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Fall-related injuries contribute to increased frailty, disability, and premature death in older adults (≥65 years). The US Centers for Medicare and Medicaid Services began reimbursing annual wellness visits (AWVs) in 2011. In the present study, we assessed the effect of AWV receipt in 2017 on fall and fracture prevention through December 31, 2018. Using Texas Medicare data for 2014-2018, we identified cohorts of Medicare beneficiaries ≥68 years, matched for the presence/absence of an AWV in 2017 by propensity score, and observed two outcomes: fracture as a primary diagnosis, and fall occurrences. Rates of each outcome were estimated using the Kaplan-Meier method. Of the 2017 beneficiaries, 32.2% received an AWV. For the 742,494 beneficiaries in the matched cohort, conditional Cox proportional hazards models revealed that receiving an AWV in 2017 was associated with reduced risks for future falls (3.9%) and fractures (4%). The effect of the AWV was stronger on fall reduction in rural residents (HR: 0.799; 95% CI: 0.679 to 0.941) and on fracture reduction in beneficiaries with ≥4 morbidities (HR: 0.918; 95% CI: 0.867 to 0.972). Receipt of an AWV in three consecutive years (2015-2017) further lowered the risk of future falls. We conclude that the risks for future falls/fractures are lower in older adults receiving AWVs. Our study underscores the need for expanded public education programs that raise awareness about AWVs and the potential for AWV data to inform fall prevention interventions and other health promotion practices., Competing Interests: Declaration of Competing Interest All authors have no conflicts of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Aim: To examine whether rehabilitation therapy type would be associated with transitions to skilled nursing facilities (SNF) in community-living seniors with acute medical illnesses. Methods: Using administrative and clinical data, multivariate regression analysis examined the relationship between the extent of rehabilitation therapy and transitions to SNF in all participants, as well as participants by physical function at admission. Results: In all participants ( n = 929), the intensified rehabilitation therapy was associated with a lower probability of transitions to SNF (14% vs 21%; odds ratio [OR] 0.59; 95% confidence intervals [CI] 0.22-0.96; P = 0.02). In participants with mild physical limitations ( n = 270), less frequent transitions to SNF occurred when patients received intensified rehabilitation therapy [16% vs 23%; OR 0.46; 95% CI 0.17-0.94; P = 0.01]. In participants with moderate to severe physical limitations ( n = 265), the decreased frequency of transitions to SNF associated with rehabilitation therapy became more pronounced (18% vs 28%; OR 0.34; 95% CI 0.07-0.89; P = 0.004). By contrast, in participants without physical limitation ( n = 394), the number of transitions to SNF did not change significantly when they received intensified rehabilitation therapy ( P = 0.53). Conclusions: We found a significant relationship between intensified rehabilitation therapy and the decrease of transitions to SNF in community-living seniors with acute medical illness. The magnitude of this relationship increased in participants with more physical limitations, but not in participants without physical limitations at admission. Geriatr Gerontol Int 2013; 13: 547-554. [ABSTRACT FROM AUTHOR]

The article presents a summary of the report of the Agency for Healthcare Research and Quality and Mathematica Policy research which helps smaller primary care practices transform into effective medical homes that serve patients with complex needs in the U.S. It illustrates approaches for supporting and collaborating with smaller, independent primary care practices. In addition, the programs allow patients with complex needs to maintain existing relationships with their primary care clinicians.

This study aims to investigate the association of patient-reported improvement and rehabilitation characteristics with mortality among older adults who received rehabilitation. To do so, a national sample of Medicare beneficiaries from the National Health and Aging Trends Study was examined. Among those who reported receiving rehabilitation services in the 2015 interview (N = 1,188), 4.2% were deceased at the 2016 follow-up interview. Mortality was more common among those who had received rehabilitation in nursing home or inpatient and in-home settings compared to outpatient rehabilitation settings. In multivariable analyses accounting for demographics and health status, patient-reported worsening of functioning during rehabilitation (OR=15.69; 95% CI: 1.84-133.45) and cardiovascular disease (OR=4.15; 95% CI: 1.41-12.17) were associated with mortality. Among older adults who received rehabilitation, 1 in 25 were deceased at follow-up. That patient-reported functioning is associated with mortality suggests that more systematically including patient-reported outcomes in rehabilitation care may be clinically pertinent., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies., Design: Expert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure., Setting: Five southwestern states., Participants: A total of 1833 community-dwelling Mexican Americans aged 67 years or older., Measurements: Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing "low physical activity" with "limitations in walking half a mile"). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13)., Results: The original and modified frailty phenotype measures had a strong correlation (r = .89; P < .000) and agreement (κ = .84; 95% confidence interval [CI] = .81-.86; weighted κ = .86; 95% CI = .84-.88; bootstrap κ = .84; 95% CI = .81-.86; bootstrap-weighted κ = .86; 95% CI = .84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants., Conclusion: "Limitations in walking half a mile" can be used as a substitute criterion for "low physical activity" in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans. J Am Geriatr Soc 67:2393-2397, 2019., (© 2019 The American Geriatrics Society.)