Han JW, Kim TH, Kwak KP
… +11 more, Kim BJ, Kim SG, Kim JL, Moon SW, Park JH, Ryu SH, Lee DW, Lee SB, Lee JJ, Jhoo JH, Kim KW
J Am Geriatr Soc
· 2026 May · PMID 42138370
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BACKGROUND: Older drivers exhibit elevated crash risk per distance driven, yet accurately identifying high-risk individuals without unjustly restricting mobility remains challenging. Whether older drivers can accurately...BACKGROUND: Older drivers exhibit elevated crash risk per distance driven, yet accurately identifying high-risk individuals without unjustly restricting mobility remains challenging. Whether older drivers can accurately assess their own driving-related risks remains controversial, and educational attainment-as a proxy for cognitive reserve-may influence this capacity for self-assessment. METHODS: This population-based prospective cohort study included 1673 male drivers aged 60 years and older from the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD). Participants were classified into four risk phenotypes based on concordance between baseline self-reported driving concerns and subsequent crash occurrence: Drivers with inherent safety (DIS), drivers with regulated safety (DRS), drivers with recognized risk (DRR), and drivers with unrecognized risk (DUR). Self-reported and informant-reported driving problems were assessed using the driving risk questionnaire (DRQ). Crash records were obtained from the Korean National Police Agency (KNPA) over a 2-year follow-up. RESULTS: Of 290 drivers involved in crashes, 179 (61.7%) had reported baseline concerns (DRR), while 111 (38.3%) had not, representing 'silent' at-risk drivers-those who reported no driving concerns at baseline but subsequently experienced crashes (DUR). Lower baseline Self-Informant Discrepancy (mean SID: -0.05 in the unrecognized risk group vs. 3.15 in the recognized risk group; p < 0.001) characterized the unrecognized risk group, while informant reports showed a floor effect (94.3% zero) and did not predict crashes, necessitating objective screening. Among drivers without self-reported concerns, lower education (≤ 9 years) combined with slower TMT-B performance (≥ 180 s) identified a high-risk subgroup with a crash rate of 20.9% (OR, 2.04; 95% CI, 1.29-3.22; p = 0.002). CONCLUSIONS: Self-reported driving concerns demonstrate predictive validity for future crashes, but a substantial minority of crash-involved drivers remain undetected by self-report. Education and TMT-B performance may serve as clinically actionable markers for identifying these "silent" at-risk drivers.
Boucher V, Gagnon AP, Tardif PA
… +6 more, Menear M, Thompson W, McFaull SR, Dumais-Michaud AA, Émond M, Mercier E
J Am Geriatr Soc
· 2026 May · PMID 42130168
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BACKGROUND: The main objective of this study was to describe the characteristics of older Emergency Department (ED) patients consulting for suicidal ideation/suicide attempts. The secondary objective was to explore mater...BACKGROUND: The main objective of this study was to describe the characteristics of older Emergency Department (ED) patients consulting for suicidal ideation/suicide attempts. The secondary objective was to explore material and social deprivation status in those patients. METHODS: We used data from a Public Health Agency of Canada specialized mental health database. Older adults (≥ 65 years old) were included if they consulted in a participating ED between 2020 and 2022 for suicidal ideations or suicide attempts. Medical archivists collected relevant sociodemographic and clinical information from patients' medical records using a standardized form. The Material and Social Deprivation Index was used to describe socioeconomic status Low Deprivation (Q1)-High Deprivation (Q5). RESULTS: Of 1352 consultations (2.3%), the mean age was 74.1 ± 7.2; 58.9% were aged 65-74 and 57.8% were female. Most lived at home (66.8%), arrived by ambulance (65.3%), and had a mental health history (91.2%). Most patients received multidisciplinary management, with 94.2% of patients who attempted suicide being assessed by a psychiatrist, and 72.1% were hospitalized. 638 (47.2%) had a suicide plan, and 190 (14.1%) attempted suicide. The most common method of suicide attempts was poisoning (suicide attempts: 76% plan: 31%). 24.3% of patients came from deprived areas (Q5). Social deprivation was also severe, with Q4 and Q5 patients accounting for nearly 50% of all patients. CONCLUSION: Suicidal behaviors are a serious concern among older ED patients. This study characterizes the clinical presentation and ED trajectories of older adults with suicidal ideation or behavior. These descriptive data can inform future research on care transitions and emergency care models for mental health crises in later life.
Gangavati A, Johnson KS, Platt A
… +12 more, Olsen M, Durant RW, Ejem D, Bakitas M, Dolor R, Williams-Bryant SN, Barrett N, Elk R, Quest T, Hasan M, Bethea K, Rhodes R
J Am Geriatr Soc
· 2026 Jun · PMID 42124477
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BACKGROUND: Rates of advance care planning (ACP) are lower and preferences for life-prolonging treatment are higher among Black compared to White older adults. We examined whether these differences persisted during the C...BACKGROUND: Rates of advance care planning (ACP) are lower and preferences for life-prolonging treatment are higher among Black compared to White older adults. We examined whether these differences persisted during the COVID-19 pandemic. METHODS: Between February 2021 and September 2022, we conducted a cross-sectional COVID-19-focused survey of seriously ill adults ≥ 65 years in 10 primary care clinics participating in a clinical trial of two ACP interventions. Logistic regression models examined associations between COVID-19 related ACP discussion (defined as discussions with family, friends, or doctors about COVID-related medical care) and treatment preferences if very sick with COVID-19 (life-prolonging treatment, comfort care, trial of life-prolonging with transition to comfort care if no improvement) overall and by race, controlling for baseline characteristics. RESULTS: Among 428 participants (55.9% Black, 44.2% White; mean age 74.6), 25% reported discussing COVID-19 treatment preferences with family/friends and 6% with doctors. Most reported no change in willingness to participate in ACP due to the pandemic, though increased willingness was more common among Black than White participants (22.4% vs. 14.0%, p = 0.016). Despite this, COVID-19-related ACP discussion did not differ by race (family/friends: 22.7% vs. 28.3%, p = 0.19; doctors: 6.9% vs. 4.8%, p = 0.37). Most seriously ill older adults preferred a time-limited trial of life-prolonging treatment (71% White, 56.2% Black); though preferences varied by race (p < 0.0001); Black participants compared to White participants more often preferred life-prolonging treatment (28.5% vs. 10.3%). In adjusted models, race was not associated with COVID-19-related ACP discussion (OR 0.72, 95% CI 0.44-1.18), while preferences for life-prolonging treatments predicted greater COVID-19 related ACP discussion (OR 1.98, 95% CI 1.14-3.44). CONCLUSION: In contrast to pre-pandemic ACP research, no racial differences were observed in COVID-19-related ACP discussion, though differences in treatment preferences persisted. These findings underscore the need for culturally responsive, context-sensitive ACP approaches among seriously ill older adults.
van der Velde N, Supiano MA, Montero-Odasso M
… +2 more, Rochon PA, Petrovic M
J Am Geriatr Soc
· 2026 May · PMID 42117876
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Health care systems differ worldwide, allowing learning from each other and improving care for older adults with similar clinical profiles. In the early 1990s, Dr. Howard Bergman and Dr. Mark Clarfield from Canada and Dr...Health care systems differ worldwide, allowing learning from each other and improving care for older adults with similar clinical profiles. In the early 1990s, Dr. Howard Bergman and Dr. Mark Clarfield from Canada and Dr. Joseph Ouslander from the United States described the approach to care for the same patient in their respective health care systems. Yet, challenges identified then, such as limited access to geriatric medicine care, as well as multimorbidity and system constraints, remain relevant to the care of older adults today. This article revisits the original exercise summarizing the joint symposium of the America, Canadian, and European geriatric medicine societies, held at the 2025 European Geriatric Medicine Society (EuGMS) Congress in Iceland. Using the case of an 82-year-old woman with multimorbidity, frailty, and social vulnerability, experts examined how three systems would manage key aspects of care for this patient: Delirium prevention (U.S.), falls and rehabilitation (Canada), and medication optimization (Europe). Each presentation situated clinical priorities within broader systemic realities, including workforce shortages, care fragmentation, and policy challenges. Emerging models, such as Age-Friendly Health Systems and the Hospital Elder Life Program in the U.S., Acute Care for the Elderly units and Geriatric Rehabilitation Units in Canada and structured medication review initiatives in Europe, illustrate innovations and persistent gaps. By contrasting clinical strategies and organizational structures, this analysis identifies transferable best practices and policy levers to improve geriatric medicine care globally. Recommendations emphasize harmonizing geriatric expertise, embedding evidence-based interventions, and fostering cross-system learning to optimize outcomes for older adults.
Beckert A, Fernandez H, Harlow E
… +2 more, Hansen L, O'Brien CC
J Am Geriatr Soc
· 2026 Jun · PMID 42117874
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BACKGROUND: The demand for Geriatricians is outpacing the current supply, indicating a need for innovative workforce solutions. Early exposure and mentorship are key factors influencing trainees' decisions to pursue geri...BACKGROUND: The demand for Geriatricians is outpacing the current supply, indicating a need for innovative workforce solutions. Early exposure and mentorship are key factors influencing trainees' decisions to pursue geriatric medicine. In response, the Med-Geri pathway, a 48-month integrated Internal/Family Medicine Residency and Geriatric Medicine Fellowship, was developed. METHODS: The Med-Geri pathway was created through national collaboration and stakeholder engagement, supported by the Association of Directors of Geriatric Academic Programs (ADGAP) and the American Geriatrics Society (AGS). A needs assessment and environmental scan culminated in application for an Accreditation Council for Graduate Medical Education (ACGME) Advancing Innovation in Residency Education (AIRE) pilot. The program was approved and launched at three initial sites in 2020. RESULTS: The Med-Geri pathway integrates geriatric medicine clinical experiences, mentorship, and competency-based assessments throughout all 4 years of training. The fourth year is distinguished by enhanced professional development tailored to individual career goals. Program structures vary to reflect local strengths. Since 2020, the number of approved programs has grown from 3 to 14, with 38 trainees enrolled for the 2025-2026 academic year. CONCLUSIONS: The Med-Geri pathway offers a promising strategy to address the geriatrics workforce gap. The initial experience of pilot sites indicates many benefits with high retention, increased visibility of geriatric medicine in the residency program, and development of trainees poised for leadership careers in geriatric medicine. Continued evaluation of outcomes is essential. Transitioning from an AIRE pilot to a recognized ACGME pathway is a critical next step toward national scalability and sustainability.
Uemura K, Kamitani T, Nagai K
… +4 more, Ueda T, Fukuda E, Kuzuya M, Yamada M
J Am Geriatr Soc
· 2026 May · PMID 42105326
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BACKGROUND: Community gathering places in Japan, supported by local governments, are expected to promote physical and cognitive health through physical activity and social interaction, in line with the World Health Organ...BACKGROUND: Community gathering places in Japan, supported by local governments, are expected to promote physical and cognitive health through physical activity and social interaction, in line with the World Health Organization's concept of age-friendly environments. However, evidence regarding their effects on dementia prevention remains inconsistent. This study aimed to assess whether habitual exercise modifies the association between participation in community gathering places and incident cognitive disability in older adults. METHODS: This retrospective cohort study used data from the Public Survey of Long-Term Care Prevention in Habikino City, Japan, and included community-dwelling adults aged ≥ 65 years without certified care needs. Participation in community gathering places was investigated at baseline and incident cognitive disability was tracked from January 2020 to January 2024. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for demographics and health status. To test the effect modification by exercise habit, product terms between participation and exercise status were included in the model. We addressed missing baseline data using multiple imputation. RESULTS: A total of 2758 eligible older adults were included in the primary analysis. We observed a potential effect modification by exercise habit status (p for interaction = 0.092). Participation in community-gathering places was associated with a lower hazard of cognitive disability among individuals without exercise habits (adjusted HR [95% CI], 0.51 [0.27, 0.97]), whereas no such association was observed among those with exercise habits (1.09 [0.57, 2.09]). CONCLUSIONS: The association between participation in community gathering places and cognitive disability may differ according to habitual exercise status. These findings suggest that municipally supported community gathering places may represent an accessible form of participation associated with a lower risk of cognitive disability among older adults without established exercise habits.
Lee EA, Lin JC, Kanter MH
… +8 more, Hsieh TI, Martin JP, Silverman JS, Yoshinaga MA, Chiu G, Asrat MF, Kohanim SY, Broder BI
J Am Geriatr Soc
· 2026 May · PMID 42095749
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BACKGROUND: Short-acting sulfonylureas are preferred over long-acting sulfonylureas due to reduced risk of hypoglycemia in older adults. Whether older patients can be transitioned from long-acting to short-acting sulfony...BACKGROUND: Short-acting sulfonylureas are preferred over long-acting sulfonylureas due to reduced risk of hypoglycemia in older adults. Whether older patients can be transitioned from long-acting to short-acting sulfonylureas with equivalent glycemic control while experiencing fewer emergency department (ED) visits or hospitalizations due to hypoglycemia is unknown. We investigated whether the conversion of long-acting glimepiride to short-acting glipizide led to equivalent glycemic control and whether it was associated with reduced ED or hospital utilization. METHODS: We conducted a retrospective-cohort study of 625 Kaiser Permanente Southern California members between ages 64 and 110 years old dispensed glimepiride between 03/15/2023 and 03/14/2024. The conversion to glipizide occurred at the dispensing pharmacy after the index date in March 2024. The co-primary outcomes were to determine whether glycemic control could be maintained with the conversion of one sulfonylurea to another based on a follow-up HgbA1c at 6 to 12-weeks post-conversion while reducing ED utilization or hospitalization for patients within 2 and 4-months of the index date. RESULTS: Of 625 patients eligible for the intervention, 472 converted to glipizide and 153 remained on glimepiride. Results 6 to 12-weeks post-index date showed no difference in HgbA1c between those who remained on glimepiride (mean = 7.8; SD = 1.3) and those who converted (mean = 7.8; SD = 1.1). For risk of ED or hospitalization from hypoglycemia, no significant difference was found within 2 months (OR: 0.68, 95% CI: 0.34, 1.36) after adjusting for age and comorbidities. Those who converted to glipizide had lower risk of ED or hospitalization within 4-months (OR: 0.49, 95% CI: 0.29, 0.85) than patients remaining on glimepiride. CONCLUSION: Patients 64 years and older converted from long-acting to short-acting sulfonylureas had no change in glycemic control, and lower rates of ED or hospital utilization at 4-months were observed. This paper reaffirms the Beers Criteria statement that shorter-acting sulfonylureas are preferred over longer-acting sulfonylureas.
Shi S, Maclean K, Wolfe A
… +4 more, Liu Y, Bakaev I, Travison T, Kim DH
J Am Geriatr Soc
· 2026 May · PMID 42095705
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BACKGROUND: Although over 80% of older adults admitted to skilled nursing facilities (SNFs) for post-acute care are frail, it is unclear whether frailty interventions are feasible in this setting. We piloted a multicompo...BACKGROUND: Although over 80% of older adults admitted to skilled nursing facilities (SNFs) for post-acute care are frail, it is unclear whether frailty interventions are feasible in this setting. We piloted a multicomponent frailty intervention in a post-acute SNF population. METHODS: We recruited community-dwelling adults ≥ 65 years old from 2 SNFs (08/2023-10/2024). We excluded those who had a feeding tube, did not have an oral diet, had chronic kidney disease (CKD) stage 4 or worse, could not consent, or were non-English-speaking. We measured demographics, comorbidities, frailty index (FI), and functional status on admission. The intervention consisted of individualized exercises and ≥ 15 g of protein supplementation within 30 min of exercise. Sessions were offered ≥ 5 times a week in addition to regular therapy. Our primary outcome was feasibility of recruitment, defined by the proportion of eligible participants enrolled. RESULTS: Of 515 admissions screened, 147 were eligible and 50 enrolled (50/147 = 34.0% of eligible; 50/515 = 9.7% of screened). Mean age was 81.2 years (SD: 7.7), 34 (68%) were female, and mean prehospitalization frailty index (FI) was 0.32 (SD: 0.08). Mean SNF length of stay was 16.2 days (SD: 7.7). Overall, 55.3% of sessions offered were completed. Forty participants (80.0%) were discharged to the community, 4 (8.0%) were re-hospitalized, 4 (8.0%) transitioned to long-term care, and 2 (4.0%) had unknown discharge disposition. Eleven participants (22%) withdrew during the SNF stay. No serious adverse events occurred. Among completers (n = 34), descriptive improvements from admission to discharge included grip strength +1.4 kg (SD: 3.2), Modified Barthel Index +15.9 (SD: 16.8), AM-PAC Basic Mobility +3.6 (SD: 4.2), and PROMIS Physical Health +3.7 (SD: 7.3). CONCLUSIONS: Delivering a multicomponent frailty intervention in post-acute SNFs is safe, feasible, and acceptable to older adults with frailty. These pilot data support larger trials to test efficacy and scalability.
J Am Geriatr Soc
· 2026 Jun · PMID 42095703
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BACKGROUND: As populations age, extending healthspan, or years lived in good health, is a global priority. Most evidence on healthy lifestyle and prolonged healthspan comes from middle-aged or comorbid populations, leavi...BACKGROUND: As populations age, extending healthspan, or years lived in good health, is a global priority. Most evidence on healthy lifestyle and prolonged healthspan comes from middle-aged or comorbid populations, leaving it unclear whether benefits apply to healthy older adults. This study evaluates whether combined lifestyle behaviors are associated with disability-free survival in community-dwelling older adults. METHODS: The study included 11,287 Australian participants (median age 74 [IQR 72-77]) from the ASPirin in Reducing Events in the Elderly (ASPREE) study, with a median follow-up of 6.6 years (IQR 5.5-7.9). Participants received one point for adherence to each of the following lifestyle factors: Mediterranean diet, moderate physical activity, non-smoking, and moderate alcohol consumption and categorized as having low (0-1 factors), moderate (2 factors), or favorable (≥ 3 factors) lifestyle. The primary outcome was a composite endpoint comprised of the first occurrence of either death, dementia, or persistent physical disability. Associations of lifestyle categories with the composite endpoint and the individual components were examined, alongside effect modification by key demographic and health variables. Years gained in disability-free survival and compression of morbidity were calculated. RESULTS: Compared to those with an unfavorable lifestyle, a moderate [HR 0.75 (95% CI 0.65-0.87)] and favorable [HR 0.60 (95% CI 0.52-0.70)] lifestyle were associated with a lower risk of the composite endpoint. Over a median of 6.6 years, a favorable lifestyle was prospectively associated with a 10% gain in years of healthspan and a moderate compression of morbidity. Associations did not differ across groups of age, sex, education, aspirin treatment, BMI, diabetes, and hypertension. CONCLUSION: In healthy older adults, adherence to a healthy lifestyle was associated with a greater likelihood of surviving free from disability and dementia and was prospectively linked with a prolonged healthspan and a compression of morbidity, highlighting its potential importance in promoting healthy aging. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01038583.