic devices that may improve morbidity and mortality in select patients with heart failure. Although the benefits of these devices have been well defined, competing mortality risks, comorbid conditions, and frailty pose difficulty in determining risk‐benefit trade‐offs when these options are considered for older adults. CONCLUSION: In this review, we focus on the benefit, risk, and use of ICD and CRT in older adults, particularly because the goals of care for many older adults include a shift away from life‐prolonging interventions. Additionally, we discuss periprocedural risk, cost, and maintenance in older populations. Finally, we introduce a framework for helping clinicians and older adults make these challenging decisions collectively. J Am Geriatr Soc 67:2193–2199, 2019 [ABSTRACT FROM AUTHOR]

Objectives: Sedative and hypnotic medications are associated with harm, and guidelines suggest limiting their use. Only limited evidence has described how older adults are managed following an initial sleep disorder diagnosis. We aimed to describe clinical management patterns of sleep disorders in older women and men at the time of initial diagnosis. Design: Population‐based retrospective cohort study using linked administrative databases. Setting: Ontario, Canada. Participants: Community‐dwelling adults aged 66 and older, diagnosed with a new sleep disorder by a primary care provider (n = 30 729; 56% women and 44% men). We compared women and men for each outcome. Measurements: The primary outcome was prescription of a medication used for sleep within 30 days of a new sleep disorder diagnosis. Additional analysis included medical investigations such as sleep studies and visits to specialists who manage obstructive sleep disorders within 90 days of diagnosis. Results: Among the 30 729 older adults with a new sleep disorder diagnosis, 5512 (17.9% total; 18.8% of women and 16.9% of men) were prescribed a medication used for sleep. Compared with men, women were somewhat more likely to be prescribed at least one sedative medication (adjusted odds ratio = 1.09; 95% confidence interval = 1.03‐1.16). A total of 2573 (8.4%) older adults underwent a sleep study, and 3743 (12.2%) were evaluated by a specialist; both occurred more commonly in men. Conclusion: In our cohort, almost 1 in 5 older adults with a new sleep disorder diagnosis were prescribed a medication used for sleep; of these, a higher proportion were women. Comparatively few older adults were further evaluated; of these, a higher proportion were men. Our study highlights the high rates at which medications are prescribed to older adults with a new sleep disorder diagnosis and identifies potential sex differences in the management of such diagnoses. J Am Geriatr Soc 1–8, 2019. J Am Geriatr Soc 67:2094–2101, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long‐term effects of adherence to statins on mortality and cardiovascular morbidity among older adults. DESIGN: A historical population‐based cohort study using routinely collected data. SETTING: Clalit Health Services Northern District. PARTICIPANTS: We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years. MEASUREMENTS: We fitted Cox regression models to assess the association between the adherence to statin therapy and all‐cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time‐updated variables. RESULTS: The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All‐cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] =.66; 95% confidence interval [CI] =.56‐.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR =.80; 95% CI =.71‐.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men. CONCLUSION: Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex. J Am Geriatr Soc 67:2038–2044, 2019 [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: The goal of this study was to describe the pattern of statin adherence in older patients, aged 80 years or older; identify factors associated with high adherence; and determine the association between statin adherence and all‐cause mortality. DESIGN: Retrospective population‐based cohort study. SETTING: An integrated healthcare system in Southern California. PARTICIPANTS: Patients hospitalized with a principal diagnosis of acute myocardial infarction (MI) between January 1, 2006, and December 31, 2016. MEASUREMENTS: Statin adherence, as measured using pharmacy dispensing records over the 365 days following hospital discharge, based on proportion of days covered (PDC). Adherence levels were categorized as high (PDC 80% or higher), partial (PDC 40% or higher and lower than 80%), and low (PDC lower than 40%). RESULTS: Between 2006 and 2016, 5629 patients, 80 years or older, hospitalized for acute MI met the inclusion criteria. Among this group, 68.8% were highly adherent to statin therapy, 20.4% were partially adherent, and 10.8% were not adherent. Male sex (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.25‐1.62) and white race (OR = 1.35; 95% CI = 1.18‐1.55) were associated with high statin adherence. Follow‐up was 4.3 ± 2.6 years. Both low and partial adherence were associated with increase mortality (low adherence: adjusted hazard radio [HR] = 1.12; 95% CI = 1.01‐1.25; partial adherence: adjusted HR = 1.22; 95% CI = 1.12‐1.32). CONCLUSIONS: In older patients, aged 80 years or older, high adherence to statins after MI was associated with improved survival. This association may not have been due only to adherence to statins but to other related factors as well. Findings from this study may inform discussions on the potential benefits of statin adherence. J Am Geriatr Soc 67:2045–2049, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the prevalence of adverse childhood experiences (ACEs) and the associations of ACEs with psychiatric and substance use disorders among older adults in the United States. DESIGN: Cross‐sectional analysis of the 2012‐2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC‐III). SETTING: Nationally representative drug‐related health interview survey in the United States. PARTICIPANTS: Survey respondents aged 65 or older (n = 5806 unweighted). MEASUREMENTS: ACEs, the key independent variable, were assessed using validated measures. Outcome variables consisted of past‐year psychiatric disorders (eg, major depressive disorder and generalized anxiety disorder) and substance use disorders (eg, alcohol use disorder) using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We estimated the national prevalence of ACEs in older adults and used multivariable‐adjusted logistic regression analyses to assess the association between ACEs and the outcomes after adjusting for sociodemographics and clinical comorbidities. RESULTS: Overall, 35.9% of older adults, representative of 14.8 million older adults nationwide, reported some form of ACEs. The most common types were parental psychopathology (20.3%), other traumatic events (14.0%), and physical/psychological abuse (8.4%). Having experienced any ACEs was associated with higher odds of having a past‐year psychiatric disorder (adjusted odds ratio = 2.11; 95% confidence interval = 1.74‐2.56). Similar results were found for substance use disorders (P < .01). CONCLUSION: ACEs are linked to an increased risk for past‐year psychiatric and substance use disorders in older adults. ACEs may have long‐term effects on older adults' mental well‐being. Although further research is needed, preventing ACEs may lead to large improvements in public mental health that persist well into older age. J Am Geriatr Soc 67:2085–2093, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Polypharmacy is common, costly, and harmful for hospitalized older adults. Scalable strategies to reduce the burden of potentially inappropriate medications (PIMs) are needed. We sought to leverage medication reconciliation in hospitalized older adults by pairing with MedSafer, an electronic decision support tool for deprescribing. DESIGN: This was a nonrandomized controlled before‐and‐after study. SETTING: The study took place on four internal medicine clinical teaching units. PARTICIPANTS: Subjects were aged 65 years and older, had an expected prognosis of 3 or more months, and were taking five or more usual home medications. INTERVENTION: In the baseline phase, patients received usual care that was medication reconciliation. Patients in the intervention arm also had a "deprescribing opportunity report" generated by MedSafer and provided to their in‐hospital treating team. MEASUREMENTS: The primary outcome was ascertained at the time of hospital discharge and was the proportion of patients who had one or more PIMs deprescribed. RESULTS: A total of 1066 patients were enrolled, and deprescribing opportunities were present for 873 (82%; 418 during the control and 455 during the intervention phases, respectively). The proportion of patients with one or more PIMs deprescribed at discharge increased from 46.9% in the control period to 54.7% in the intervention period with an adjusted absolute risk difference of 8.3% (2.9%‐13.9%). Not all classes of drugs in the intervention arm were associated with an increase in deprescribing, and new PIM starts were equally common in both arms of the study. CONCLUSION: Using an electronic decision support tool for deprescribing, we increased the proportion of patients with one or more PIMs deprescribed at hospital discharge as compared with usual care. Although this type of intervention may help address medication overload in hospitalized patients, it also underscores the importance of powering future trials for a reduction in adverse drug events. Trial registration: NCT02918058. J Am Geriatr Soc 67:1843–1850, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVE To examine the influence of smoking status on the health profiles of community‐dwelling older Chinese American men in the greater Chicago, IL, area. DESIGN This study utilized a cross‐sectional study design to analyze data obtained from the larger Population Study of Chinese Elderly in Chicago (PINE). SETTING A population‐based study conducted in Chicago. PARTICIPANTS Baseline data from Chinese American men who participated in PINE (N = 1492). MEASURES Demographic characteristics measured included age, education years, marital status, income, health insurance coverage, and smoking pack‐years. Self‐reported smoking status included never smoker, current smoker, and former smoker. Health profile indicators included perceived health status, past 12‐month changes in health, chronic medical conditions (heart diseases, stroke, cancer, diabetes, hypertension, high cholesterol, thyroid disease, and osteoarthritis), quality of life, and depression and anxiety. RESULTS: The mean age of the study sample was 72.5 years. Of the sample, 65% reported a smoking history, with 25.1% current smokers and 40.1% former smokers. Current smokers were younger, less educated, and uninsured. Former smokers had the poorest overall health profiles. Compared to former smokers, current smokers were less likely to have heart disease (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.39‐0.90), hypertension (OR = 0.54; 95% CI = 0.41‐0.72), high cholesterol (OR = 0.74; 95% CI = 0.56‐0.99), thyroid disease (OR = 0.44; 95% CI = 0.21‐0.90), depression (rate ratio [RR] = 0.76; 95% CI = 0.58‐0.99), and anxiety (RR = 0.72; 95% CI = 0.59‐0.89), and they had fewer overall chronic medical conditions (RR = 0.79; 95% CI = 0.70‐0.88) after controlling for demographic factors and smoking pack‐year history. Compared to never smokers, former and current smokers reported poorer self‐rated health (OR = 1.58; 95% CI = 1.11‐2.26) and lower perceived quality of life (OR = 2.11; 95% CI = 1.04‐4.29). CONCLUSIONS: Consistent with prior research, smoking rates were elevated among this sample of older Chinese men. Counter to study hypotheses, former smokers had worse overall health. Study findings suggest the need for health promotion interventions for both current and former smokers. J Am Geriatr Soc 67:S577–S583, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Limited research is available on the relationship between oral health symptoms and cognitive function among community‐dwelling US Chinese older adults. The purpose of this study was to examine the associations between tooth/gum symptoms and changes in cognitive function. DESIGN: Two‐wave epidemiological study. SETTING: Population Study of Chinese Elderly in Chicago (PINE). PARTICIPANTS: US Chinese older adults (N = 2713; mean age = 72.6 y; 58.4% women). MEASUREMENTS: We selected self‐reported oral (tooth and gum) symptoms as independent variables. To examine changes in cognitive function (wave 2: Baseline), we chose the following three domains: episodic memory (East Boston Memory Test); executive function (Symbol Digit Modalities Test); and working memory (Digit Span Backwards). In addition, we assessed global cognitive function by constructing a composite measure. RESULTS: At baseline, 1297 participants (47.8%) reported having teeth symptoms, and 513 participants (18.9%) reported having gum symptoms. Adjusting for sociodemographic and health‐related characteristics, participants who reported having teeth symptoms at baseline experienced their global cognition decrease by 0.07 units (estimate = −0.07; p =.003) and their episodic memory decrease by 0.07 units (estimate = −0.07; p =.026). Participants who reported having teeth symptoms at baseline experienced a faster rate of decline in global cognition for every additional year (estimate = 0.02; p =.047). However, this effect disappeared once we adjusted for all covariates (estimate = 0.02; p =.069). We found no significant relationship between baseline gum symptoms and change of cognitive function. CONCLUSION: Having teeth symptoms was associated with a decline in cognitive function among US Chinese older adults. Developing policy measures aimed at ameliorating health and improving cognition in this high‐risk fast‐growing population in the United States would need to include oral health preventive and dental care services. J Am Geriatr Soc 67:S532–S537, 2019. [ABSTRACT FROM AUTHOR]

As life expectancy in Ghana improves, a large and growing population of older adults require healthcare. Despite governmental support for the care of older adults, there have been no geriatricians and no in‐country educational path for those desiring to become specialists in this field. In fact, 23 of 54 countries in sub‐Saharan Africa (SSA) lack even a single geriatrician. We describe a novel and collaborative approach used to develop the first geriatric training fellowship in Ghana. Faculty from the Ghana College of Physicians and Surgeons and the University of Michigan worked together to develop a rigorous and evidence‐based geriatrics curriculum, based on US standards but adapted to be appropriate for the cultural, economic, educational, and social norms in Ghana. This approach led to a strong training model for care of older adults while also strengthening the ongoing collaboration between the two partner universities in Ghana and the United States. The fellowship has been inaugurated in Ghana and can serve as a concrete educational model for other countries in SSA. J Am Geriatr Soc 67:1718–1723, 2019 [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, and transgender (LGBT) older adults face an increased risk of adverse behavioral health outcomes compared with the general population of older adults, yet little attention has been given to factors contributing to these disparities or to the ways in which clinicians can address these challenges. We present the case of a 75‐year‐old widowed lesbian woman with depression to illustrate how a lifetime of exposure to discrimination and stigma can produce high levels of stress and isolation while also fostering resilience. We then offer recommendations and resources for promoting psychological health among LGBT older adults by attending to the historical and cultural forces that affect LGBT health, and by implementing inclusive policies and programming. The article concludes with suggestions for advancing research and policy to help achieve greater health equity for LGBT older adults. J Am Geriatr Soc 67:1565–1570, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess adverse effects of pharmacologic antidepressants for treatment of major depressive disorder (MDD) in adults 65 years of age or older. DESIGN: Systematic review and meta‐analysis. SETTING: Specialist or generalist outpatient setting, rehabilitation facility, and nursing facilities. PARTICIPANTS: Persons 65 years and older with MDD. INTERVENTION: Selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), bupropion, mirtazapine, trazodone, vilazodone, or vortioxetine compared with another antidepressant, placebo, or nonpharmacologic therapy. MEASUREMENTS: Adverse events, arrhythmias, cognitive impairment, falls, fractures, hospitalization, mortality, QTc prolongation, serious adverse events, and withdrawals due to adverse events. RESULTS: Nineteen randomized controlled trials and two observational studies were included. Most studies evaluated treatment of the acute phase (<12 wk) of MDD of moderate severity. SSRIs led to a statistically similar frequency of overall adverse events vs placebo (moderate strength of evidence [SOE]), but SNRIs caused more overall adverse events vs placebo (high SOE) during the acute treatment phase. Both SSRIs and SNRIs led to more study withdrawals due to adverse events vs placebo (SSRIs low SOE; SNRIs moderate SOE). Duloxetine led to a more falls vs placebo (moderate SOE) during 24 weeks of acute and continuation treatment of MDD. CONCLUSION: In patients 65 years of age or older with MDD, treatment of the acute phase of MDD with SNRIs, but not SSRIs, was associated with a statistically greater number of overall adverse events vs placebo. SSRIs and SNRIs led to a greater number of study withdrawals due to adverse events vs placebo. Duloxetine increased the risk of falls that as an outcome was underreported in the literature. Few studies examined head‐to‐head comparisons, most trials were not powered to evaluate adverse events, and results of observational studies may be confounded. Comparative long‐term studies reporting specific adverse events are needed to inform clinical decision making regarding choice of antidepressants in this population. J Am Geriatr Soc 67:1571–1581, 2019 See related editorial by Lenze and Ajam Oughli [ABSTRACT FROM AUTHOR]

OBJECTIVES: Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and are at risk for age‐related adverse events including fractures. Understanding recipient, transplant, and donor factors and the outcomes associated with fractures may help identify older KT recipients at increased risk. We determined incidence of hip, vertebral, and extremity fractures; assessed factors associated with incident fractures; and estimated associations between fractures and subsequent death‐censored graft loss (DCGL) and mortality. DESIGN: This was a prospective cohort study of patients who underwent their first KT between January 1, 1999, and December 31, 2014. SETTING: We linked data from the Scientific Registry of Transplant Recipients to Medicare claims through the US Renal Data System. PARTICIPANTS: The analytic population included 47 815 KT recipients aged 55 years or older. MEASUREMENTS: We assessed the cumulative incidence of and factors associated with post‐KT fractures (hip, vertebral, or extremity) using competing risks models. We estimated risk of DCGL and mortality after fracture using adjusted Cox proportional hazards models. RESULTS: The 5‐year incidence of post‐KT hip, vertebral, and extremity fracture for those aged 65 to 69 years was 2.2%, 1.0%, and 1.7%, respectively. Increasing age was associated with higher hip (adjusted hazard ratio [aHR] = 1.37 per 5‐y increase; 95% confidence interval [CI] = 1.30‐1.45) and vertebral (aHR = 1.31; 95% CI = 1.20‐1.42) but not extremity (aHR =.97; 95% CI =.91‐1.04) fracture risk. DCGL risk was higher after hip (aHR = 1.34; 95% CI = 1.12‐1.60) and extremity (aHR = 1.30; 95% CI = 1.08‐1.57) fracture. Mortality risk was higher after hip (aHR = 2.31; 95% CI = 2.11‐2.52), vertebral (aHR = 2.80; 95% CI = 2.44‐3.21), and extremity (aHR = 1.85; 95% CI = 1.64‐2.10) fracture. CONCLUSION: Our findings suggest that older KT recipients are at higher risk for hip and vertebral fracture but not extremity fracture; and those with hip, vertebral, or extremity fracture are more likely to experience subsequent graft loss or mortality. These findings underscore that different fracture types may have different underlying etiologies and risks, and they should be approached accordingly. J Am Geriatr Soc 67:1680–1688, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Older adult patients are underrepresented in clinical trials comparing non–vitamin K antagonist oral anticoagulants (NOACs) and warfarin. This subgroup analysis of the ARISTOPHANES study used multiple data sources to compare the risk of stroke/systemic embolism (SE) and major bleeding (MB) among very old patients with nonvalvular atrial fibrillation (NVAF) prescribed NOACs or warfarin. DESIGN: Retrospective observational study. SETTING: The Centers for Medicare & Medicaid Services and three US commercial claims databases. PARTICIPANTS: A total of 88 582 very old (aged ≥80 y) NVAF patients newly initiating apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, to September 30, 2015. MEASUREMENTS: In each database, six 1:1 propensity score matched (PSM) cohorts were created for each drug comparison. Patient cohorts were pooled from all four databases after PSM. Cox proportional hazards models were used to estimate hazard ratios (HRs) of stroke/SE and MB. RESULTS: The patients in the six matched cohorts had a mean follow‐up time of 7 to 9 months. Compared with warfarin, apixaban (HR =.58; 95% confidence interval [CI] =.49‐.69), dabigatran (HR =.77; 95% CI =.60‐.99), and rivaroxaban (HR =.74; 95% CI =.65‐.85) were associated with lower risks of stroke/SE. For MB, apixaban (HR =.60; 95% CI =.54‐.67) was associated with a lower risk; dabigatran (HR =.92; 95% CI =.78‐1.07) was associated with a similar risk, and rivaroxaban (HR = 1.16; 95% CI = 1.07‐1.24) was associated with a higher risk compared with warfarin. Apixaban was associated with a lower risk of stroke/SE and MB compared with dabigatran (stroke/SE: HR =.65; 95% CI =.47‐.89; MB: HR =.60; 95% CI =.49‐.73) and rivaroxaban (stroke/SE: HR =.72; 95% CI =.59‐.86; MB: HR =.50; 95% CI =.45‐.55). Dabigatran was associated with a lower risk of MB (HR =.77; 95% CI =.67‐.90) compared with rivaroxaban. CONCLUSION: Among very old NVAF patients, NOACs were associated with lower rates of stroke/SE and varying rates of MB compared with warfarin. J Am Geriatr Soc 67:1662–1671, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the effects of bilateral custom‐made ankle‐foot orthoses (AFOs) to prevent falls for older adults with concern about or at risk for falling over 12‐month daily use. DESIGN: Secondary analysis of a randomized controlled trial. SETTING: Community‐dwelling older adults. INTERVENTION: Half of the participants were randomly allocated to an intervention group (IG) that received fitted walking shoes and bilateral custom‐made AFOs, and the other half were randomly allocated to a control group (CG) that only received fitted walking shoes. MEASUREMENTS: Self‐reported fall history of 12‐month duration was investigated at baseline and 12‐month follow‐up for both groups. Fall incidence rate and proportion of fallers were used as outcome measures to determine effects of 12‐month footwear intervention in either group. PARTICIPANTS: Adults aged 65 years and older with concern about or at risk for falling (n = 44). RESULTS: No significant between‐group differences in participant characteristics were observed at the baseline (P = .144‐.882). Within the IG, significant reductions were found in the fall incidence rate (P = .039) and the proportion of fallers (P = .036) at the 12‐month follow‐up compared to the baseline. Within the CG, no significant change was found at the 12‐month follow‐up compared to the baseline for the fall incidence rate (P = .217) or the proportion of fallers (P = .757). When comparing the IG with the CG, there was no significant difference in the change from the baseline to the 12‐month follow‐up for the fall incidence rate (P = .572) or the proportion of fallers (P = .080). CONCLUSION: This study failed to demonstrate a significant benefit of bilateral custom‐made AFOs to reduce falls compared to fitted walking shoes. However, the AFO users had significant reductions in falls compared to the preceding year. A future study with a larger sample size is recommended to confirm these observations. CLINICAL TRIAL REGISTRATION—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02819011. J Am Geriatr Soc 67:1656–1661, 2019 [ABSTRACT FROM AUTHOR]

As our population ages, the ability to take time off to care for an ill family member or close friend without losing income or a job is a growing social, health, and economic issue for American families. Therefore, the need for paid family leave policies for workers with caregiving responsibilities is an important topic for employers and policymakers, in the clinical care of older adults, and at kitchen tables across the United States. Despite this growing need, paid family leave is not available to most workers, and there is no national paid family leave policy. Health care and social service providers have a role in ensuring that family members of their patients with a serious health condition or disability are aware of the potential availability of paid family leave benefits in the states and businesses that provide them. Building a better system of care for older adults means changes not only in health care settings and in long‐term services and supports, but in workplaces too. This article describes the challenges faced by workers with family caregiving responsibilities, explains why paid family leave matters, indicates which states have adopted these protections, and reviews research on existing paid family leave policies. Finally, actions by clinicians and other stakeholders are offered to advance awareness about paid family leave benefits, including coverage for workers with care responsibilities for older people. See related editorial by Jennifer Wolff et al. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. DESIGN: Retrospective cohort study. SETTING: Academic hospital with ambulatory follow‐up. PARTICIPANTS: Community‐dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). MEASUREMENTS: Baseline, 3‐ and 6‐month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. RESULTS: Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in‐hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in‐hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in‐hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in‐hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. CONCLUSION: Age, dementia, in‐hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Patient Health Priorities Identification (PHPI) is a values‐based process in which trained facilitators assist older adults with multiple chronic conditions identify their health priorities. The purpose of this study was to evaluate patients' perceptions of PHPI. DESIGN: Qualitative study using thematic analysis. SETTING: In‐depth semistructured telephone and in‐person interviews. PARTICIPANTS: Twenty‐two older adults who participated in the PHPI process. MEASUREMENTS: Open‐ended questions about patient perceptions of the PHPI process, perceived benefits of the process, enablers and barriers to PHPI, and recommendations for process enhancement. RESULTS: Patient interviews ranged from 9 to 63 minutes (median = 20 min; interquartile range = 15–26). The mean age was 80 years (standard deviation = 7.96), 64% were female, and all patients identified themselves as white. Of the sample, 73% reported no caregiver involvement in their healthcare; 36% lived alone. Most patients felt able to complete the PHPI process with ease. Perceived benefits included increased knowledge and insight into disease processes and treatment options, patient activation, and enhanced communication with family and clinicians. Patients identified several factors that were both enablers and barriers to PHPI including facilitator characteristics, patient demographic and clinical characteristics, social support, relationships between the patient and their primary care provider, and the changing health priorities of the patient. Recommendations for process enhancement included more frequent and flexible facilitator contacts, selection of patients for participation based on specific patient characteristics, clarification of process aims and expectations, involvement of family, written reminders of established health priorities, short duration between facilitation and primary care provider follow‐up, and the inclusion of health‐related tasks in facilitation visits. CONCLUSIONS: Patients found the PHPI process valuable in identifying actionable health priorities and healthcare goals leading to enhanced knowledge, activation, and communication regarding their treatment options and preferences. PHPI may be useful for aligning the healthcare that patients receive with their values‐based priorities. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Older patients with asthma or chronic obstructive pulmonary disease are particularly susceptible to exacerbations that may be associated with incorrect use of inhalers. Educational programs with inhaler technique review seem to be effective, but no studies have addressed their cost‐effectiveness in older adult patients. The objective was to perform a cost‐effectiveness analysis of education programs in older patients and estimate the cost benefit of applying such a program in Portugal. DESIGN: We developed a decision tree analysis from a healthcare perspective, according to intervention costs and the exacerbation rates and costs described in a previous meta‐analysis. A sensitivity analysis of worst and best case scenarios was performed to estimate thresholds for intervention affordable limits, as well as cost‐saving estimations and incremental cost‐effectiveness ratios (ICERs) for a Portuguese scenario. SETTING AND PARTICIPANTS: We estimated cost‐effectiveness thresholds applicable in all settings and performed a sensitivity analysis of a theoretical intervention model in all patients including an inhaler technique review at an annual appointment with a doctor and a nurse. RESULTS: In the best case scenario, the intervention affordable budget could be up to almost 1800€ (US $1585.24) per patient per year. Mean intervention‐associated savings in Portugal would be 311.88€ (US $274.68) per patient per year, representing annual savings up to €131 million (US $150 million) for the whole health system, already including intervention costs. ICERs for Portugal vary between 93.73€ (US $82.55) and 437.43€ (US $385.25) per exacerbation avoided. CONCLUSION: A model of an intervention program with an inhaler technique review in older adult patients suggests that this intervention is cost‐effective and can generate significant savings. J Am Geriatr Soc 1–7, 2019. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN: Prospective cohort study. SETTING: A total of 306 ICUs from 24 European countries. PARTICIPANTS: Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81‐87 y]; 51.8% male). MEASUREMENTS: Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30‐day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves. RESULTS: The 30‐day‐mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was.80, and the Brier score was.18. At a cut point of 10 or higher (75% of all patients), the model predicts 30‐day mortality in 91.1% of all patients who die. CONCLUSION: A predictive model of cumulative events predicts 30‐day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision‐making capacity. [ABSTRACT FROM AUTHOR]

Dissemination of cutting‐edge geriatrics‐focused research is essential for academic geriatrics researchers, clinicians, and older adults and their caregivers. Social media channels, such as Twitter, provide a means of quickly reaching a wide array of users, globally. Besides standard tweets with links to research articles, visual abstracts are a means of delivering research results visually to end users succinctly. We compared the use of a standard tweet with a linked article with a tweet that held an added visual abstract, for a recent Journal of the American Geriatrics Society article. While the standard tweet received 24 984 impressions with 17 retweets and 36 likes over 8 days, the visual abstract inclusive tweet received 168 447 impressions with 81 retweets and 100 likes in 4 days. To assist researchers on future visual abstract development, we provide a framework and real‐world guide on translation of research abstracts into visual abstracts. We hope that by providing evidence and the means to create visual abstracts, researchers in geriatrics may be empowered to disseminate their research through this method and potentially advance the care of older adults worldwide. See related editorial by Eric Widera et al. in this issue. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To test the effect of monthly high‐dose vitamin D supplementation on mental health in pre‐frail older adults. DESIGN: Ancillary study of a 1‐year double‐blind randomized clinical trial conducted in Zurich, Switzerland. SETTING AND PARTICIPANTS: A total of 200 community‐dwelling adults 70 years and older with a prior fall event in the last year. Participants were randomized to receive 24 000 IU vitamin D3 (considered standard of care), 60 000 IU vitamin D3, or 24 000 IU vitamin D3 plus 300 μg calcifediol per month. MEASURES: The primary end point was the Mental Component Summary (MCS) of the SF‐36. Secondary end points were the SF‐36 Mental Health (MH) subscale and the Geriatric Depression Scale (GDS‐15). RESULTS: Participants' mean age was 78 years (67% women), and 58% were vitamin D deficient (<20 ng/mL). Over time, primary and secondary end points did not differ significantly among the three treatment groups or in subgroups by vitamin D status at baseline. Given the lack of a true placebo group, we explored in a predefined observational analysis the change in mental health scales by achieved 25(OH)D levels at 12 months. After adjusting for confounders, participants achieving the highest 25(OH)D quartile (Q) at 12 months (44.7‐98.9 ng/mL) had the greatest improvements in MCS (Q4 = 0.79 vs Q1 = −2.9; p = .03) and MH scales (Q4 = 2.54 vs Q1 = −3.07; p = .03); these associations were strongest among participants who were vitamin D deficient at baseline. No association was found for GDS (p = .89). CONCLUSIONS: For mental health, our study suggests no benefit of higher monthly doses of vitamin D3 compared with the standard monthly dose of 24 000 IU. However, irrespective of vitamin D treatment dose, achieving higher 25(OH)D levels at 12‐month follow‐up was associated with a small, clinically uncertain but statistically significant improvement in mental health scores. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Use of harmful and/or unnecessary medications in older adults is common. Understanding older adult and caregiver attitudes toward deprescribing will contribute to medication optimization in practice. The aims of this study were to capture the attitudes and beliefs of older adults and caregivers toward deprescribing and determine what participant characteristics and/or attitudes (if any) predicted reported willingness to have a medication deprescribed. DESIGN: Self‐completed questionnaire. SETTING: Australia. PARTICIPANTS: Older adults (n = 386), 65 years or older, taking one or more regular prescription medications and caregivers of older adults (n = 205) who could self‐complete a written questionnaire in English. MEASUREMENTS: Older adult and caregiver versions of the validated revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire were completed. The rPATD includes two global questions and four factors: perceived burden of medications, belief in appropriateness of medications, concerns about stopping, and involvement in medication management. Participant characteristics, self‐rated health, trust in physician, and health autonomy were also collected. RESULTS: Older adult participants had a median age of 74 years (interquartile range [IQR] = 70‐81 y), and caregivers were aged 67 years (IQR = 59‐76) and were caring for a person aged 81 years (IQR = 75‐86.25 y). Most of both older adults (88%) and caregivers (84%) agreed or strongly agreed that they would be willing to stop one or more of their or their care recipient's medications if their or their care recipient's doctor said it was possible. In a binary logistic regression model, a low concern about stopping factor score was the strongest predictor of willingness to have a medication deprescribed in older adults (odds ratio [OR] = 0.12; 95% confidence interval [CI] = 0.04‐0.34). Excellent/good rating of physical health was the strongest predictor in caregivers (OR = 3.71; 95% CI = 1.13‐12.23). CONCLUSIONS: Most older adults and caregivers are willing to have one of their or their care recipient's medication deprescribed, although different predictors (characteristics/attitudes) of this willingness were identified in these two groups. [ABSTRACT FROM AUTHOR]

Family caregivers provide the vast majority of care for individuals with serious illness living in the community but are not often viewed as full members of the healthcare team. Family caregivers are increasingly expected to acquire a sophisticated understanding of the care recipient's condition and new skills to execute complex medical or nursing tasks, often without adequate preparation and support, and with little choice in taking on the role. This review draws on peer‐reviewed literature, government reports, and other publications to summarize the challenges faced by family caregivers of older adults in the context of serious illness and to identify opportunities to better integrate them into the healthcare workforce. We discuss promising approaches such as inclusion of family caregivers in consensus‐based practice guidelines; the "no wrong door" function, directing consumers to needed resources, regardless of where initial contact is made; and caregiver‐friendly workplace policies allowing flexible arrangements. We present specific recommendations focusing on research, clinical practice, and policy changes that promote family‐centered care and improve outcomes for caregivers as well as persons with serious illness. J Am Geriatr Soc 67:S451–S456, 2019. [ABSTRACT FROM AUTHOR]

As originally defined, the term "prescribing cascade" describes a sequence of events that begins when an adverse drug event (ADE) occurs, is misinterpreted as a new medical condition, and a subsequent drug is then inadvertently prescribed to treat the new condition. We refine the definition to encompass both recognized and unrecognized ADEs because they can both contribute to problematic prescribing practices. In addition, we discuss that although prescribing cascades are most commonly viewed as problematic, they may be appropriate and therapeutically beneficial in certain clinical situations. We differentiate between appropriate and problematic prescribing cascades by adopting a similar approach to the framework proposed in the highly acclaimed King's Fund report Polypharmacy and Medicines Optimization. Practical considerations are also presented to aid clinicians in preventing the propagation of problematic prescribing cascades within their clinical practice. Providing new perspectives on the scope and appropriateness of the prescribing cascade concept is an important step in describing clinically relevant cascades and in encouraging safe prescribing practices. J Am Geriatr Soc 67:1023–1026, 2019. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the efficacy and toxicity of immune checkpoint inhibitors (ICIs) in older patients with advanced non–small cell lung cancer (NSCLC) seen in routine clinical practice. DESIGN: Retrospective study. SETTING: Single academic institution and its affiliated centers. PARTICIPANTS: Patients 70 years or older with advanced‐stage NSCLC seen between April 1, 2015, and April 1, 2017, and treated with ICIs. MEASUREMENTS: Efficacy data included overall survival (OS) and time to treatment failure (TTF), stratified by age, comorbidities (Charlson Comorbidity Index [CCI]), and Eastern Cooperative Oncology Group Performance Status (ECOG PS), and estimated using the Kaplan‐Meier method and log‐rank test. Toxicity data included immune‐related adverse events (irAEs), need for glucocorticoids, and hospitalization. The associations of toxicity with age, CCI, and ECOG PS were evaluated using the exact χ2 test or Fisher exact test. RESULTS: We included 75 patients (median age: 74 y; range, 70‐92 y); 53% had a CCI of 3 or higher; 49% had ECOG PS of 2 or higher. Median OS for the whole cohort was 8.2 months (ECOG PS 0‐1 vs ≥2: 13.7 vs 3.8 mo; p <.01). Median TTF was 4.2 months (ECOG PS 0‐1 vs ≥2: 5.6 vs 2.0 mo; p =.02). Overall, 37% of patients experienced irAE of any grade (a total of 37 events); 8% were grade 3 or higher (no ICI‐related deaths). Of those who discontinued ICIs (N = 64), 15% were due to irAEs. Of those who experienced irAEs, 64% required glucocorticoids. Hospitalizations during ICI treatment occurred in 72%. Toxicity generally did not differ by age, CCI, or ECOG PS. CONCLUSIONS: Outcomes in our cohort were driven by ECOG PS rather than chronological age or comorbidities. The relatively high rates of ICI discontinuation, use of glucocorticoids, and hospitalization during ICI treatment in our study highlight the vulnerability of older adults with advanced NSCLC even in the immunotherapy era. J Am Geriatr Soc 67:905–912, 2019. [ABSTRACT FROM AUTHOR]

Objectives: To analyze self‐reported changes in physical function in older women with breast cancer receiving adjuvant chemotherapy. Design: Secondary analysis of the Cancer and Leukemia Group B (CALGB) 49907 prospective randomized clinical trial. Setting: CALGB institutions in the United States. Participants: Women aged 65 and older with Stage I to III breast cancer enrolled in CALGB 49907 who had physical function data from before and after receipt of adjuvant chemotherapy (N=256; mean age 71.5, range 65–85). Measurements: Participants were administered the physical function subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before chemotherapy, at the end of chemotherapy, and 12 months after chemotherapy initiation. Functional decline was defined as a more than 10‐point decrease from baseline at each time point. Resilience was defined as return to within 10 points of baseline. Multivariable regression was used to examine pretreatment characteristics associated with physical function changes. Results: Of 42% of participants who had physical function decline from before to the end of chemotherapy, 47% recovered by 12 months (were resilient). Almost one‐third experienced functional decline from before chemotherapy to 12 months later. Pretreatment fatigue was a risk factor for functional decline from before to the end of chemotherapy (P=.02). Risk factors for functional decline at 12 months included pretreatment dyspnea (P=.007) and being unmarried (P=.01). Conclusion: Functional decline was common in older women receiving adjuvant chemotherapy for breast cancer in a clinical trial. Although half recovered their physical function, one‐third had a clinically meaningful decline at 12 months. Strategies are needed to prevent functional decline in older adults receiving chemotherapy. J Am Geriatr Soc 67:920–927, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND: The need for mentorship in aging research among postdoctoral trainees and junior faculty across medical disciplines and subspecialties is increasing, yet senior personnel with expertise in aging are lacking to fulfill the traditional dyadic mentorship role. Facilitated peer mentorship is grounded in collaborative work among peers with the guidance of a senior mentor. METHODS AND RESULTS: We evaluated the Columbia University Mentor Peer Aging Research (CoMPAdRE) program, an interprofessional facilitated peer mentorship program for early stage investigators, using the Reach Effectiveness Adoption Implementation and Maintenance framework (RE‐AIM). Reach: A total of 15 participants, of which 20% were women, from five states and across six medical specialties participated. Effectiveness: Participants published 183 papers, of which more than 20% were collaborative papers between CoMPAdRE mentees or mentees‐mentor. Participants reported developing skills in negotiation, navigating the academic role, organizing a seminar, management, and leadership over the course of the program. According to the qualitative findings, the most important components of the program included alignment around the aging, learning from national leaders, developing leadership skills and career networking. Adoption: Individual‐level factors included selecting participants with a research track record, willingness to sign a compact of commitment and involvement in shaping the program. An institutional‐level factor that facilitated program adoption included strong commitment from department leaders. Implementation: The program cost $3,259 per participant. Maintenance: CoMPAdRE is being maintained and currently incorporating a second cohort of mentees. CONCLUSION: This RE‐AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of an aging‐focused facilitated peer mentorship program. J Am Geriatr Soc 67:804–810, 2019. See related editorial by High et al. in this issue. [ABSTRACT FROM AUTHOR]

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3‐year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674–694, 2019. See related editorial by Steinman et al. in this issue. [ABSTRACT FROM AUTHOR]

Loneliness and social isolation are strongly associated with several adverse health outcomes in older persons including death and functional impairments. The strength of these associations has been compared with smoking. Accordingly, loneliness and isolation have significant public health implications. Despite the adverse impacts of loneliness and social isolation on quality of life, and their strong association with health outcomes, the evaluation of loneliness and isolation have not been integrated into medical care. The risks for loneliness may be of particular concern to persons with serious illness as patients and caregivers cope with the experience of loss, loss of independence, and increasing care needs. To date, there has been no uniform way of evaluating and documenting loneliness and social isolation as a part of a review of a patient's social determinants of health. This article provides a framework for healthcare systems, providers, and community members working with older adults to (1) understand loneliness, isolation, and its counterpart social connection; (2) describe the different ways loneliness affects health; and (3) create a framework for asking about and documenting these experiences. Finally, because the lack of studies assessing whether targeting loneliness can improve health outcomes is a major gap, we provide guidance on the future of interventions. J Am Geriatr Soc 67:657–662, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: A lower risk of falls is commonly cited as a reason to treat hypertension conservatively in older individuals. We examined the effect of hypertension treatment and control status and measured blood pressure (BP) level on the risk of falls in older women. DESIGN/SETTING: Prospective cohort study. PARTICIPANTS: A total of 5971 women (mean age 79 years; 50.4% white, 33.1% black, 16.5% Hispanic/Latina) enrolled in the Women's Health Initiative and Objective Physical Activity and Cardiovascular Health study. MEASUREMENTS: BP was measured by trained nurses, and hypertension treatment was assessed by medication inventory. Participants mailed in monthly calendars to self‐report falls for 1 year. RESULTS: Overall, 70% of women had hypertension at baseline (53% treated and controlled, 12% treated and uncontrolled, 5% untreated). There were 2582 women (43%) who reported falls in the 1 year of surveillance. Compared with nonhypertensive women, when adjusted for fall risk factors and lower limb physical function, the incidence rate ratio (IRR) for falls was 0.82 (confidence interval [CI] = 0.74‐0.92) in women with treated controlled hypertension (p =.0008) and 0.73 (CI = 0.62‐0.87) in women with treated uncontrolled hypertension (p =.0004). Neither measured systolic nor diastolic BP was associated with falls in the overall cohort. In women treated with antihypertensive medication, higher diastolic BP was associated with a lower risk of falls in a model adjusted for fall risk factors (IRR = 0.993 per mm Hg; 95% CI = 0.987‐1.000; p =.04). The only class of antihypertensive medication associated with an increased risk of falls compared with all other types of antihypertensive drugs was β‐blockers. CONCLUSION: Women in this long‐term research study with treated hypertension had a lower risk of falls compared with nonhypertensive women. Diastolic BP (but not systolic BP) is weakly associated with fall risk in women on antihypertensive treatment (<1% decrease in risk per mm Hg increase). J Am Geriatr Soc, 2019. J Am Geriatr Soc 67:726–733, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Mind‐body exercise has positive effects on cognitive performance, according to clinical observation and experts' recommendations. However, its potential benefits for the cognitive function of aging adults are uncertain and still lack systematic estimations. Therefore, we conducted a systematic review and meta‐analysis to evaluate the overall efficacy and effectiveness of mind‐body exercises for cognitive performance in aging individuals with or without cognitive impairment. DESIGN: A systematic review and meta‐analysis. SETTING AND PARTICIPANTS: We searched related trials through June 2018 from four databases: Medline, Embase, PsycINFO (all via Ovid), and the Cochrane Library/Central Register of Controlled Trials. MEASUREMENTS: Methodological quality was assessed using the Cochrane Risk of Bias Tool. A meta‐analysis of comparative effects was performed using Review Manager v.5.3 software, and publication bias was examined using Egger's test. RESULTS: A total of 32 randomized controlled trials with 3624 participants were ultimately included in this meta‐analysis. The results revealed that mind‐body exercises as a whole had benefits in improving global cognition compared with that of the control group (mean difference [MD] = 0.92; 95% confidence interval [CI] = 0.33‐1.51; p =.002) and were more effective than control interventions in promoting cognitive flexibility (MD = −8.80; 95% CI = −15.22 to −2.38; p =.007), working memory (MD = 0.32; 95% CI = 0.01‐0.64; p =.05), verbal fluency (standardized mean difference [SMD] = 0.27; 95% CI = 0.09‐0.45; p =.003), and learning (SMD = 0.24; 95% CI = 0.10‐0.39; p =.001) on cognitively intact or impaired older adults. In dose‐subgroup analysis, only moderate exercise intensity (60‐120 min per week) significantly increased global cognition scores compared with those of the control group (MD = 1.15; 95% CI = 0.34‐1.97; p =.006). CONCLUSION: Mind‐body exercises, especially tai chi and dance mind‐body exercise, are beneficial for improving global cognition, cognitive flexibility, working memory, verbal fluency, and learning in cognitively intact or impaired older adults. Moderate intensity is recommended as the optimal dose for older adults. J Am Geriatr Soc 67:749–758, 2019. [ABSTRACT FROM AUTHOR]

Objective: To describe and compare two age groups' knowledge of medications linked to falls and willingness to change these medications to reduce their fall risk. Method: We analyzed data from community‐dwelling adults age 55 and older (n = 1812): 855 adults aged 55 to 64 years and 957 older adults (65 and older) who participated in the 2016 summer wave of the ConsumerStyles survey, an annual Web‐based survey. The data are weighted to match the US Current Population Survey proportions on nine US Census Bureau demographic characteristics. Measurements: Survey respondents were asked about medication use, knowledge of side effects, their willingness to change their medications to reduce fall risk, communication in the previous year about fall risk with their healthcare provider, and their comfort in discussing fall risk with their healthcare provider. All data were weighted to match the 2016 population estimates. Descriptive statistics and χ2 (p ≤.05) were used to identify differences between the two age groups. Results: About one‐fifth of all respondents reported using at least one class of medication that increases fall risk. Older adults were less likely to report using medications for mood or sadness, less likely to report knowing the side effects of pain medications, and more willing to change their sleep medications compared with their younger counterparts. Among all respondents using these medication classes, less than one‐third knew the potential fall‐related side effects. However, most of them expressed willingness to change their medication if advised by their healthcare provider. Conclusion: Most older adults were unaware of potential fall risks associated with medications prescribed to address pain, difficulty sleeping, mood or sadness, and anxiety‐ or nervousness‐related health issues. However, most were willing to change their medication if recommended by a healthcare provider. J Am Geriatr Soc 67:527–533, 2019. [ABSTRACT FROM AUTHOR]

After passage of the 21st Century Cures Act, the National Institutes of Health held a workshop in 2017 to consider expanding its inclusion policy to encompass individuals of all ages. American Geriatrics Society (AGS) leaders and members participated in the workshop and formal feedback period. AGS advocacy clearly impacted the resulting workshop report and Inclusion Across the Lifespan policy that eliminates upper‐age limits for research participation unless risk justified and changes the language used to describe older adults and other vulnerable groups. AGS recommendations that were not specifically stated in the updated policy were to encourage active recruitment of older adults, add standard measures of function and/or frailty, and change review criteria to ensure the health status of a study population mirrors typical clinical populations. The updated inclusion policy ultimately offers academic geriatrics programs the opportunities to expand knowledge about health in aging and to continue to provide leadership for research and advocacy efforts on behalf of older adults. J Am Geriatr Soc 67:211–217, 2019. See related Editorial by George Kuchel in this issue. [ABSTRACT FROM AUTHOR]

BACKGROUND The prospective association between protein intake and falls has been little studied. We assessed this association in a Spanish community‐dwelling cohort. METHODS: We performed a prospective cohort study of 2464 men and women 60 years or older who were recruited in 2008‐2010 and followed up through 2012. At baseline, the habitual protein intake was determined with a validated dietary history. At the end of follow‐up, participants reported the number of falls experienced in the preceding year. Participants were stratified by an unintentional weight loss of 4.5 kg or more. Logistic regression was used after adjustment for the main confounders. RESULTS: A total of 522 participants (21.2%) experienced at least one fall. The odds ratios (ORs) and 95% confidence intervals (CIs) of falling for the three increasing tertiles of total protein intake were 1.00, 0.86 (0.66‐1.11), and 0.93 (0.70‐1.24) (p for trend = 0.14). However, a statistically significant interaction with unintentional weight loss was observed for the association between protein intake and fall risk (p for interaction = 0.004). Among 163 participants (6.6%) who experienced unintentional weight loss, the ORs (95% CI) of falling for the three increasing tertiles of total protein intake were 1.00, 0.68 (0.21‐2.23), and 0.23 (0.05‐1.08) (p for trend = 0.01). CONCLUSION: No protective association between protein intake and fall risk in older adults was found. However, high total protein intake tended to confer substantial benefits to participants who experienced an unintentional weight loss of 4.5 kg or more in the preceding year. J Am Geriatr Soc 67:329–335, 2019. [ABSTRACT FROM AUTHOR]

Objectives: To review intervention programs that measure gait to investigate what features of the intervention may contribute to improving gait in older adults with cognitive impairment or dementia. Design: Systematic review using Medline, Cinahl, Scopus, PsychInfo, Amed, Embase, Web of Science, and PubMed for original research published in English between January 1, 2000, and July 23, 2018, to identify interventional controlled trials. Narrative synthesis was undertaken. Results: Of 6,379 citations, 36 articles met inclusion criteria. Interventions were categorized as medication or medical devices (8 studies), exercise (19 studies), and exercise plus cognitive training (9 studies). Antidementia medication may improve gait variability in people with Alzheimer's disease. Exercise programs focusing on strength and balance training, especially when combined with functional mobility training, improve gait in people with mild cognitive impairment or dementia. Exercise plus cognitive training programs combining strength and balance training, functional mobility training, and training on attention and executive function also improve gait. Conlusion: Physical and cognitive factors affect gait performance, and both should be addressed in intervention programs. Physical exercises including functional mobility training, especially walking, have better results than physical programs with only static, resistance, and flexibility training. Cognitive intervention should be concomitant with physical exercises rather than separate, with a focus on attention and executive function. Combining physical training with cognitive training in a functional context may assist older adults with cognitive impairment generalize from training to everyday activity. J Am Geriatr Soc 67:381–391, 2019. [ABSTRACT FROM AUTHOR]