Tucker SB, Love BL, Okeke CM
… +7 more, Zwick ED, Teng C, Wei J, Karaye IM, Alsahali S, Rajagopalan K, Yunusa I
J Am Geriatr Soc
· 2026 May · PMID 41833520
·
Publisher ↗
BACKGROUND: Prescribing cascades occur when cholinesterase inhibitor (ChEI)-induced urinary incontinence is misinterpreted as a new condition, leading to overactive bladder (OAB) antimuscarinic initiation. We evaluated w...BACKGROUND: Prescribing cascades occur when cholinesterase inhibitor (ChEI)-induced urinary incontinence is misinterpreted as a new condition, leading to overactive bladder (OAB) antimuscarinic initiation. We evaluated whether the ChEI-OAB antimuscarinic prescribing cascade was associated with delirium or falls compared with mirabegron in older adults living with dementia. METHODS: We conducted a retrospective cohort study using the Anlitiks All-Payor Claims database (2015-2020). Participants were adults aged ≥ 65 years with dementia newly prescribed a ChEI with no prior ChEI or OAB therapy (180 days). A 60-day window identified OAB treatment initiation after ChEI therapy. Exposures were OAB antimuscarinics or mirabegron. Outcomes were incident delirium and falls identified using diagnosis codes. Propensity score-based weighting balanced baseline characteristics. RESULTS: Among 2693 patients (mean age 80 years; 66.3% female), 201 (7.5%) initiated antimuscarinics and 2492 (92.5%) started mirabegron. Over 1 year, 8 (4.0%) antimuscarinic users developed delirium versus 95 (3.8%) mirabegron users (adjusted HR 1.35; 95% CI, 0.64-2.86). Falls occurred in 3 (1.5%) antimuscarinic users and 63 (2.5%) mirabegron users (adjusted HR 0.66; 95% CI, 0.20-2.15). CONCLUSIONS: In older adults living with dementia, the estimated association between initiation of OAB antimuscarinics following ChEIs and the risks of delirium or falls, compared with mirabegron, was statistically compatible with benefit, harm, or no clinically meaningful difference. These findings highlight the need to evaluate whether OAB antimuscarinics are prescribed in response to true clinical need or as part of a prescribing cascade. Given the limited number of outcome events and resulting wide 95% CIs, future studies are needed to more precisely estimate the risk.
Gill TM, Leo-Summers L, Gahbauer EA
… +3 more, Becher RD, Ferrante LE, Han L
J Am Geriatr Soc
· 2026 May · PMID 41807297
·
Full text
BACKGROUND: Days spent at home have been identified as a clinically meaningful patient-centered outcome, especially in older persons. Serious health events in this population have pronounced deleterious effects on functi...BACKGROUND: Days spent at home have been identified as a clinically meaningful patient-centered outcome, especially in older persons. Serious health events in this population have pronounced deleterious effects on functional well-being. Our objective was to determine whether and how days spent at home differ in the 6 months after specific types of serious health events. METHODS: From a prospective longitudinal study of 754 community-living persons, aged 70 years or older, we calculated the number of days at home as 180 minus the number of overnight days in a health care facility and days not alive. The occurrence of serious health events, including critical illness, major surgery (non-elective and elective), and other hospitalizations, were ascertained primarily through linkages with Medicare data. RESULTS: Days at home were diminished in the 180 days after each type of serious health event. Relative to a reference group, the adjusted rate ratios (95% CI), representing the mean number of days at home as a proportion, were 0.70 (0.64-0.77) for critical illness, 0.70 (0.64-0.76) for non-elective major surgery, 0.87 (0.84-0.91) for elective major surgery, and 0.86 (0.83-0.89) for other hospitalization. The corresponding absolute reductions (95% CI) in mean days at home were 48.6 (37.9-59.3), 50.1 (39.7-60.5), 20.7 (14.3-27.0), and 22.9 (17.9-28.0), respectively. Of the time not spent at home, days in a nursing facility were most common except for critical illness, which had the highest mortality; days in a hospice facility were least common; and days in a hospital differed relatively little across the groups. CONCLUSION: Days spent at home are considerably diminished after serious health events. These findings may help guide older persons, their families, and physicians about what to expect after hospital discharge for different types of serious health events, and they suggest potential strategies that may optimize time spent at home.
J Am Geriatr Soc
· 2026 Jun · PMID 41793188
·
Full text
BACKGROUND: Evidence supporting the use of statins for primary prevention of cardiovascular disease (CVD) in individuals aged ≥ 80 years remains limited. This study aimed to evaluate the long-term clinical benefits and s...BACKGROUND: Evidence supporting the use of statins for primary prevention of cardiovascular disease (CVD) in individuals aged ≥ 80 years remains limited. This study aimed to evaluate the long-term clinical benefits and safety of statins for primary prevention in patients aged 80 years and older. METHODS: We conducted a population-based retrospective cohort study using electronic medical records and pharmacy dispensing data from Clalit Health Services in Israel, covering the period from January 2015 to December 2020. Patients aged ≥ 80 years without prior CVD who were persistent statin users were compared with similar patients not receiving statins. Exclusions included prior CVD, dialysis, or death within 1 year of follow-up. Outcomes included all-cause mortality, new coronary events, myopathy, dementia, and diabetes mellitus. Cox proportional hazards models, adjusted for potential confounders, were used to assess the association between statin use and clinical outcomes. RESULTS: Among 15,745 patients (mean age 84.5 years; 66% female), 8413 were statin users. Over a 4-year mean follow-up, statin use was associated with a 31% reduction in mortality (HR 0.69; 95% CI: 0.34-0.74; p < 0.001) and a 20% reduction in new coronary events (HR 0.80; 95% CI: 0.68-0.94; p = 0.008). No significant differences were observed in the incidence of myopathy, diabetes, or dementia. Benefits were not observed in patients who discontinued statins before age 80. CONCLUSIONS: In patients aged ≥ 80 years, statin therapy for primary prevention was associated with reduced all-cause mortality and coronary morbidity, without increased risk of adverse events. Early discontinuation diminished these benefits.
J Am Geriatr Soc
· 2026 Jun · PMID 41786645
·
Publisher ↗
Geriatricians have struggled to describe a complex and sometimes ambiguous professional identity. Unlike other medical specialties anchored in discrete organ systems, diagnostic and interventional technologies, or clearl...Geriatricians have struggled to describe a complex and sometimes ambiguous professional identity. Unlike other medical specialties anchored in discrete organ systems, diagnostic and interventional technologies, or clearly defined clinical settings, geriatric medicine encompasses the care of a heterogeneous population of older adults with widely varying clinical needs, priorities, and trajectories relevant to function, multimorbidity, and complexity. This Special Article examines four distinct but overlapping perspectives on geriatrician identity-the complexivist, the healthful longevitist, the syndromist, and the contextualist. The complexivist perspective emphasizes expertise in managing multimorbidity, frailty, and the interplay of medical, functional, cognitive, and social challenges. The healthful longevitist reframes the discipline around extending healthspan, promoting resilience, and supporting healthy aging. The syndromist reflects a trend toward syndrome-specific specialization, such as "brain health," in some respects, paralleling subspecialty evolution in other fields. The contextualist highlights geriatricians who center their work within specific care settings or models of care, including home-based primary care, skilled nursing facilities, PACE programs, ACE units, co-management models of care with other specialties, and Age-Friendly Health Systems. While each perspective offers valuable insights, none alone fully captures the breadth of geriatric medicine or resolves long-standing tensions around recognition, prestige, and the profession's future. Debates over identity should not be viewed as divisive, but rather as essential to strengthening the profession. Continued examination of geriatrician identity is critical to ensuring that the specialty remains relevant, valued, and morally ambitious in the face of an aging population, major advances in geroscience and technology, and an evolving healthcare system.
Saliba D, Mor V, Hilliard KA
… +15 more, Mochel AL, Baumann M, Boxer R, D'Adamo H, Gotanda H, House KW, Joshi S, Sohn L, Tayade A, Tubbesing S, Berlowitz DR, Intrator O, Gutman R, Phibbs CS, Ouslander JG
J Am Geriatr Soc
· 2026 Apr · PMID 41733928
·
Full text
BACKGROUND: Hospitalization rates from nursing homes (NHs) have gained traction as pragmatic quality measures that can be derived from claims data. However, claims-based hospitalization measures do not account for clinic...BACKGROUND: Hospitalization rates from nursing homes (NHs) have gained traction as pragmatic quality measures that can be derived from claims data. However, claims-based hospitalization measures do not account for clinical complexity and the extent to which they reflect quality of care or quality of transfer decision making is unknown. We aim to examine agreement between a claims-based measure of potentially avoidable hospitalizations and expert clinician review of transfer decision making and care quality. METHODS: We randomly selected 252 hospital transfers across eight Veterans Administration (VA) NHs, known as Community Living Centers (CLCs). Eleven expert clinicians independently completed Structured Implicit Reviews (SIRs) of medical records to assess: (1) whether the transfer decision was appropriate (i.e., hospital was the lowest safe level-of-care given the resident's acute condition); (2) quality of care for evaluation or treatment of the acute change (adequate management of acute change), (3) quality of care for chronic conditions and preventing decline. We used VA Corporate Data Warehouse (CDW) data to determine a claims-based measure of potentially avoidable hospitalization. RESULTS: CDW data were available for 242 VA hospitalizations. The claims-based measure categorized 29 (12%) hospitalizations as potentially avoidable; only 2 of which matched the 20 SIR identified as inappropriate decisions to transfer. Furthermore, the claims-based measure flagged only 5 of 33 cases rated as inadequate treatment of acute decline and 6 of 17 rated as poor quality of chronic disease or preventive care. CONCLUSIONS: In a geographically diverse sample of CLC transfers, independent clinical experts' judgments of transfer decision appropriateness, quality of care for acute decline, and quality of chronic care differ from a claims-based potentially avoidable hospitalizations measure. Findings underscore the need for nuanced clinical consideration of hospitalization metrics for assessing quality and for understanding which aspects of care should be addressed to safely reduce NH transfers to hospitals.
Vennard O, Stewart C, Tolia M
… +2 more, Soiza RL, Myint PK
J Am Geriatr Soc
· 2026 Jun · PMID 41730788
·
Full text
BACKGROUND: Anticholinergic burden refers to the cumulative anticholinergic effect of all medications taken by an individual. Anticholinergic burden scales help identify patients at risk of anticholinergic adverse effect...BACKGROUND: Anticholinergic burden refers to the cumulative anticholinergic effect of all medications taken by an individual. Anticholinergic burden scales help identify patients at risk of anticholinergic adverse effects and guide prescribing. However, substantial variation exists between scales, with no gold standard identified. This variability may contribute to inconsistent risk assessment, suboptimal prescribing, and adverse outcomes. AIM: To systematically review available anticholinergic burden scales and their variability in medication lists, development strategies and scoring methods. As a secondary objective, the clinical outcomes associated with each scale were summarized. METHODS: A systematic search was conducted up to January 2025. Studies proposing novel or updated anticholinergic burden scales were included. Two reviewers independently performed study selection, data extraction, and quality assessment, using a custom tool based on expert consensus and principles of scale development. Findings were narratively synthesized. RESULTS: From 10,969 identified records, 21 studies met inclusion criteria. Medications included per scale ranged from 27 to 217, with 74% of high-potency drugs scored inconsistently. Variability was influenced by geographical origin and methodology, with literature review followed by expert opinion the most common method of development. Dosage consideration, among others, was inconsistent across scales, affecting clinical relevance. Clinical outcome studies reflected such inconsistencies. CONCLUSION: No gold standard anticholinergic burden scale was identified. Scales with broader drug coverage and accounting for individual variability appeared more clinically relevant. This review highlights the need for a clinically accessible, universal scoring system to better address the risks associated with anticholinergic polypharmacy.
Reckrey JM, Liu B, Arora A
… +5 more, Ritchie C, Leff B, Brody AA, Burgdorf JG, Ornstein KA
J Am Geriatr Soc
· 2026 Apr · PMID 41724735
·
Full text
BACKGROUND: People living with dementia frequently use Medicare skilled home health care and have unique usage patterns as compared to people without dementia, but little is known about variation in measured quality of h...BACKGROUND: People living with dementia frequently use Medicare skilled home health care and have unique usage patterns as compared to people without dementia, but little is known about variation in measured quality of home health care received by this population. METHODS: Using 2021 Medicare Fee-for-Service Claims data, we examined receipt of high-quality home health (i.e., care from an agency with a star rating > 3.5) as determined by two publicly available measures: the Quality of Patient Care Star Rating (based on standardized clinical status measures) and the Patient Survey Star Rating (based on satisfaction with care reported by patients or caregivers). For each quality measure, we mapped the county-level high-quality-home health agency utilization rate among people living with dementia and compared differences in utilization of high-quality home health agencies by dementia status. RESULTS: We found significant county-level variability in utilization of high-quality home health. When quality was operationalized based on clinical status measures (i.e., Quality of Patient Care Star Rating), dementia patients did not receive care from lower quality agencies. However, when quality was operationalized based on satisfaction with care (i.e., Patient Survey Star Ratings), people living with dementia were less likely than those without dementia to receive care from high-quality home health agencies. CONCLUSIONS: These findings highlight variability in receipt of high-quality home health care among people living with dementia nationally and suggest a need for further investigation as to what constitutes high-quality home health care in this population. To ensure home health meets the unique care needs of people living with dementia, policy makers should work to ensure quality measures are better aligned with the needs of people living with dementia, incentivize access to high-quality home health care where services are limited, and promote systems to improve family caregiver identification and engagement with home health care.
Friedmann DR, Winchester A, Bender O
… +5 more, Ching J, Nicholson A, Hamilton F, Chodosh J, Dickson VV
J Am Geriatr Soc
· 2026 Apr · PMID 41720576
·
Full text
BACKGROUND: Age-related hearing loss is common and a particularly prevalent disability among Veterans. In response, comprehensive hearing services are available within the Veterans Affairs (VA) integrated healthcare syst...BACKGROUND: Age-related hearing loss is common and a particularly prevalent disability among Veterans. In response, comprehensive hearing services are available within the Veterans Affairs (VA) integrated healthcare system. Severe hearing loss may pose distinct communication challenges inadequately addressed by hearing aids, but data suggest severe hearing loss is often not treated differently. We sought to identify barriers and facilitators to evidence-based and individualized management of severe hearing loss from the perspectives of VA clinicians and Veterans. METHODS: We used purposeful sampling to conduct remote semi-structured video interviews with 33 current VA clinicians encompassing multiple disciplines and 39 Veterans with severe hearing loss over approximately an 18 month period (May 2022 to December 2023). We analyzed qualitative data using content thematic analysis. Coding categories were summarized within each participant; then across all participants to yield clinician-specific and Veteran themes. RESULTS: In the sample of 33 VA clinicians (20 audiologists, 9 otolaryngologists and 4 primary care clinicians), the overarching theme of qualitative data is that hearing loss is undertreated in the Veteran population. Across clinician groups, the qualitative data revealed multi-level factors (system-, clinician-, and patient-level) that influence the delivery of hearing care and management for Veterans with severe hearing loss. Interviews revealed that efficient access and collaborative care facilitate evidence-based practice. Among Veterans, inadequately managed hearing loss impacts quality of life; lack of knowledge and misconceptions about hearing care options and system-level barriers influence Veterans' perceptions of their hearing care and management. CONCLUSION: Although hearing care is available to Veterans, multi-level factors influence the delivery of hearing care and management for Veterans with severe hearing loss. Greater attention both in primary and specialty care is needed to ensure tailored treatments are available to Veterans with severe hearing loss across the integrated VA health care system.
J Am Geriatr Soc
· 2026 Feb · PMID 41720496
·
Full text
BACKGROUND: Socioeconomically disadvantaged neighborhoods disproportionately include minority and poor populations that are often underrepresented in clinical trials. Our objective was to determine whether recruitment an...BACKGROUND: Socioeconomically disadvantaged neighborhoods disproportionately include minority and poor populations that are often underrepresented in clinical trials. Our objective was to determine whether recruitment and retention of participants differ based on neighborhood disadvantage. METHODS: In a multi-center clinical trial that included 86 primary care practices within 10 US health care systems in 9 states, outreach to 140,850 patients led to enrollment of 5451 persons, 70 or older, at high risk for serious fall injuries. Multiple indicators of recruitment and retention were evaluated. Neighborhood disadvantage was defined as the highest quintile of scores on the state area deprivation index. RESULTS: Patients who lived in a disadvantaged neighborhood were less likely to return a screening postcard (risk ratio [RR] [95% CI]: 0.88 [0.85-0.91]) than their non-disadvantaged counterparts, but they were more likely to have a positive screen (RR [95% CI]: 1.05 [1.00-1.09], p = 0.047). The likelihood of study enrollment (RR [95% CI]: 0.79 [0.70-0.90]) was substantially lower among patients living in a disadvantaged neighborhood. Among enrolled participants, a significantly higher percentage of those living in a disadvantaged neighborhood, relative to their non-disadvantaged counterparts, were Black (10.6 vs. 4.8), had a high school education or less (36.7 vs. 21.6), and were less affluent (21.8 vs. 13.8). After study enrollment, participants who lived in a disadvantaged neighborhood had a higher likelihood of death (adjusted RR [95% CI]: 2.64 [1.76-3.98]) and refused interviews (adjusted RR [95% CI]: 2.15 [1.20-3.85]), but not study withdrawal (adjusted RR [95% CI]: 0.94 [0.63-1.39]) or loss to follow-up (adjusted RR [95% CI]: 1.18 [0.84-1.65]). CONCLUSION: In this large multi-center clinical trial of older persons, living in a socioeconomically disadvantaged neighborhood was associated with diminished yields in both recruitment and retention. Assessing neighborhood disadvantage and implementing targeted strategies may improve recruitment and retention of diverse populations of older persons in clinical trials.
BACKGROUND: Monitoring the dementia care quality is key for healthcare services. Dementia care quality indicators (QIs) have been reported in the literature, fragmented by setting or stage of care. We aimed to conduct an...BACKGROUND: Monitoring the dementia care quality is key for healthcare services. Dementia care quality indicators (QIs) have been reported in the literature, fragmented by setting or stage of care. We aimed to conduct an umbrella review (review of systematic reviews) to identify, evaluate, and summarize dementia care QIs throughout the disease trajectory. METHODS: We conducted an umbrella review reporting the development, review, or testing of dementia care QIs. We used a structured search in MEDLINE (Ovid), PsycINFO (EBSCO), Cochrane Library, and LILACS. Two researchers independently screened titles, abstracts, and full-texts. QIs from included articles were extracted by one reviewer and checked by a second one. The AMSTAR 2 and AIRE tools were used to assess the methodological quality of reviews and QIs, respectively. Included QIs were categorized and coded based on their stage of care (initial assessment after diagnosis, follow-up and treatment, and end-of-life), type of indicator (structure, process, outcome), and specific aspects of care measured. RESULTS: Six systematic reviews were included, comprising 554 dementia care QIs that were synthesized into 120 QIs. 86 (72%) were classified as process, 20 (16%) as structure, and 14 (12%) as outcome indicators. 32 QIs (27%) are recommended exclusively for community settings, 7 (6%) for hospital settings, and 81 (67%) for more than one care setting. The 120 QIs are related to 60 different aspects of care, with advanced care planning and having an individualized healthcare plan being the most frequently quoted QIs. The quality of systematic reviews was low to critically low, and over a third of QIs were considered to have high methodological quality. CONCLUSIONS: Our umbrella review synthesized a broad overview of dementia care QIs, facilitating healthcare organizations to monitor and improve areas in need. Future research should focus on validating these QIs in local contexts.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the standard treatment for severe aortic stenosis, particularly among very old adults, and long-term comprehensive management post-TAVR is becoming inc...BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the standard treatment for severe aortic stenosis, particularly among very old adults, and long-term comprehensive management post-TAVR is becoming increasingly important. Although cardiac rehabilitation (CR) is strongly recommended for patients with heart failure (HF) or post-cardiac surgery, cohort studies evaluating the long-term efficacy of CR in patients who have undergone TAVR are scarce. This study aimed to examine the association between outpatient CR and long-term clinical outcomes post-TAVR utilizing a nationwide administrative claims database in Japan. METHODS: Among 46,885 patients who underwent TAVR between April 2014 and March 2021, 34,165 patients who participated in inpatient CR and were discharged alive were included. Patients were categorized by outpatient CR participation. After propensity score matching, the primary outcome, a composite of all-cause mortality and HF hospitalization, was compared over a 3-year period. RESULTS: Among the eligible patients, 29,552 (86.5%) were aged ≥ 80 years, and 22,805 (66.7%) were female. The participation rate in outpatient CR was 10.2%, with no observed increasing trend over the years. Advanced age, female sex, dementia, and multiple comorbidities were associated with non-participation in CR. The outpatient CR group exhibited reduced risk for the primary outcome (hazard ratio: 0.87, 95% confidence interval: 0.79-0.96) with a median follow-up of 734 days. CONCLUSIONS: The participation rate in outpatient CR after TAVR remains low, with identifiable barriers in Japan. Participation was associated with improved outcomes, suggesting a beneficial management strategy for older patients post-TAVR.