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

Generating real‐world evidence about the effect of medication discontinuation or dose reduction on outcomes, such as reduction of adverse drug effects (ADE; intended benefit) and occurrence of adverse drug withdrawal events (ADWE; unintended harm), is crucial to informing deprescribing decisions. Determining the causal effects of deprescribing is difficult for many reasons, including lack of randomization in real‐world study designs and other design and measurement issues that pose threats to internal validity. The inherent challenge is how to identify the effects, both intended benefits and unintended harms, of a new medication stoppage or reduction when implemented in patients with many potential clinical and social risks that may influence the likelihood of deprescribing as well as outcomes. We discuss methodological issues of estimating the effect of medication discontinuation or reduction on risk of ADEs and ADWEs considering: (1) sampling study populations of sufficient size with the potential to demonstrate clinically meaningful and quantifiable outcomes, (2) accurate and appropriately timed measurement of covariates, outcomes, and discontinuation, and (3) statistical approaches to managing confounding and other biases inherent in long‐term medication use by individuals with multiple morbidities. Designing rigorous deprescribing studies that address internal validity threats will support evidence generation by improving the ability to assess benefits and harms when the exposure of interest is the absence of a medication. Iterative learnings about data quality, variable definition, variable measurement, and exposure‐outcome associations will inform strategies to improve the causal inferences possible in real‐world deprescribing studies. [ABSTRACT FROM AUTHOR]

Background: Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression on cardiovascular outcomes remains uncertain. Methods: To determine whether frailty progression is associated with adverse cardiovascular outcomes, independent of baseline frailty and age, we evaluated all Medicare Fee‐for‐Service beneficiaries ≥65 years at cohort inception with continuous enrollment from 2003 to 2015. Linear mixed effects models, adjusted for baseline frailty and age, were used to estimate change in a validated claims‐based frailty index (CFI) over a 5‐year period. Survival analysis was used to examine frailty progression and risk of adverse health outcomes. Results: There were 8.9 million unique patients identified, mean age 77.3 ± 7.2 years, 58.7% female, 10.9% non‐White race. In total, 60% had frailty progression and 40% frailty regression over median follow‐up of 2.4 years. Compared to those with frailty regression, when adjusting for age and baseline CFI, those with frailty progression had a significantly greater risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.31–1.31), all‐cause mortality (HR 1.34, 95% CI 1.34–1.34), acute myocardial infarction (HR 1.08, 95% CI 1.07–1.09), heart failure exacerbation (HR 1.30, 95% CI 1.29–1.30), ischemic stroke (HR 1.14, 95% CI 1.14–1.15). There was also a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer days alive at home (DAH) with more rapid progression compared to the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87–0.88, p < 0.001). Conclusions: In this large, nationwide sample of older Medicare beneficiaries, frailty progression, independent of age and baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all‐cause mortality, myocardial infarction, heart failure, and ischemic stroke compared to those with frailty regression. [ABSTRACT FROM AUTHOR]

Background: Individuals with Alzheimer's disease and related dementias (ADRD) often face high acute care clinical utilization and costs with unclear benefits in survival or quality of life. The emergency department (ED) is frequently the site of pivotal decisions in these acute care episodes. This study uses national Medicare data to explore this population's ED utilization. Methods: Retrospective cohort study of persons aged ≥66 years enrolled in traditional Medicare with a Chronic Condition Warehouse diagnosis of dementia. Primary 1‐year outcome measures included ED visits with and without hospitalization, ED visits per 100 days alive, and health‐care costs. A multivariate random effects regression model (clustered by county of residence), adjusted for sociodemographics and comorbidities, examined how place of care on January 1, 2018, was associated with subsequent ED utilization. Results: In 2018, 2,680,006 ADRD traditional Medicare patients (mean age 82.9, 64.2% female, 9.4% Black, 6.2% Hispanic) experienced a total of 3,234,767 ED visits. Over half (52.2%) of the cohort experienced one ED visit, 15.5% experienced three or more, and 37.1% of ED visits resulted in hospitalization. Compared with ADRD patients residing at home without services, the marginal difference in ED visits per 100 days alive varied by location of care. Highest differences were observed for those with hospitalizations (0.48 visits per 100 days alive, 95% confidence interval [CI] 0.47–0.49), skilled nursing facility (rehab/skilled nursing facility [SNF]) stays (0.27, 95% CI 0.27–0.28), home health stays (0.25, 95% CI 0.25–0.26), or observation stays (0.82, 95% CI 0.77–0.87). Similar patterns were observed with ED use without hospitalization and health‐care costs. Conclusions: Persons with ADRD frequently use the ED—particularly those with recent hospitalizations, rehab/SNF stays, or home health use—and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal‐concordant care. [ABSTRACT FROM AUTHOR]

The article discusses the need to urgently resolve diverse population and older adult exclusion in clinical trials and research to improve drug evaluation in these groups as of 2024. Topics covered include the consequences of exclusion in trials, the barrier of institutional structures to inclusivity, and the process of trial recruitment and compensation for these people. Also noted are recommendations made for this effort and their implementation.

Background: Sensory disability in older adults is associated with increased rates of depressive symptoms and loneliness. Here, we examined the impact of hearing, vision, and olfaction disability on mental health outcomes in older US adults. Methods: We studied respondents from the first three rounds (2005/6, 2010/11, and 2015/16) of the National Social Life, Health and Aging Project, a nationally representative, longitudinal study of older US adults. Sensory function was assessed by structured interviewer ratings (hearing and vision) and objective assessment (olfaction). Cox proportional hazards models and one degree of freedom tests for trend were utilized to analyze the relationships between sensory disability and self‐rated mental health, frequent depressive symptoms, frequent perceived stress, frequent anxiety symptoms, and frequent loneliness symptoms over time, adjusting for demographics, health behaviors, comorbidities, and cognitive function. Results: We analyzed data from 3940 respondents over 10 years of follow‐up. A greater number of sensory disabilities was associated with greater hazard of low self‐rated mental health, frequent depressive symptoms, frequent perceived stress, and frequent loneliness symptoms over time (p ≤ 0.003, all). After adjusting for covariates, older adults with a greater number of sensory disabilities had greater hazard of low self‐rated mental health (HR = 1.22, CI = [1.08, 1.38], p = 0.002) and loneliness symptoms (HR = 1.13, CI = [1.05, 1.22], p = 0.003) over time in our tests for trend. In our Cox proportional hazards model, older adults with vision disability had greater hazard of low self‐rated mental health (HR = 1.34, 95% CI = [1.05, 1.72], p = 0.02) and loneliness symptoms (HR = 1.21, CI = [1.04, 1.41], p = 0.01). Conclusions: Older US adults with greater numbers of sensory disabilities face worse subsequent mental health. Future longitudinal studies dissecting the relationship of all five classical senses will be helpful in further understanding how improving sensory function might improve mental health in older adults. [ABSTRACT FROM AUTHOR]

Background: Management of geriatric trauma patients requires balancing chronic comorbidities with acute injuries. We developed a care model in which patients are managed by hospitalists with trauma‐centered education and hypothesized that clinical outcomes would be similar to outcomes in patients primarily managed by trauma surgeons. Methods: This was a retrospective study of trauma patients aged ≥65 from January 2020 to December 2021. Groups were defined by admitting service: trauma surgery service (TSS) or geriatric trauma hospitalist service (GTHS). The primary outcome was in‐hospital mortality. Regression analyses and inverse probability treatment weighted (IPTW) propensity score (PS) analyses were performed to determine the association between admitting service and outcomes. Results: A total of 1004 patients were eligible for inclusion—580 GTHS and 424 TSS admissions. GTHS patients were older (82 vs. 74, p < 0.001), more likely to have suffered blunt trauma (99.5% vs. 95%, p < 0.001), more likely to have comorbidities (91.2% vs. 87%, p < 0.001), had higher Charlson Comorbidity Indexes (CCIs), and had lower median injury severity scores (9 vs. 13, p < 0.001). Rates of mortality, delirium, 30‐day readmission, and overall complications were low and similar between groups. While TSS patients were likely to be discharged home, GTHS had more discharges to skilled nursing facilities and longer length of stay (LOS). On multivariable analysis adjusted for age, ISS, CCI, and sex, patients admitted to GTHS had lower odds of death with an odds ratio of 0.15 (95% confidence interval [CI] 0.02–0.75, p = 0.03) when compared to TSS. On IPTW PS analysis, patients admitted to GTHS had similar odds of death with an odds ratio of 0.3 (95% CI 0.06–1.6, p = 0.16). Conclusions: Protocolized admission criteria to a GTHS resulted in similar low mortality rates but longer LOS when compared to patients admitted to a TSS. This care model may inform other trauma centers in developing their strategies for managing the increasing volume of vulnerable injured older adults. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is a major health issue worldwide. As the population ages, more older patients including octogenarians will require CRC treatment. However, this vulnerable group has decreased functional reserves and increased surgical risks. Enhanced recovery after surgery (ERAS) pathways aim to reduce surgical stress and complications, but concerns remain about applying ERAS protocols to older patients. We assessed whether a modified ERAS (mERAS) protocol combined would improve outcomes in octogenarian CRC patients undergoing minimally invasive surgery. Methods: In this retrospective cohort study, we compared 360 non‐octogenarians aged 50–64 years and 114 octogenarians aged 80–89 years before and after mERAS protocol implementation. Outcomes including postoperative functionary recovery, length of stay, complications, emergency department visits, and readmissions were analyzed. Results: Despite comparable tumor characteristics, octogenarians had poorer nutrition, American Society of Anesthesiologists status, and more comorbidities. After mERAS, octogenarians had reduced complications, faster return of bowel function, and shorter postoperative length of stay, similar to non‐octogenarians. mERAS implementation improved recovery in both groups without increasing emergency department visits or readmissions. Conclusion: Although less remarkable than in non‐octogenarians, mERAS protocols mitigated higher complication rates and improved recovery in octogenarians after minimally invasive surgery for CRC, confirming protocol feasibility and safety in this vulnerable population. [ABSTRACT FROM AUTHOR]

Under‐representation of subgroups of the population in clinical trials has been and continues to be a problem despite goals of academia, industry, and government. Older adults are among the groups that are under‐represented in trials of medications that they are likely to receive once marketing approval has been received. Recent legislation that mandates that clinical trial participants be representative of patient population has been passed and creates hope that greater numbers of older adults will be enrolled in clinical trials and that they will be representative of "typical" geriatric patients. However, there is the need for collection of current data on disease prevalences with granularity as to age, gender, and race as well as geriatric co‐morbidities to assess the representativeness of clinical trial participants relative to patient populations. Consensus on definitions and collection of data relevant to geriatric patient populations are needed to evaluate effects of comorbidities, frailty, cognitive and physical function. There will also be a need for expansion of the geriatric research workforce, facilities for research both in academic centers but also in the community and long‐term care facilities, and for engagement with and involvement of communities that have been traditionally under‐represented to conduct clinical trials that enroll truly representative patient populations. [ABSTRACT FROM AUTHOR]

The article discusses the National Institute of Aging's (NIA) push for inclusion of diverse older adults in clinical studies as of September 2024. Topics covered include the barriers of comorbidities' exclusion, age limits, concerns on vulnerable persons, and distrust of the healthcare system, and the needs to ensure representation and for appropriate analysis and research expertise in designing trials. Also noted is the NIA's support of initiatives to diversify the research workforce.

The International Union of Basic and Clinical Pharmacology (IUPHAR) Geriatric Committee aims to improve the use of drugs in older adults and develop new therapeutic approaches for the syndromes and diseases of old age through advocacy, education, and research. In the present paper, we propose strategies relevant to drug development and evaluation, spanning preclinical and the full range of clinical studies. Drugs for older adults need to consider not only age, but also other characteristics common in geriatric patients, such as multimorbidity, polypharmacy, falls, cognitive impairment, and frailty. The IUPHAR Geriatric Committee's position statement on 'Measurement of Frailty in Drug Development and Evaluation' is included, highlighting 12 key principles that cover the spectrum of translational research. We propose that where older adults are likely to be major users of a drug, that frailty is measured at baseline and as an outcome. Preclinical models that replicate the age, frailty, duration of exposure, comorbidities, and co‐medications of the proposed patients may improve translation. We highlight the potential application of recent technologies, such as physiologically based pharmacokinetic–pharmacodynamic modeling informed by frailty biology, and Artificial Intelligence, to inform personalized medicine for older patients. Considerations for the rapidly aging populations in low‐ and middle‐income countries related to health‐care and clinical trials are outlined. Involving older adults, their caregivers and health‐care providers in all phases of research should improve drug development, evaluation, and outcomes for older adults internationally. [ABSTRACT FROM AUTHOR]

Older adults are persistently underrepresented in clinical drug trials worldwide, despite increasing multiple long‐term conditions and significant prescribing in this demographic. We discuss systemic challenges such as the exclusion of people with comorbid conditions and the lack of assessment for comorbidities as modifiers of treatment effects and highlight the rising trend of polypharmacy, especially among the oldest age groups, which is linked to a significant percentage of unplanned hospitalizations and medication errors. The consequences of these trends prompted the United Kingdom National Overprescribing review, culminating in a set of recommendations for drug development tailored to older adults. Building on this, two critical reports released in April 2023 by the International Longevity Centre (ILC) and the Nuffield Council on Bioethics (NCOB) are discussed. These reports emphasize the importance of diversity and inclusion in clinical trials, advocating for ethical frameworks and methodologies that cater to the complex needs of older adults. The development of inclusive criteria, innovative statistical methodologies, and the integration of patient‐reported outcomes are needed to address the persistent barriers to older adult participation in research, suggesting that pragmatic trials, exemplified by the UK's RECOVERY trial during the COVID‐19 pandemic, could pave the way for more inclusive research practices. [ABSTRACT FROM AUTHOR]

Background: For persons with diabetes, incidence of dementia has been associated with increased hospitalization; however, little is known about healthcare use preceding and following incident dementia. We describe healthcare utilization in the 3 years pre‐ and post‐incident dementia among older adults with diabetes. Methods: We used the National Health and Aging Trends Study (NHATS) linked to Medicare fee‐for‐service claims from 2011 to 2018. We included community‐dwelling adults ≥65 years who had diabetes without dementia. We matched older adults with dementia (identified with validated NHATS algorithm) at the year of incident dementia to controls using coarsened exact matching. We examined annual outpatient visits, emergency department (ED) visits, hospitalization, and post‐acute skilled nursing facility (SNF) use 3 years preceding and 3 years following dementia onset. Results: We included 195 older adults with diabetes with incident dementia and 1107 controls. Groups had a similar age (81.6 vs 81.7 years) and were 56.4% female. Persons with dementia were more likely to be of minority racial and ethnic groups (26.7% vs 21.3% Black, non‐Hispanic, 15.3% vs 6.7% other race or Hispanic). We observed a larger decrease in outpatient visits among persons with dementia, primarily due to decreasing specialty visits (mean outpatient visits: 3 years pre‐dementia/matching 6.8 (SD 2.6) dementia vs 6.4 (SD 2.6) controls, p < 0.01 to 3 years post‐dementia/matching 4.6 (SD 2.3) dementia vs 5.5 (SD 2.7) controls, p < 0.01). Hospitalization, ED visits, and post‐acute SNF use were higher for persons with dementia and rose in both groups (e.g., ED visits 3 years pre‐dementia/matching 3.9 (SD 5.4) dementia vs 2.2 (SD 4.8) controls, p < 0.001; 3 years post‐dementia/matching 4.5 (SD 4.7) dementia vs 3.5 (SD 6.1) controls, p = 0.04). Conclusions: Older adults with diabetes with incident dementia have higher rates of acute and post‐acute care use, but decreasing outpatient use over time, primarily due to a decrease in specialty visits. [ABSTRACT FROM AUTHOR]

Background: Relationships of midlife inflammation with late‐life mobility and influences of chronic health conditions, race, and social determinants of health (SDoH) on these relationships are poorly understood. Methods: Among 4758 community‐dwelling participants (41% men, 20% Black), high‐sensitivity C‐reactive protein (hsCRP) was measured over 20+ years: in midlife at study visit 2 (V2: 1990–1992, 47–68 years); at V4 (1996–1998, 53–74 years); and with concurrent late‐life 4‐m gait speed at V5 (2011–2013, 67‐88 years, mean 75 years). SDoH measures included race, the national‐rank area deprivation index, education, and income. We examined associations of late‐life gait speed with midlife hsCRP (V2 continuous and clinically high ≥3 mg/L), with 20‐year hsCRP history from midlife (V2–V5 average continuous hsCRP and clinically high ≥3 mg/L) and with inflammation accumulation (visits and years with high hsCRP). Regression models adjusted for demographic, cardiovascular, and SDoH measures; effect modification by the presence of other common chronic conditions (obesity, diabetes, hypertension) and race were examined, with and without accounting for SDoH. Results: High midlife hsCRP was associated with slower late‐life gait speed, even among those without chronic conditions in midlife: −4.6 cm/s (95% CI: −6.4, −2.8). Importantly, sustained high hsCRP was associated with a 20‐year slowing of −10.0 cm/s (−14.9, −5.1) among those who never experienced obesity, diabetes, or hypertension over the 20‐year period. Associations were similar between Black participants, −3.8 cm/s (−6.9, −0.7) and White participants −3.3 (−4.5, −2.2) per interquartile range of midlife hsCRP; effect modifications by chronic conditions and race were unsupported throughout. Results were robust to accounting for SDoH or otherwise; however, worse SDoH was associated with higher inflammation and slower gait speed in both Black and White participants. Conclusions: Inflammation in midlife may contribute to clinically meaningful late‐life slowing of gait speed, even among otherwise healthy‐appearing adults and regardless of race and socioeconomic disadvantage. Regular monitoring and interventions for inflammation may be warranted from midlife. [ABSTRACT FROM AUTHOR]

This editorial comments on the article by Shwayder et al. [ABSTRACT FROM AUTHOR]

Background: To examine the willingness of older patients to take less diabetes medication (de‐intensify) and to identify characteristics associated with willingness to de‐intensify treatment. Methods: Survey conducted in 2019 in an age‐stratified, random sample of older (65–100 years) adults with diabetes on glucose‐lowering medications in the Kaiser Permanente Northern California Diabetes Registry. We classified survey responses to the question: "I would be willing to take less medication for my diabetes" as willing, neutral, or unwilling to de‐intensify. Willingness to de‐intensify treatment was examined by several clinical characteristics, including American Diabetes Association (ADA) health status categories used for individualizing glycemic targets. Analyses were weighted to account for over‐sampling of older individuals. Results: A total of 1337 older adults on glucose‐lowering medication(s) were included (age 74.2 ± 6.0 years, 44% female, 54.4% non‐Hispanic white). The proportions of participants willing, neutral, or unwilling to take less medication were 51.2%, 27.3%, and 21.5%, respectively. Proportions of willing to take less medication varied by age (65–74 years: 54.2% vs. 85+ years: 38.5%) and duration of diabetes (0–4 years: 61.0% vs. 15+ years: 44.2%), both p < 0.001. Patients on 1–2 medications were more willing to take less medication(s) compared with patients on 10+ medications (62.1% vs. 46.6%, p = 0.03). Similar proportions of willingness to take less medications were seen across ADA health status, and HbA1c. Willingness to take less medication(s) was similar across survey responses to questions about patient‐clinician relationships. Conclusions: Clinical guidelines suggest considering treatment de‐intensification in older patients with longer duration of diabetes, yet patients with these characteristics are less likely to be willing to take less medication(s). See related Editorial by Pilla and Maruthur [ABSTRACT FROM AUTHOR]

Background: Deprescribing is the planned/supervised method of dose reduction or cessation of medications that might be harmful, or no longer be beneficial. Though benefits of deprescribing are debatable in improving clinical outcomes, it has been associated with decreased number of potentially inappropriate medications, which may potentially reduce the risk of adverse events among hospitalized older adults. With unclear evidence for deprescribing in this population, this study aimed to examine time‐to‐first unplanned healthcare utilization, which included 90‐day emergency department (ED) visits or hospital readmission and associated predictors, during a deprescribing intervention. Methods: A secondary data analysis of a clinical trial (Shed‐MEDS NCT02979353) was performed. Cox regression was used to compare the time‐to‐first 90‐day ED visit/readmission/death from hospital discharge for the intervention and control groups. Additionally, we performed exploratory analysis of predictors (comorbidities, functional health status, drug burden index (DBI), hospital length of stay, health literacy, food insecurity, and financial burden) associated with the time‐to‐first 90‐day ED visit/readmission/death. Results: The hazard of first 90‐day ED visits/readmissions/death was 15% lower in the intervention versus the control group (95% CI: 0.61–1.19, p = 0.352, respectively); however, this difference was not statistically significant. For every additional number of comorbidities (Hazard ratio (HR): 1.12, 95% CI: 1.04–1.21) and each additional day of hospital length of stay (HR: 1.04, 95% CI: 1.01–1.07) were significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the intervention group; whereas for each unit of increase in pre‐hospital DBI score (HR: 1.08 and HR 1.16, respectively) was significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the control group. Conclusions: The intervention and control groups had comparable time‐to‐first 90‐day ED visit/readmission/death during a deprescribing intervention. This finding suggests that deprescribing did not result in a higher risk of ED visit/readmission/death during the 90‐day period following hospital discharge. [ABSTRACT FROM AUTHOR]

Background: "Super‐agers" are adults aged ≥80 with cognitive performance similar to persons two to three decades younger. Characteristics such as larger hippocampal volume, APOE‐ε4 allele absence, higher educational attainment, female sex, and lifelong cognitive stimulation are associated with cognitive performance compatible with super‐aging. These findings are based on predominantly white research samples. Limited data are available on African‐American super‐agers. To fill this gap, we explored potential factors associated with super‐aging in older African‐American adults. Methods: Data from African‐American participants aged ≥80 in the National Alzheimer's Coordinating Center (NACC) dataset were analyzed. Using global Clinical Dementia Rating (CDR) scores, participants were first categorized as impaired (score ≥0.5) or non‐impaired/normal cognition (NC) (score = 0). From the NC group, super‐agers were identified using NACC‐data‐driven cutoffs. Participants were considered super‐agers if their memory performance was similar to persons aged 50–60 with NC, and their performance on other domains was within one standard deviation of the mean for persons aged ≥80. We examined group characteristics (NC, super‐ager, impaired) using chi‐square and ANOVA with pairwise comparisons. Multinomial logistic regression, adjusted for sex and education, evaluated correlates of super‐ager group assignment. Results: Data for 1285 African‐American participants aged ≥80 were analyzed. We identified 24.7% (n = 316) NC, 4.8% (n = 61) super‐agers, and 70.6% (n = 905) impaired. Super‐agers were mostly female and more educated, had similar vascular comorbidities as the other groups, and had less sleep disorders, depression, and alcohol use. After adjusting for sex and education, super‐ager group assignment was associated with less sleep disorders, less depression, and moderate alcohol use. Conclusions: Participants with controlled vascular risk, mental health, alcohol use, and sleep disorders tended to be in the super‐ager group. These factors may be important focus areas in clinical practice to support cognitive resilience with aging in older African‐American adults. [ABSTRACT FROM AUTHOR]

Background: Older adults with hearing loss struggle to communicate with care providers and experience higher mortality rates when hospitalized (Genther et al., 2015), even after controlling for age and comorbidities. Personal hearing amplifiers (PHAs), (e.g., Pocketalkers™), can improve communication with older patients. Methods: We conducted a scoping review to identify research gaps and summarize findings on the clinical use of PHAs with patients with hearing loss. After refining search terms relating to hearing loss and PHAs, we searched MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL Complete, Web of Science Core Collection, ERIC (Proquest), PubMed, ClinicalTrials.gov, International Clinical Trials Registry Platform, and the International Standard Randomised Controlled Trial Number Registry. We identified articles published in English between 1980 and 2022 that reported empirical outcomes relating to PHA use in clinical settings. Two reviewers independently extracted data from articles. We then organized data into an evidence map, and a narrative review summarizing outcomes. Results: From 4234 initially identified titles and abstracts, 12 met our criteria as full texts. These included three surveys on clinicians' awareness and use of PHAs, one evaluation of the acoustic output of a PHA, and eight interventions wherein PHAs were provided to patients with hearing loss. These papers used 10 different terms for PHAs and largely did not cite one another. Results showed high levels of satisfaction with PHAs, and consistently improved speech understanding. Despite this, care providers used devices inconsistently, with challenges around provider awareness, and device maintenance and location tracking. Conclusions: PHAs have a consistent positive effect on patients' ability to understand their care providers despite hearing loss. Barriers and facilitators to their use in clinical settings should be further explored. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity and functional limitation are associated with poor outcomes in heart failure (HF). However, the individual and combined effect of these on health‐related quality of life in patients with HF is not well understood. Methods: Patients aged ≥30 years with two or more HF diagnostic codes and one or more HF‐related prescription drugs from four U.S. institutions were mailed a survey to measure patient‐centric factors including functional status (activities of daily living [ADLs]) and health‐related quality of life (PROMIS‐29 Health Profile). Patients with HF from January 1, 2013 to February 1, 2018 were included. Multimorbidity was defined as ≥2 non‐cardiovascular comorbidities; functional limitation as any limitation in at least one of eight ADLs. Patients were categorized into four groups by multimorbidity (Yes/No) and functional limitation (Yes/No). We dichotomized the PROMIS‐29 sub‐scale scores at the median and calculated odd ratios for the four multimorbidity/functional limitation groups. Results: A total of 3330 patients with HF returned the survey (response rate 31%); 3020 completed the questions of interest and were retained. Among these patients (45% female; mean age 73 [standard deviation: 12] years), 29% had neither multimorbidity nor functional limitation, 24% had multimorbidity only, 22% had functional limitation only, and 25% had both. After adjustment, having functional limitation only was associated with higher anxiety (odds ratio [OR]: 3.44, 95% confidence interval [CI]: 2.66–4.45), depression (OR: 3.11, 95% CI: 2.39–4.06), and fatigue (OR: 4.19, 95% CI: 3.25–5.40); worse sleep (OR: 2.14, 95% CI: 1.69–2.72) and pain (OR: 6.73, 95% CI: 5.15–8.78); and greater difficulty with social activities (OR: 9.40, 95% CI: 7.19–12.28) compared with having neither. Results were similar for having both multimorbidity and functional limitation. Conclusion: Patients with only functional limitation have similar poor health‐related quality of life scores as those with both multimorbidity and functional limitation, underscoring the important role that physical functioning plays in the well‐being of patients with HF. [ABSTRACT FROM AUTHOR]

Background: The Health Care for Reentry Veterans (HCRV) program was established to support community reintegration for veterans after incarceration. Yet, it is unclear how those with and without HCRV contact differ. We sought to evaluate differences in medical and psychiatric conditions and healthcare utilization among mid‐to late‐life reentry veterans who did and did not receive HCRV outreach. Methods: Study participants were veterans aged ≥50 years who qualified for Medicare fee‐for‐service, had experienced incarceration for ≥1 year, and were released from incarceration between October 1, 2006, and September 30, 2018 (N = 9733). Using VA and Medicare claims data, we compared prevalence of medical and psychiatric diagnoses, and use of emergency, inpatient, and outpatient medical and mental health services up to 12 months after release between those with and without HCRV contact. Results: Veterans with HCRV contact (35.5%) had significantly higher rates of psychiatric conditions and medical conditions related to substance use (e.g., liver disease) compared to veterans without HCRV contact. Average time between release and first healthcare service use was significantly lower for HCRV veterans (36.5 ± SD 59.5 days) versus non‐HCRV veterans (58.9 ± SD 77.5 days) and HCRV veterans were more likely to utilize the emergency department, inpatient and outpatient mental health services, and inpatient medical services. Conclusion: HCRV reaches older reentry veterans with a large burden of mental health and substance use disorders. However, levels of multimorbidity were high among all older reentry veterans, pointing to a need to develop specialized geriatric models of care for this reentry population. [ABSTRACT FROM AUTHOR]

Background: Older adults with multimorbidity are under‐represented in clinical drug trials. Their inclusion will not increase unless they are willing and able to participate. Data on motivators and barriers to participation in trials of new medications of older adults with multimorbidity are needed. Methods: Cross‐sectional internet and telephone survey of a nationally representative sample of adults ≥65 years with ≥3 chronic conditions (NORC University of Chicago Amerispeak Panel) conducted from March–April, 2023 to determine motivators and barriers to drug trial participation, described graphically and using statistics. Results: Surveyed 1318 (1142 Internet, 176 phone) with mean age 72.3 ± 6.3 (SD), 52% women; race: 83% White, 10% Black or African American, 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Barriers included fear of side effects (48%), taking too many medications (44%), placebo (44%), mobility (33%), bathroom needs (25%), hearing (19%), eyesight (15%), video visits (33%; higher in women, Black or African‐American respondents, and those ≥80 years). Sixty‐five percent would join all in‐person trials, 49% would join all‐video trials. Travel >1 h was difficult for 66%, most difficult for women. Trust was a concern in 25% of Black respondents. Caregiving responsibilities or lack of time were not obstacles. Participants were most likely to consider a drug trial for a problem they have (63%) versus prevention (44%) and if invited by a physician (80%) or University healthcare system (58%). Getting better care was ranked very important (79%) followed by helping others (57%). Conclusions: Major concerns of older patients with multimorbidity about participation in drug trials are potential side effects, taking too many medicines, and video visits. Physicians have the greatest influence on decisions and in‐person visits are preferred. Proposed changes in trial design to increase enrollment of under‐represented older adults may not align with patient‐reported preferences. [ABSTRACT FROM AUTHOR]

The 2015 Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Statement was published to improve reporting transparency for prediction modeling studies. The objective of this review is to highlight methodologic challenges that aging‐focused researchers will encounter when designing and reporting studies involving prediction models for older adults and provide guidance for addressing these challenges. In following the 22‐item TRIPOD checklist, researchers must consider the representativeness of cohorts used (e.g., whether older adults with frailty, cognitive impairment, and social isolation were included), strategies for incorporating common geriatric predictors (e.g., age, comorbidities, functional status, and frailty), methods for handling missing data and competing risk of death, and assessment of model performance heterogeneity across important subgroups (e.g., age, sex, race, and ethnicity). We provide guidance to help aging‐focused researchers develop, validate, and report models that can inform and improve patient care, which we label "TRIPOD‐65." [ABSTRACT FROM AUTHOR]

Background: Recent studies have reported an association between presurgical frailty and postoperative delirium. However, it remains unclear whether the frailty‐delirium relationship differs by measurement tool (e.g., frailty index vs. frailty phenotype) and whether frailty is associated with delirium, independent of preoperative cognition. Methods: We used the successful aging after elective surgery (SAGES) study, a prospective cohort of older adults age ≥70 undergoing major non‐cardiac surgery (N = 505). Preoperative measurement of the modified mini‐mental (3MS) test, frailty index and frailty phenotype were obtained. The confusion assessment method (CAM), supplemented by chart review, identified postoperative delirium. Delirium feature severity was measured by the sum of CAM‐severity (CAM‐S) scores. Generalized linear models were used to determine the relative risk of each frailty measure with delirium incidence and severity. Subsequent models adjusted for age, sex, surgery type, Charlson comorbidity index, and 3MS. Results: On average, patients were 76.7 years old (standard deviation 5.22), 58.8% of women. For the frailty index, the incidence of delirium was 14% in robust, 17% in prefrail, and 31% in frail patients (p < 0.001). For the frailty phenotype, delirium incidence was 13% in robust, 21% in prefrail, and 27% in frail patients (p = 0.016). Frailty index, but not phenotype, was independently associated with delirium after adjustment for comorbidities (relative risk [RR] 2.13, 95% confidence interval [CI] 1.23–3.70; RR 1.61, 95% CI 0.77–3.37, respectively). Both frailty measures were associated with delirium feature severity. After adjustment for preoperative cognition, only the frailty index was associated with delirium incidence; neither index nor phenotype was associated with delirium feature severity. Conclusion: Both the frailty index and phenotype were associated with the development of postoperative delirium. The index showed stronger associations that remained significant after adjusting for baseline comorbidities and preoperative cognition. Measuring frailty prior to surgery can assist in identifying patients at risk for postoperative delirium. See related Editorial by Callahan and Kuchel in this issue. [ABSTRACT FROM AUTHOR]

Background: Half of all Medicare beneficiaries are enrolled in Medicare Advantage (MA). Many studies document lower care utilization and mortality in MA than traditional Medicare (TM), but evidence for persons with Alzheimer's disease and related dementias (ADRD) is limited. Methods: We conducted a retrospective cohort study of 2015–2018 Medicare claims and encounter data for community‐dwelling beneficiaries aged 65 and over in TM and MA with an incident ADRD diagnosis in 2017. We compared monthly hospitalization rates and outpatient visits 12 months before and after diagnosis and mortality 1 year from diagnosis. Models adjusted for sociodemographic characteristics and comorbidities. Sensitivity analyses addressed residual confounding using a control group with incident arthritis/glaucoma or excluding MA Special Needs Plans, and potential underreporting by restricting to MA plans with high data completeness. Results: Among 454,508 beneficiaries diagnosed with ADRD in 2017, 250,837 (55%) were in TM and 203,671 (45%) in MA. Four to 12 months before diagnosis, monthly hospitalizations and outpatient visits were similar in TM and MA. In the diagnosis month, 36.5% of beneficiaries in TM had a hospitalization compared with 25.4% in MA, an adjusted difference of 10.7 percentage points [95% CI: 10.3, 11.1]. Beneficiaries in TM averaged 10.5 outpatient visits in the diagnosis month compared with 8.4 in MA, an adjusted difference of 1.59 visits [95% CI: 1.47–1.70]. Utilization differences narrowed but remained higher in TM for many months. One‐year mortality was 27.9% in TM and 22.2% in MA; an adjusted odds ratio of 1.152 [95% CI: 1.135–1.169] for those in TM compared with MA. Controlling for hospitalization in the diagnosis month substantially reduced the mortality difference. Conclusion: Hospitalization rates and outpatient visits increased more after an ADRD diagnosis in TM than MA. One‐year post‐diagnosis, mortality was not higher in MA than TM but comparisons of quality of life and caregiver burden are needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Disparities in readmission risk and reasons they might exist among diverse complex patients with multimorbidity, disability, and unmet social needs have not been clearly established. These characteristics may be underestimated in claims-based studies where individual-level data are limited. We sought to examine the risk of readmissions and postdischarge mortality by race and ethnicity after rigorous adjustment for multimorbidity, physical functioning, and sociodemographic and lifestyle characteristics. METHODS: We used Health and Retirement Study (HRS) data linked to Medicare claims. To obtain ICD-9-CM diagnostic codes to compute the ICD-coded multimorbidity-weighted index (MWI-ICD) we used Medicare Parts A and B (inpatient, outpatient, carrier) files between 1991-2015. Participants must have had at least one hospitalization between January 1, 2000 and September 30, 2015 and continuous enrollment in fee-for-service Medicare Part A 1-year prior to hospitalization. We used multivariable logistic regression to assess the association of MWI-ICD with 30-day readmissions and mortality 1-year postdischarge. Using HRS data, we adjusted for age, sex, BMI, smoking, physical activity, education, household net worth, and living arrangement/marital status, and examined for effect modification by race and ethnicity. RESULTS: The final sample of 10,737 participants had mean ± SD age 75.9 ± 8.7 years. Hispanic adults had the highest mean MWI-ICD (16.4 ± 10.1), followed by similar values for White (mean 14.8 ± 8.9) and Black (14.7 ± 8.9) adults. MWI-ICD was associated with a higher odds of readmission, and there was no significant effect modification by race and ethnicity. For postdischarge mortality, a 1-point increase MWI-ICD was associated with a 3% higher odds of mortality (OR = 1.03, 95% CI: 1.03-1.04), which did not significantly differ by race and ethnicity. CONCLUSIONS: Multimorbidity was associated with a monotonic increased odds of 30-day readmission and 1-year postdischarge mortality across all race and ethnicity groups. There was no significant difference in readmission or mortality risk by race and ethnicity after robust adjustment.

BACKGROUND/OBJECTIVES: Home-based medical care (HBMC) is longitudinal medical care provided by physicians, advanced practice providers, and, often, inter-professional care teams to patients in their homes. Our objective is to determine the prevalence of HBMC among older adults (≥65) insured by a Medicare Advantage (MA) plan and compare characteristics of those who receive HBMC to those who do not. METHODS: Study used de-identified medical claims and enrollment records for MA beneficiaries during calendar years 2017 and 2018 linked with socioeconomic status data in the OptumLabs Data Warehouse. We defined a cohort of MA beneficiaries age ≥65 receiving HBMC for at least 2 months during 2017-2018, described the cohort using demographic, utilization, and comorbidity data and compared it to a 5% random sample of a population of MA beneficiaries age ≥65 not receiving HBMC (No HBMC). RESULTS: Overall, 1.45% of the study cohort age ≥65 received HBMC. Compared to No HBMC (n = 132,147), those receiving HBMC (n = 38,800) were more likely to be: older (46.6% vs. 11.9% age 85+); female (70.8% vs. 58.5%); Black (12.3% vs. 11.3%); urban (90.3% vs. 81.3%); experience hospitalization (38.0% vs. 13.3%), emergency department visit (58.3% vs. 26.9%), ambulance trip (44.1% vs. 9.6%), skilled nursing facility (37.6% vs. 6.4%), or hospice care admission (21.1% vs. 3.5%). They also were more likely to experience a wide range of chronic conditions including dementia (58.1% vs. 5.2%), morbidity burden (Charlson score 3.4 vs. 1.8), and serious illness (77.1% vs. 29.5%). All comparisons p

Background: Most fractures occur in women aged ≥80 years but competing mortality unrelated to fracture may limit the benefit of osteoporosis drug therapy for some women in late life. Our primary aim was to develop separate prediction models for non‐spine fracture (NSF) and mortality before fracture to identify subsets of women with varying fracture versus mortality risks. Methods: Separate prediction models were developed for NSF and mortality before NSF for 4895 women aged ≥80 years enrolled in the Study of Osteoporotic Fractures (SOF) or the Health Aging and Body Composition (HABC) study. Proportional hazards models modified to account for competing mortality were used to identify candidate risk factors for each outcome. Predictors associated with NSF or mortality (p < 0.2) were included in separate competing risk models to estimate the cumulative incidence of NSF and mortality before NSF during 5 years of follow‐up. This process was repeated to develop separate prediction models for hip fracture and mortality before hip fracture. Results: Significant predictors of NSF (race, total hip BMD, grip strength, prior fracture, falls, and use of selective serotonin reuptake inhibitors, benzodiazepines, or oral/transdermal estrogen) differed from predictors of mortality before NSF (age, walking speed, multimorbidity, weight change, shrinking, smoking, self‐rated health, dementia, and use of warfarin). Within nine subsets of women defined by tertiles of risk, 5‐year outcomes varied from 28% NSF and 8% mortality in the high‐risk NSF/low‐risk mortality subset, to 9% NSF and 22% mortality in the low‐risk NSF/high‐risk mortality subset. Similar results were seen for predictors of hip fracture and mortality before hip fracture. Conclusion: Considerable variation in 5‐year competing mortality risk is present among women in late life with similar 5‐year NSF risk. Both fracture risk and life expectancy should inform shared clinical decision‐making regarding initiation or continuation of osteoporosis drug therapy for women aged ≥80 years. [ABSTRACT FROM AUTHOR]

The article highlights the U13 Bench-to-Bedside (B2B) conference series, a collaborative effort by the American Geriatrics Society (AGS) and the National Institute on Aging. Topics include the transition of the AGS/National Institute on Aging (NIA) U13 B2B conference series from 2004 to 2017, progressive exploration of key issues in geriatrics reflected in the series of conferences, and an overview of the conferences in the series from 2018 to 2023.

The article presents a study which explored real-time benefit tool (RTBT) cost estimate viewing patterns among primary care providers (PCPs) caring for adults with multimorbidity in one large academic health system to provide an overview of early update and identify opportunities for improving implementation. Topics discussed include reason that PCPs may be reluctant to use RTBT cost estimates, the proportion of medications with RTBT queries, and RTBT queries among PCPs.

The authors comment on the lessons that can be learned from the COVID-19 triage schemes aimed to help U.S. states be better prepared, both clinically and ethically, for the next public health emergency. Cited are when states should trigger triage protocols, how to protect the vulnerable during a health crisis, and how triage protocols should operate in practice.

Background: Loneliness is a significant public health challenge in the United States, especially among older adults. The epidemiology of loneliness among older adults in primary care is lacking, and specific research is needed on how loneliness impacts older primary patients' physical, mental, and cognitive health. A large sample of older primary care patients were recruited for a trial during the COVID‐19 pandemic to measure the relationship between loneliness and physical and mental quality of life (QOL). Methods: Baseline data come from the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer's disease and related dementias screening among primary care patients ages 65 and older, collected April 2020 to September 2021. Loneliness was measured with the 5‐item, Loneliness Fixed Form Ages 18+ from The NIH Toolbox Emotion Battery, physical and mental health‐related QOL was measured with the SF‐36v2, and depression and anxiety severity were measured with the PHQ‐9 and GAD‐7, respectively. Results: Spearman correlation analyses revealed that loneliness was moderately correlated with mental health QOL (r[601] = −0.43, p < 0.001), anxiety severity (r[601] = 0.44, p < 0.001), and depression severity (r[601] = 0.42, p < 0.001), while weakly correlated with physical health QOL (r[601] = −0.15, p < 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was significantly associated with both lower mental (p < 0.001) and physical (p < 0.001) QOL. Furthermore, loneliness remained significantly associated with worse mental QOL after adjusting for age, gender, race, ethnicity, educational level, perceived income status, neighborhood disadvantage, severity of comorbidities, and comorbid depression and anxiety. Conclusion: Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships. [ABSTRACT FROM AUTHOR]

Background: The broad concept of health as "the ability to adapt and self‐manage in the face of social, physical and emotional challenges" has been operationalized by "Positive Health," a framework increasingly used in the Netherlands. We explored to what degree the impact of the COVID‐19 pandemic and preventive measures on Positive Health differed between community‐dwelling older adults without, with mild and with complex health problems, as well as differences flowing from their use of preventive measures. Methods: During the second wave in the Netherlands (November 2020–February 2021), a convenience sample of adults aged ≥65 years completed an online questionnaire. Positive Health impact was measured based on self‐reported change of current health status, across six dimensions, compared to before the pandemic (decreased/unchanged/increased). The complexity of health problems (past month) was assessed using the validated ISCOPE tool, comparing subgroups without, with mild or with complex health problems. High use of preventive measures was defined as ≥9 of 13 measures and compared to low use (<9 measures). Results: Of the 2397 participants (median age 71 years, 60% female, and 4% previous COVID‐19 infection), 31% experienced no health problems, 55% mild health problems, and 15% complex health problems. Overall, participants reported a median decrease in one Positive Health dimension (IQR 1–3), most commonly in social participation (68%). With an increasing complexity of health problems, subjective Positive Health declined more often across all six dimensions, ranging from 3.3% to 57% in those without, from 22% to 72% in those with mild, and from 47% to 75% in those with complex health problems (p‐values for trend <0.001; independent of age and sex). High users of preventive measures more often experienced declined social participation (72% vs. 62%, p < 0.001) and a declined quality of life (36% vs. 30%, p = 0.007) than low users, especially those with complex health problems. Conclusion: As the complexity of health problems increased, the adverse impact of the COVID‐19 pandemic and related preventive measures was experienced more frequently across all dimensions of Positive Health. Acknowledging this heterogeneity is pivotal to the effective targeting of prevention and healthcare to those most in need. [ABSTRACT FROM AUTHOR]

The author reflects on the need for revisions in clinical guidelines for the treatment of older people with HIV. Topics discussed include the extension of lifespans for people with HIV, the challenge facing geriatric care professionals in providing HIV treatment to such patients, and changes in the health impacts of living with HIV.

BackgroundAccumulating evidence indicates that behaviors in Alzheimer's disease and related dementias could result in incarceration. Yet, the proportion of persons diagnosed with dementia and mild cognitive impairment (MCI) before they were incarcerated is largely unknown. By leveraging a national sample of mid- to late-life adults who were incarcerated, we determined the prevalence of dementia and MCI before their incarceration.MethodsIn this current study, participants were Medicare-eligible U.S. veterans who transitioned from incarceration to the community in mid- to late-life from October 1, 2012, to September 30, 2018, after having been incarcerated for ≤10 consecutive years (N = 17,962). Medical claims data were used to determine clinical diagnoses of dementia and MCI up to three years before incarceration. Demographics, comorbidities, and duration of incarceration among those with dementia and MCI were compared to those with neither diagnosis.ResultsParticipants were >97% male, 65% non-Hispanic white, 30% non-Hispanic black, and 3.3% had a diagnosis of either dementia (2.5%) or MCI (0.8%) before their most recent incarceration. Individuals with MCI or dementia diagnoses were older, were more likely to be non-Hispanic white, had more medical and psychiatric comorbidities, and experienced homelessness and traumatic brain injury at higher rates than those with neither diagnosis. Average duration of incarceration was significantly shorter among those with MCI (201.8 [±248.0] days) or dementia (312.8 [±548.3] days), as compared to those with neither diagnosis (497.0 [±692.7] days) (p

Background: Post‐acute sequelae of SARS‐CoV‐2 (PASC) describes a syndrome of physical and cognitive decline that persists after acute symptoms of infection resolve. Few studies have explored PASC among nursing home (NH) residents. Methods: A retrospective cohort study was conducted at two NHs in Michigan. COVID‐positive patients were identified from March 21, 2020 to October 26, 2021. The comparison group were patients who lived at the same NH but who were never infected during the study period. Minimum Data Set was used to examine trajectories of functional dependence (Activity of Daily Living [ADL] composite score) and cognitive function (Brief Interview for Mental Status [BIMS]). Linear mixed‐effects models were constructed to estimate short‐term change in function and cognition immediately following diagnosis and over time for an additional 12 months, compared to pre‐COVID and non‐COVID trajectories and adjusting for sex, age, and dementia status. Results: We identified 171 residents (90 COVID‐19 positive, 81 non‐COVID) with 719 observations for our analyses. Cohort characteristics included: 108 (63%) ≥ 80 yrs.; 121 (71%) female; 160 (94%) non‐Hispanic white; median of 3 comorbidities (IQR 2–4), with no significant differences in characteristics between groups. COVID‐19 infection affected the trajectory of ADL recovery for the first 9 months following infection, characterized by an immediate post‐infection decrease in functional status post‐infection (−0.60 points, p = 0.002) followed by improvement toward the expected functional trajectory sans infection (0.04 points per month following infection, p = 0.271). Conclusions: NH residents experienced a significant functional decline that persisted for 9 months following acute infection. Further research is needed to determine whether increased rehabilitation services after COVID‐19 may help mitigate this decline. [ABSTRACT FROM AUTHOR]

Background: Falls are the most common medication‐related safety event in older adults. Deprescribing fall risk‐increasing drugs (FRIDs) may mitigate fall risk. This study assesses the effects of an innovative deprescribing program in reducing FRID burden and falls‐related acute visits over 1 year. Methods: The Falls Assessment of Medications in the Elderly (FAME) Program is a pilot deprescribing program designed to improve medication safety in Veterans aged ≥65, screening positive for high fall risk at the Durham Veterans Affairs Health Care System. Central case finding and electronic case reviews with deprescribing recommendations were completed by an interdisciplinary team, forwarded to prescribers for approval, then implemented during follow‐up telephone visits by FAME team. Primary outcome was change in FRID burden calculated by modified Drug Burden Index (DBI) at 1 year and an exploratory outcome was 1‐year fall‐related acute visits. Results: Overall, 472 patients (236 intervention cases, 236 matched controls) were included in the study. Of the 236 patients receiving a FAME deprescribing plan, 147 had recommendations approved by prescriber and patient. In the intention‐to‐treat analysis, the 1‐year change in modified DBI was −0.15 (95% CI −0.23, −0.08) in the intervention cohort and −0.11 (−0.21, −0.00) in the matched control cohort (p = 0.47). The odds of increasing DBI by a clinically important threshold of 0.5 was significantly lower in the FAME cohort (OR 0.37, 0.21, 0.66). Fall‐related acute events occurred in 6.3% of patients in the intervention group versus 11.0% in control patients over a one‐year period (p = 0.10). Conclusions: The program was associated with a significantly lower odds of further increasing FRID burden at 1 year compared to matched controls. An electronic case review and telephone counseling program has the potential to reduce drug‐related falls in high‐risk older adults. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems are increasingly turning to data‐driven approaches, such as clustering techniques, to inform interventions for medically complex older adults. However, patients seeking care in multiple healthcare systems may have missing diagnoses across systems, leading to misclassification of resulting groups. We evaluated the impact of multi‐system use on the accuracy and composition of multimorbidity groups among older adults in the Veterans Health Administration (VA). Methods: Eligible patients were VA primary care users aged ≥65 years and in the top decile of predicted 1‐year hospitalization risk in 2018 (n = 558,864). Diagnoses of 26 chronic conditions were coded using a 24‐month lookback period and input into latent class analysis (LCA) models. In a random 10% sample (n = 56,008), we compared the resulting model fit, class profiles, and patient assignments from models using only VA system data versus VA with Medicare data. Results: LCA identified six patient comorbidity groups using VA system data. We labeled groups based on diagnoses with higher within‐group prevalence relative to the average: Substance Use Disorders (7% of patients), Mental Health (15%), Heart Disease (22%), Diabetes (16%), Tumor (14%), and High Complexity (10%). VA with Medicare data showed improved model fit and assigned more patients with high accuracy. Over 70% of patients assigned to the Substance, Mental Health, High Complexity, and Tumor groups using VA data were assigned to the same group in VA with Medicare data. However, 41.9% of the Heart Disease group and 14.7% of the Diabetes group were reassigned to a new group characterized by multiple cardiometabolic conditions. Conclusions: The addition of Medicare data to VA data for older high‐risk adults improved clustering model accuracy and altered the clinical profiles of groups. Accessing or accounting for multi‐system data is key to the success of interventions based on empiric grouping in populations with dual‐system use. [ABSTRACT FROM AUTHOR]

Background: Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity‐limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. Methods: Data were taken from the Hispanic Established Population for the Epidemiological Study of the Elderly (2010–2016). Pain interference, or pain that limited daily activities in the last 12 months, was categorized into none, untreated pain interference, and treated pain interference. Cognitive impairment was defined as scoring <21 on the Mini‐Mental State Examination and difficulty with at least one instrumental activity of daily living. We used general estimation equations to assess this relationship between pain and incident cognitive impairment over the 6‐year period (n = 313). Results: Participants reporting both untreated and treated pain interference had higher odds of incident cognitive impairment than those reporting no pain or pain interference (untreated adjusted odds ratio [aOR]: 2.18; 95% confidence interval [CI]: 1.09–4.36; treated aOR: 1.99; 95% CI: 1.15–3.44). Depressive symptoms explained 15.0% of the total effect of untreated pain and 25.3% of treated pain. Conclusions: Among very old Mexican American adults, both treated and untreated pain interference was associated with incident cognitive impairment. This association was partially mediated by depressive symptoms, underscoring a need for depression screening in patients with chronic pain. Future work is needed to examine mechanistic/causal pathways between pain and subsequent cognitive impairment and the role of pharmacological and non‐pharmacological treatments in these pathways. [ABSTRACT FROM AUTHOR]

Background: Veterans Affairs (VA) home‐based primary care (HBPC) provides comprehensive longitudinal care to patients with complex, chronic disabling disease. While enrollment is associated with lower hospitalization rates and costs, detailed trajectories have not been well described. Methods: We performed a longitudinal descriptive study of patients newly enrolled in VA HBPC in fiscal year (FY) 2015. We extracted demographics, comorbidities, functional status, and social supports from VA and Medicare data and examined patterns of care and clinical outcomes, including hospital, nursing home (NH), hospice use and mortality from FY2015–2017. We present results using descriptive statistics, alluvial plots, and heat maps. Results: We identified 10,571 HBPC enrollees in FY2015; mean age was 77.7. HBPC patients commonly had chronic medical conditions with high self‐management burden (e.g., diabetes 48.2%) and disabling conditions such as dementia (39.3%). Over half had ≥2 deficits in activities of daily living, 46% had caregivers with functional limitations or no caregiver, and 25% resided in a socially deprived area. Patients experienced variable care trajectories. Mean time enrolled in HBPC was 331 days, 8.3% of patients were discharged after 3 months, and 22.8% stayed enrolled for over 2 years. Institutional health care use declined in the 6 months after initial enrollment: (e.g., hospital: 41%–25%, NH: 34%–11%). At 2 years, 36% of patients had died; among decedents, 58% received hospice and 72% died in a non‐institutional setting. In the last 180 days of life, 84% of time was spent at home, and once enrolled in hospice, 97% of time was spent outside of institutional care. Conclusions: HBPC patients experience highly variable care trajectories but on average have reductions in acute care use and spend a majority of time in non‐institutional settings. These data allow for a nuanced understanding of HBPC, providing a platform for monitoring, evaluating, and improving program function. [ABSTRACT FROM AUTHOR]

Background: Drug‐related readmissions (DRAs) are defined as rehospitalizations with an adverse drug event as their main or significant contributory cause. DRAs represent a major adverse health burden for older patients. A prediction model which identified older hospitalized patients at high risk of a DRA <1 year was previously developed using the OPERAM trial cohort, a European cluster randomized controlled trial including older hospitalized patients with multimorbidity and polypharmacy. This study has performed external validation and updated the prediction model consequently. Methods: The MedBridge trial cohort (a multicenter cluster randomized crossover trial performed in Sweden) was used as a validation cohort. It consisted of 2516 hospitalized patients aged ≥65 years. Model performance was assessed by: (1) discriminative power, assessed by the C‐statistic with a 95% confidence interval (CI); (2) calibration, assessed by visual examination of the calibration plot and use of the Hosmer–Lemeshow goodness‐of‐fit test; and (3) overall accuracy, assessed by the scaled Brier score. Several updating methods were carried out to improve model performance. Results: In total, 2516 older patients were included in the validation cohort, of whom 582 (23.1%) experienced a DRA <1 year. In the validation cohort, the original model showed a good overall accuracy (scaled Brier score 0.03), but discrimination was moderate (C‐statistic 0.62 [95% CI 0.59–0.64]), and calibration showed underestimation of risks. In the final updated model, the predictor "cirrhosis with portal hypertension" was removed and "polypharmacy" was added. This improved the model's discriminative capability to a C‐statistic of 0.64 (95% CI 0.59–0.70) and enhanced calibration plots. Overall accuracy remained good. Conclusions: The updated OPERAM DRA prediction model may be a useful tool in clinical practice to estimate the risk of DRAs in older hospitalized patients subsequent to discharge. Our efforts lay the groundwork for the future development of models with even better performance. [ABSTRACT FROM AUTHOR]

Background: Research on factors associated with recurrent emergency department (ED) visits and their implications for improving dementia care is lacking. The objective of this study was to examine associations between the individual characteristics of older adults living with dementia and recurrent ED visits. Methods: We used health administrative databases to conduct a population‐based retrospective cohort study among older adults with dementia in Ontario, Canada. We included community‐dwelling adults 66 years and older who visited the ED between April 1, 2010, and March 31, 2019 and were discharged home. We recorded all ED visits within one year after the baseline visit. We used recurrent event Cox regression to examine associations between repeat ED visits and individual clinical, demographic, and health service use characteristics. We fit conditional inference trees to identify the most important factors and define subgroups of varying risk. Results: Our cohort included 175,863 older adults with dementia. ED use in the year prior to baseline had the strongest association with recurrent visits (3+ vs.0 adjusted hazard ratio (aHR): 1.92 (1.89, 1.94), 2vs.0 aHR: 1.45 (1.43, 1.47), 1vs.0 aHR: 1.23 (1.21, 1.24)). The conditional inference tree utilized history of ED visits and comorbidity count to define 12 subgroups with ED revisit rates ranging from 0.79 to 7.27 per year. Older adults in higher risk groups were more likely to live in rural and low‐income areas and had higher use of anticonvulsants, antipsychotics, and benzodiazepines. Conclusions: History of ED visits may be a useful measure to identify older adults with dementia who would benefit from additional interventions and supports. A substantial proportion of older adults with dementia have a pattern of recurrent visits and may benefit from dementia‐friendly and geriatric‐focused EDs. Collaborative medication review in the ED and closer follow‐up and engagement with community supports could improve patient care and experience. See related editorial by Shah and Hwang in this issue. [ABSTRACT FROM AUTHOR]

The article provides an overview of the National Institute on Aging (NIA)/American Geriatrics Society (AGS) conferences. Topics discussed include accomplishments of these conferences, major recommendations from the R13 conferences from 2004 to 2009, and progress made in the conferences from 2004 to 2024.

Background: Older age is a well‐known risk factor for recurrent and severe Clostridioides difficile infection (CDI). Fecal microbiota transplantation (FMT) is widely recognized as an effective and safe therapeutic option for the treatment of recurrent CDI (rCDI). However, the efficacy and safety of FMT for rCDI in very old patients are uncertain. This study evaluated the efficacy and safety of FMT in a group of very old subjects with rCDI, and the reliability of overall comorbidity and frailty assessment for identifying patients at higher risk of worse clinical outcomes. Methods: This is a retrospective single‐center study including patients ≥85 years undergoing FMT for rCDI between 2014 and 2022. Primary outcomes included efficacy of FMT, defined as cure of CDI at 8 week‐follow‐up, and safety evaluation. At baseline, comorbidity was measured with the Charlson Comorbidity Index (CCI). Frailty was measured with the Clinical Frailty Scale (CFS). Results: Overall, 43 patients with a median age of 88 years underwent FMT by colonoscopy in the study period. The rate of first FMT success was 77%. Five of the 10 patients who failed the first FMT infusion were cured after repeat FMT, with an overall efficacy of 88%. In patients with successful treatment, the CFS was significantly lower compared to those who failed the FMT or underwent repeat FMT (p < 0.01 for both). Mild adverse events occurred in 11 patients (25%). One death, not related to FMT or rCDI, occurred within 7 days from the first procedure. Conclusions: FMT is effective and safe in very old patients. Frailty and high comorbidity do not limit use of FMT in these patients. Frailty assessment has potential to better identify patients at higher risk of worse outcomes or for repeat treatment with FMT. [ABSTRACT FROM AUTHOR]

Background: Males constitute 25% of older adults who experience hip fractures in the United States; a concerning upward trend given poorer health and outcomes among male survivors. Male sex is associated with worse cognitive performance after hip fracture, impacting participation in rehabilitation and long‐term outcomes especially for those with Alzheimer's disease or related dementias (ADRD). However, little research has evaluated whether sex differences in post‐fracture recovery are greater among those living with ADRD. Methods: Data were drawn from 2010 to 2017 Medicare fee‐for‐service beneficiaries aged 65 years and older who survived hospitalization for hip fracture (n = 69,581). The primary outcome was days alive and at home (DAAH), a validated patient‐centered claims‐based outcome calculated as 365 days from fracture minus days in hospital, nursing home, rehabilitation facility, emergency department, or time after death. Multivariable Poisson regressions with an interaction term between sex and ADRD status were to model the association between DAAH and ADRD in the 12 months post hip fracture, adjusting for demographics, injury severity, chronic disease burden, and hospital‐level fixed effects. Results: Compared to females, males were younger and had more comorbidities at the time of fracture. Among survivors, males with ADRD spent a mean of 160.7 DAAH compared to 228.4 for males without ADRD, 177.8 for females with ADRD, and 248.0 for females without ADRD. In adjusted analyses, males without ADRD spent 8.2% fewer DAAH compared to females (rate ratio [RR] = 0.92, 95% CI 0.92–0.92). This relative sex difference increased significantly when comparing those living with ADRD, with males spending an additional 3.3% fewer DAAH (interaction RR = 0.96, 95% CI 0.96–0.97). Conclusions: Males spend fewer DAAH after hip fracture than females, and this difference increases modestly for males living with ADRD compared to females. This suggests that cognitive impairment may be a small but significant contributor to sex‐based differences observed during hip fracture recovery. [ABSTRACT FROM AUTHOR]

Background: Among older adults, non‐cardiovascular multimorbidity often coexists with cardiovascular disease (CVD) but their clinical significance is uncertain. We identified common non‐cardiovascular comorbidity patterns and their association with clinical outcomes in Medicare fee‐for‐service beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF), or atrial fibrillation (AF). Methods: Using 2015–2016 Medicare data, we took 1% random sample to create 3 cohorts of beneficiaries diagnosed with AMI (n = 24,808), CHF (n = 57,285), and AF (n = 36,277) prior to 1/1/2016. Within each cohort, we applied latent class analysis to classify beneficiaries based on 9 non‐cardiovascular comorbidities (anemia, cancer, chronic kidney disease, chronic lung disease, dementia, depression, diabetes, hypothyroidism, and musculoskeletal disease). Mortality, cardiovascular and non‐cardiovascular hospitalizations, and home time lost over a 1‐year follow‐up period were compared across non‐cardiovascular multimorbidity classes. Results: Similar non‐cardiovascular multimorbidity classes emerged from the 3 CVD cohorts: (1) minimal, (2) depression‐lung, (3) chronic kidney disease (CKD)‐diabetes, and (4) multi‐system class. Across CVD cohorts, multi‐system class had the highest risk of mortality (hazard ratio [HR], 2.7–3.9), cardiovascular hospitalization (HR, 1.6–3.3), non‐cardiovascular hospitalization (HR, 3.1–7.2), and home time lost (rate ratio, 2.7–5.4). Among those with AMI, the CKD‐diabetes class was more strongly associated with all the adverse outcomes than the depression‐lung class. In CHF and AF, differences in risk between the depression‐lung and CKD‐diabetes classes varied per outcome; and the depression‐lung and multi‐system classes had double the rates of non‐cardiovascular hospitalizations than cardiovascular hospitalizations. Conclusion: Four non‐cardiovascular multimorbidity patterns were found among Medicare beneficiaries with CHF, AMI, or AF. Compared to the minimal class, the multi‐system, CKD‐diabetes, and depression‐lung classes were associated with worse outcomes. Identification of these classes offers insight into specific segments of the population that may benefit from more than the usual cardiovascular care. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) and dementia both have profound effects on function and mortality in older persons. However, we have limited knowledge about the impact of co‐occurring HF and dementia. Our goal was to understand how often persons with HF have dementia and the impact of their co‐occurrence. Methods: Retrospective analysis of participants (age > 65) in the 2015 wave of the nationally representative Health and Aging Trends Study (NHATS) with linkage to Medicare claims. 912 participants with HF (45% older than 80, 51% women) using Medicare claims. We used the validated NHATS dementia algorithm to identify those with probable dementia. Outcomes of interest included the need for help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at baseline, functional decline, hospitalization over 1 year, and mortality over 2‐years. Baseline functional status, functional decline, and hospitalization were compared using adjusted logistic regression, mortality was analyzed using adjusted Cox regression models adjusted for demographics, socio‐economic status, baseline health, and baseline functional status. Results: 200 (21%) of the participants with HF also had dementia. For each I/ADL, patients with both HF and dementia were more likely to need help than those with HF without dementia. 71.8% of participants with HF and dementia needed help with medications versus 16.6% with HF without dementia (p < 0.001). Having HF and dementia was associated with an increased risk of requiring help with additional ADLs after one year (aOR = 2.69, 95% CI 1.53, 4.73). Participants with HF and dementia had an increased risk of being hospitalized within one year (aOR = 2.02 95% CI 1.16, 3.54), or dying within two years (aHR = 1.52 95% CI 1.03, 2.26). Conclusions: One‐fifth of persons over age 65 with HF also have comorbid dementia. Co‐occurring HF and dementia markedly increase functional impairment and subsequent ADL decline, hospitalization, and death. These results highlight the need for physician awareness for signs of dementia, and appropriate adjustments in the management of HF. [ABSTRACT FROM AUTHOR]

Background: There is mixed evidence on whether living arrangements and social interactions are associated with poorer health outcomes after hip fracture repair. Distinct social profiles among male and female older adults may explain some of the differences. However, prior studies did not evaluate these differences by sex. This article aims to assess if the associations between living alone, social interaction, and physical performance differ by sex among hip fracture survivors. Methods: This prospective cohort study is part of the Baltimore Hip Studies seventh cohort, with 168 male and 171 female hip fracture patients assessed at baseline (≤22 days after hospitalization) and at 2, 6, and 12 months post admission. Living arrangements and interaction with children or siblings and others in the past 2 weeks were collected at all visits. Physical performance was measured in the follow‐up visits with the Short Physical Performance Battery (SPPB). Linear mixed models tested associations of living alone and social interaction with SPPB over time adjusted for age, education, comorbidities, physical functioning pre‐fracture, cognitive function, self‐rated health, and time. Results: For men only, living alone was associated with worse performance (0.7 points lower SPPB scores, p = 0.05). Higher social interaction was associated with 0.8 and 1.2 point higher SPPB scores for men and women, respectively (p < 0.05). Visiting with friends was significantly associated with better function among males, while visiting with children or siblings was associated with worse SPPB among females. Conclusions: Living arrangements and types of social interaction are differentially associated with physical function for older men and women. Screening for social isolation/integration and including interventions that promote social interaction and participation should be considered in healthcare programs for hip fracture survivors. [ABSTRACT FROM AUTHOR]

Background: In multimorbid older patients with type 2 diabetes mellitus (T2DM), the intensity of glucose‐lowering medication (GLM) should be focused on attaining a suitable level of glycated hemoglobin (HbA1c) while avoiding side effects. We aimed at identifying patients with overtreatment of T2DM as well as associated risk factors. Methods: In a secondary analysis of a multicenter study of multimorbid older patients, we evaluated HbA1c levels among patients with T2DM. Patients were aged ≥70 years, with multimorbidity (≥3 chronic diagnoses) and polypharmacy (≥5 chronic medications), enrolled in four university medical centers across Europe (Belgium, Ireland, Netherlands, and Switzerland). We defined overtreatment as HbA1c < 7.5% with ≥1 GLM other than metformin, as suggested by Choosing Wisely and used prevalence ratios (PRs) to evaluate risk factors of overtreatment in age‐ and sex‐adjusted analyses. Results: Among the 564 patients with T2DM (median age 78 years, 39% women), mean ± standard deviation HbA1c was 7.2 ± 1.2%. Metformin (prevalence 51%) was the most frequently prescribed GLM and 199 (35%) patients were overtreated. The presence of severe renal impairment (PR 1.36, 1.21–1.53) and outpatient physician (other than general practitioner [GP], i.e. specialist) or emergency department visits (PR 1.22, 1.03–1.46 for 1–2 visits, and PR 1.35, 1.19–1.54 for ≥3 visits versus no visits) were associated with overtreatment. These factors remained associated with overtreatment in multivariable analyses. Conclusions: In this multicountry study of multimorbid older patients with T2DM, more than one third were overtreated, highlighting the high prevalence of this problem. Careful balancing of benefits and risks in the choice of GLM may improve patient care, especially in the context of comorbidities such as severe renal impairment, and frequent non‐GP healthcare contacts. [ABSTRACT FROM AUTHOR]