Goodwin J, Thorne J, Vinson A
… +4 more, Clark D, Kiberd B, Sun M, Tennankore K
J Am Geriatr Soc
· 2026 May · PMID 42212687
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BACKGROUND: Frailty is highly prevalent in kidney failure, but it is unclear whether frailty impacts health outcomes for those initiating dialysis who are not referred for transplantation. Our objective was to determine...BACKGROUND: Frailty is highly prevalent in kidney failure, but it is unclear whether frailty impacts health outcomes for those initiating dialysis who are not referred for transplantation. Our objective was to determine if frailty is associated with death or development of a permanent contraindication to transplantation among eligible non-referred patients following dialysis initiation. METHODS: We analyzed all incident adult dialysis patients from January 2009 to December 2018 (last follow-up December 2020) who lacked an identifiable absolute contraindication to transplant, but were not referred to our institution. Frailty was captured using the Clinical Frailty Scale (CFS) and categorized by severity. Time to death or development of a permanent contraindication to transplantation was analyzed using an adjusted Cox Proportional Hazards Regression model. Associations with the composite outcome were reported using hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: A total of 401 patients were included, 14% had a CFS of 6-8; 90% of patients with CFS 6-8 either died or developed a permanent contraindication to transplant and none received a transplant during follow-up. Among patients with CFS 6-8, 27% died or developed a permanent contraindication at 1 year; increasing to 81% by 5 years. After adjusting for patient characteristics, frailty was associated with the composite outcome (CFS 4-5: HR 1.71, 95% CI 1.17-2.21; CFS 6-8: HR 2.34, 95% CI 1.42-3.37). CONCLUSIONS: Among patients not referred for transplantation, a higher frailty severity was associated with death or development of a contraindication, particularly after the first year following dialysis initiation. Future studies should explore whether alternative approaches to the timing of transplant referral in frail patients are associated with improved outcomes and focus on novel strategies to reduce frailty severity or better support frail patients who may otherwise be eligible for transplantation.
J Am Geriatr Soc
· 2026 May · PMID 42176238
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Artificial intelligence (AI) methods, including machine learning (ML), are transforming healthcare by enabling personalized interventions that integrate multimodal data to support rehabilitation, preventive care, and rem...Artificial intelligence (AI) methods, including machine learning (ML), are transforming healthcare by enabling personalized interventions that integrate multimodal data to support rehabilitation, preventive care, and remote monitoring. Despite their broad potential, older adults remain underrepresented in model development, raising concerns about bias and limited generalizability. As AI/ML adoption expands, it is essential to critically appraise emerging tools to ensure ethical, equitable, person-centered implementation in aging populations and long-term randomized evaluations. A structured MEDLINE search identified randomized controlled trials (RCTs) published between January 2023 and December 2025 that evaluated AI/ML-based interventions in adults ≥ 65 years. Of 31 records identified, 19 underwent abstract screening, seven underwent full-text assessment, and four articles were identified as meeting all criteria for inclusion, which focused on scalability, clinical impact, and methodological rigor. Across postoperative rehabilitation and preventive care, AI/ML interventions demonstrated meaningful clinical benefits. Transformative applications of AI/ML described robotic systems quantifying weight-bearing, algorithm-guided paired rehabilitation interventions, paired exercises in geriatric hip fracture rehabilitation, smartphone platforms delivering continuously personalized exercise programs, and conversational chatbots providing tailored vaccine counseling. The included RCTs show that AI-driven interventions can enhance physical recovery, support psychosocial well-being, and improve uptake of preventive measures compared with conventional approaches. Key considerations for future implementation include digital health literacy, long-term follow-up, and potential bias arising from healthier or more motivated study populations. As evidence grows, geriatric innovation must prioritize safety, ethics, and equitable access to ensure that technological precision enhances, rather than replaces, person-centered care.
Fralick M, Stall NM, Zorcic K
… +13 more, Reppas-Rindlisbacher C, Kaplovitch E, Li AS, MacFadden DR, Kobewka D, Castellani L, Parsons P, McGeer A, McCready J, Lim B, Hodzic-Santor E, Kandel C, A‐DONUT Study Team
J Am Geriatr Soc
· 2026 May · PMID 42175687
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BACKGROUND: It is unclear whether antibiotics improve outcomes for older adults with delirium who have pyuria or bacteriuria in the absence of other signs or symptoms of a urinary tract infection. METHODS: Our study is a...BACKGROUND: It is unclear whether antibiotics improve outcomes for older adults with delirium who have pyuria or bacteriuria in the absence of other signs or symptoms of a urinary tract infection. METHODS: Our study is a multicenter, parallel-group, single-blinded, non-inferiority pragmatic randomized trial. The trial included a vanguard phase of the first 30 participants, and herein we report the aggregate results from this phase. We included hospitalized adults aged 60 years and older who had delirium and pyuria and/or bacteriuria. We excluded patients with fever, upper or lower urinary tract symptoms, an indwelling foley for more than 72 h, more than 24 h of antibiotics at the time of eligibility, or another indication for antibiotics (e.g., pneumonia). The main outcomes of the vanguard phase were rates of participant recruitment, protocol adherence, and study withdrawal. Our initial goals were 4 patients randomized monthly per site, greater than 95% adherence to allocation, and less than 5% withdrawal rate. RESULTS: The median age was 86 years (interquartile range [IQR] 81-92), 68% were female, and most (79%) had either minor or major neurocognitive impairment. Of the participating sites that recruited at least one participant, the recruitment rates ranged from 0.05 to 1.8 participants per month. Adherence to allocation was 100%. Two participants (6.7%) withdrew. For participants randomized to receive antibiotics, the median duration was 5 days (IQR 5-7). By Day 7, delirium had resolved in 39% of the participants who remained hospitalized; 25% of participants were discharged, 32% had ongoing delirium, and 4% did not have a delirium assessment available. By Day 7, 1 (3.6%) developed C. difficile, 1 (3.6%) died, and 1 (3.6%) developed bacteremia. CONCLUSION: We completed our vanguard phase with 100% adherence to allocation and withdrawal was near the target of 5%. The recruitment rate varied widely and overall was lower than anticipated.
Scannell GA, Baraldi CA, Rupper R
… +6 more, Mueller MT, Brenner RJ, White T, Sauer BC, Hansen JL, Eleazer GP
J Am Geriatr Soc
· 2026 May · PMID 42175682
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Older adults undergoing surgery are at increased risk for complications, functional decline, and prolonged recovery due to frailty and other age-related vulnerabilities. To address these challenges, we developed the Care...Older adults undergoing surgery are at increased risk for complications, functional decline, and prolonged recovery due to frailty and other age-related vulnerabilities. To address these challenges, we developed the Care Coordination and Optimization in Geriatric Surgery (COGS) program, a pilot initiative integrating comprehensive geriatric assessment and targeted optimization into routine surgical care for Veterans. Using the Risk Analysis Index-Clinical (RAI-C) to identify higher-risk patients, the COGS team-comprising geriatric providers, nursing, and surgical staff-provides individualized evaluation and interventions focused on nutrition, mobility, medication safety, cognition, and social support. By embedding geriatric expertise directly into the surgical clinic, the program fosters collaboration among surgeons and geriatricians, improving communication and supporting shared decision-making about surgical readiness. Early experience demonstrates that COGS is both feasible and well-received, enhancing the coordination of care for older Veterans and aligning surgical decisions with patients' goals and overall health status. Expansion of the program to additional surgical specialties and evaluation of short and long-term outcomes are underway. The COGS model demonstrates how integrating geriatrics principles within surgical care can promote safer, more goal-aligned surgery for older adults.
Cotter VT, Grudzen CR, Griffith J
… +11 more, Cuthel A, Hoque A, Arbaje AI, Gettel CJ, Durga A, Emami A, Goldfeld K, Chodosh J, Shah MN, Brody AA, ED‐LEAD Investigators
J Am Geriatr Soc
· 2026 May · PMID 42166326
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Most visits to the emergency department (ED) by persons living with dementia (PLWD) who are then discharged back into the community are preventable. However, care partners and other caregivers of the over 6 million PLWD...Most visits to the emergency department (ED) by persons living with dementia (PLWD) who are then discharged back into the community are preventable. However, care partners and other caregivers of the over 6 million PLWD residing in the United States lack the supports, services and timely access to clinical care to address many common needs in the community. Thus, care partners resort to taking the PLWD to the ED, a sub-optimal environment that can be traumatic to the PLWD, increase iatrogenesis, and ultimately may not resolve the underlying reason for the visit. Longitudinal nurse-led telephonic care (NLTC) provided following an ED visit with community discharge may present an effective and efficient model for health systems to support care partners, decant busy EDs, and provide high-quality, person and family-centered impactful care to support PLWD and their care partners. This paper describes the development of an NLTC program being implemented as part of the Emergency Departments LEading Transformation of Alzheimer's and Dementia Care (ED-LEAD) trial, a factorially designed embedded pragmatic clinical trial in 79 EDs. The NLTC program utilizes components of two previously tested programs, the Aliviado Dementia Care quality improvement program, and the Emergency Medicine Palliative Care Access (EMPallA) nurse-led telephonic palliative and transitional care program to support PLWD and their care partners. Successful implementation of the NLTC program may lead to increased uptake of NLTC programs by health systems, improving quality of care and quality of life for PLWD and their care partners.
Hoffman DI, Reich AJ, Sheu C
… +9 more, Laane DWPM, Wignakumar T, Tabata-Kelly M, Weaver MJ, Ritchie CS, Kennedy M, Ouchi K, Dohan D, Cooper Z
J Am Geriatr Soc
· 2026 May · PMID 42157653
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Older adults with hip fracture face a sudden decline in health, yet most never receive palliative care. This study used ethnography to examine how palliative care is woven into surgical care, revealing strengths in prima...Older adults with hip fracture face a sudden decline in health, yet most never receive palliative care. This study used ethnography to examine how palliative care is woven into surgical care, revealing strengths in primary palliative care integration as well as unmet needs such as psychosocial and caregiving challenges.
J Am Geriatr Soc
· 2026 May · PMID 42157646
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BACKGROUND: Advance directives (ADs) are intended to document patient preferences for future care, including end-of-life (EOL). Knowledge of the impact of electronic health record (EHR)-documented ADs on actual care expe...BACKGROUND: Advance directives (ADs) are intended to document patient preferences for future care, including end-of-life (EOL). Knowledge of the impact of electronic health record (EHR)-documented ADs on actual care experiences is limited. PARTICIPANTS AND SETTING: This is a retrospective cohort analysis of 2850 patients aged ≥ 65 years who died during a cluster-randomized trial of the impact of advance care planning (ACP). Subgroups included gender, marital status, patient portal access, dementia, and race. A total of 553 (19.4%) of the deceased patients had an EHR-documented AD 6 months prior to death. The setting was 51 primary care practices in two health systems in the Maryland and Washington, DC areas. METHODS: To examine the association between EHR-documented ADs and EOL experiences, a retrospective cohort study of older adults who died between September 2020 and October 2023 was conducted. Multilevel logistic regression models analyzed whether an EHR-documented AD at least 6 months before death was associated with potentially burdensome EOL care in the last 6 months of life and in-hospital death. RESULTS: Among 553 decedents who had an EHR-documented AD at least six months before death (mean [SD] age 82.5 (8.8)); 311 were women [56.2%]; 203 [36.7%] had a diagnosis of dementia, 128 (23.1%) were Black, and 400 (72.3%) were White [Correction added on 18 June 2026, after first online publication: The preceding sentence has been amended in this version.]. Patients with an AD in the EHR were less likely to experience potentially burdensome EOL care (110 (19.9%) vs. 616 (26.8%); aOR = 0.75) and in-hospital death (128 (23.2%) vs. 738 (32.1%); aOR = 0.69). Effects persisted both before and after adjusting for demographics, comorbidities, healthcare utilization, patient portal access, organization, and whether the clinic was randomized to the ACP intervention or control. Significant associations were observed in married patients and those with portal access, but not among patients with dementia or Black race. CONCLUSIONS: In this cohort study, EHR-documented ADs were associated with reduced potentially burdensome EOL care and a lower likelihood of in-hospital death.
Lu N, Kunicki ZJ, Jones RN
… +9 more, Vasunilashorn SM, Inouye SK, Pascual-Leone A, Fong TG, Metzger E, Libermann T, Travison TG, Marcantonio ER, Ngo LH
J Am Geriatr Soc
· 2026 May · PMID 42142032
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PURPOSE: (1) To describe cognitive trajectory patterns over 6 years after major surgery in older adults, and (2) To identify patient characteristics associated with severe cognitive decline. METHODS: Group-based semipara...PURPOSE: (1) To describe cognitive trajectory patterns over 6 years after major surgery in older adults, and (2) To identify patient characteristics associated with severe cognitive decline. METHODS: Group-based semiparametric trajectory modeling was performed on longitudinal cognitive data from the SAGES study, which enrolled patients aged ≥ 70 years undergoing major elective noncardiac surgery. Participants received comprehensive neuropsychological testing prior to surgery and postoperatively every 6-12 months up to 72 months. The primary outcome was change in general cognitive performance score, a composite of neuropsychological tests, at each of 11 follow-up timepoints relative to baseline. Generalized linear models were used to assess the associations of pre-surgical patient characteristics and incidence of postoperative delirium with cognitive trajectory. RESULTS: Of 560 participants, 326 were women (58%) and the average age was 76.7 (standard deviation 5.2) years. They underwent orthopedic (81%), gastrointestinal (13%), and vascular surgeries (6%), and 24% experienced postoperative delirium. We found the 3-group cognitive trajectory model to be optimal, with the groups characterized as severe decline trajectory (SDT) (15% of the cohort), slight decline (59%), or stable (26%). Of pre-surgical factors, age (relative risk [RR]: 1.06, 95% confidence interval [CI] 1.03-1.10 per 1 year increase) and 3MS (Modified-Mini-Mental) score (RR 0.95, 95% CI 0.92-0.99 per one point increase) were significantly associated with SDT. Participants who developed delirium had over two-fold higher risk of SDT compared to those who did not (RR: 2.15, 95% CI: 1.35-3.42). CONCLUSIONS: Among older adults undergoing major surgery, 15% experienced severe cognitive decline over the ensuing 6 years, 59% experienced slight decline, and 26% remained stable. Older age, baseline cognitive impairment, and delirium were associated with severe decline, with delirium having the strongest association. Our findings provide valuable information for older patients considering major surgery and may help clinicians target interventions.
Freeman L, Ku NW, Ayala AP
… +22 more, Steenstra I, Legacy N, Haase K, Smith A, Jebanesan N, Wong CL, Antonio M, Bennie F, Pitters E, Stephens A, Chesney TR, Monette J, Desforges P, Lacerte A, Mariano C, Mehta R, Menjak IB, Norman R, Jones J, Wan-Chow-Wah D, Alibhai SMH, Puts M
J Am Geriatr Soc
· 2026 May · PMID 42138422
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BACKGROUND: Comprehensive Geriatric assessment (CGA) improves the well-being of older adults, but evidence suggests not all recommendations are implemented by clinicians and patients. Currently, there is no review of int...BACKGROUND: Comprehensive Geriatric assessment (CGA) improves the well-being of older adults, but evidence suggests not all recommendations are implemented by clinicians and patients. Currently, there is no review of interventions to improve clinician implementation and older adults' adherence to CGA recommendations. Therefore, the aim of this scoping review is to identify interventions that have been evaluated to improve clinicians' implementation of and patients' adherence to CGA recommendations. METHODS: We used Arksey and O'Malley's scoping review framework with the advancements made by Levac et al. We searched OVID MEDLINE, OVID EMBASE, EBSCO CINAHL, APA PsycINFO, and Cochrane Central from inception until November 14, 2024. Two independent reviewers were used for study selection using Covidence. We screened 11,404 titles and abstracts, 111 full texts, and included 16 total manuscripts (describing 6 intervention studies) in the review. RESULTS: Among the interventions intended to improve clinician implementation, such as strong recommendations by the geriatrician to primary care and patients, physician implementation of CGA recommendations ranged from 59% to 73.9% and patient adherence to recommendations ranged from 59% to 76%. Recommendations easier to implement, such as medication changes, were more adhered to than recommendations for lifestyle changes. Clinician implementation is likely influenced by concordance with patients, involvement during and/or degree of communication after the CGA. The studies suggest that patient adherence depends on perceived relevance of recommendations and patient-provider relationships. CONCLUSION: There is a knowledge gap regarding the uptake of CGA recommendations in the context of contemporary healthcare systems. No interventions examined the value of digital technologies in improving implementation/adherence. Future efforts to increase clinician implementation of CGA recommendations and patient adherence to CGA recommendations should be considered in tandem.