Aminzade Z, Mehrizi R, Mirian S
… +7 more, Asl IM, Nasehi MM, Effatpanah M, Gholamnezhad M, Armand N, Karami H, Ghamkhar L
J Am Geriatr Soc
· 2026 May · PMID 41944196
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BACKGROUND: Older adults are highly susceptible to adverse effects from potentially inappropriate medications (PIMs). Real-time clinical decision support systems (CDSS) may reduce unsafe prescribing; yet evidence from lo...BACKGROUND: Older adults are highly susceptible to adverse effects from potentially inappropriate medications (PIMs). Real-time clinical decision support systems (CDSS) may reduce unsafe prescribing; yet evidence from low- and middle-income countries is limited. This study assessed the association between a national electronic alert system and outpatient PIM prescribing in Iran. METHODS: We examined 230,719 electronic outpatient prescriptions for adults aged 65 years and older. Prescriptions from May to August 2023 (pre-alert) were compared with those from May to August 2024 (post-alert). The primary outcome was the proportion of prescriptions containing ≥ 1 PIM, defined using the 2023 AGS Beers Criteria. Subgroup analyses stratified outcomes by age, sex, physician specialty, and drug class. RESULTS: Across 2023-2024, 230,719 prescriptions were recorded. After alert implementation, the greatest reductions occurred in adults aged 85-100 years (-9.85%) and in women (-7.89%). Significant declines were also observed in gastrointestinal drugs (-14.14%), pain medications (-11.99%), central nervous system agents (-3.03%), antihistamines (-4.60%), and in specific medications including ketorolac, clidinium-chlordiazepoxide, methocarbamol, nortriptyline, chlorpheniramine, indomethacin, and dicyclomine. By specialty, the largest reductions were seen in Surgery (-18.13%), Internal Medicine (-12.56%), and General Practice (-6.99%). CONCLUSIONS: A national, real-time, non-interruptive alert system was associated with meaningful reductions in PIM prescribing among older adults. Scalable CDSS tools may enhance medication safety in resource-constrained settings.
Lake DT, Mor V, Grabowski DC
… +2 more, Trivedi AN, Gozalo PL
J Am Geriatr Soc
· 2026 Jun · PMID 41940417
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IMPORTANCE: Enrollees in Medicare Advantage (MA) receive less intensive post-acute care (PAC) than those in traditional Medicare, but the implications of this lower intensity, particularly for patients with complex needs...IMPORTANCE: Enrollees in Medicare Advantage (MA) receive less intensive post-acute care (PAC) than those in traditional Medicare, but the implications of this lower intensity, particularly for patients with complex needs, remain poorly understood. OBJECTIVES: To estimate the association of MA enrollment with PAC use and patient outcomes for hospitalized beneficiaries with hip fracture or stroke. DESIGN, SETTING, AND PARTICIPANTS: A quasi-experimental difference-in-differences analysis leveraging the geographic expansion of MA from 2012 to 2017. The study included 148,396 stroke and 126,046 hip fracture hospitalizations, representing quasi-exogenous hospitalization events in high MA-growth counties. MAIN OUTCOME MEASURES: Initial PAC setting, 30-day all-cause hospital readmission, and 30- and 90-day all-cause mortality. RESULTS: MA enrollment was associated with fewer discharges to inpatient rehabilitation facilities (stroke: -8.9 pp; 95% CI, -9.88 to -7.92; hip fracture: -14.4 pp; 95% CI: -15.38 to -13.42). While 30-day readmissions were modestly lower for MA enrollees in both cohorts, MA enrollees experienced a 7.1% relative increase in 30-day mortality for stroke (0.6 pp; 95% CI: 0.01 to 1.19) and an 11.9% relative increase in 90-day mortality for hip fracture (1.3 pp; 95% CI: 0.52 to 2.08). This adverse mortality effect was concentrated in markets with high baseline IRF use (> = 33.3% of discharges, top tercile), where MA enrollment was associated with an 18.0% relative increase in 90-day mortality for stroke (2.0 pp; 95% CI: 0.82 to 3.18) and a 22.3% relative increase in 90-day mortality for hip fracture (2.3 pp; 95% CI: 0.93 to 3.67). CONCLUSIONS: MA enrollment was associated with lower IRF use, modestly lower readmissions, and a higher mortality risk for hip fracture and stroke. These findings suggest that MA's strategy of shifting patients to lower-cost settings may carry unintended adverse consequences for clinically complex patients.
BACKGROUND: The use of behavior change models to conceptualize deprescribing provides an opportunity to explore the components of communication needed to overcome the many barriers to deprescribing. METHODS: Consensus de...BACKGROUND: The use of behavior change models to conceptualize deprescribing provides an opportunity to explore the components of communication needed to overcome the many barriers to deprescribing. METHODS: Consensus development working group composed of care partner stakeholders and international experts in geriatrics, nursing, pharmacology, communication, and community outreach. The goal of the working group was to create a framework for the communication required among patients, care partners, and clinicians in the ambulatory setting to achieve the behavior of shared decision making about medication appropriateness and deprescribing. The COM-B (Capability, Opportunity, Motivation-Behavior) model provided an apt framework for characterizing deprescribing communication. RESULTS: Each component of the model requires specific communication skills, modes, and/or content. Capability requires clinician skills including elicitation of patient/care partner concerns and patient/care partner skills including self-efficacy for raising medication questions and concerns. This facilitates a shared understanding of constructs that inform communication content, including medication benefits and harms and the "how-to" of deprescribing. Opportunity requires the allocation of time during usual care or the creation of designated visits for communication. Motivation requires communication, such as audit and feedback directed at clinicians, and testimonials directed at patients and care partners, that encourages evaluation of medication appropriateness, increases awareness of potential problems, and overcomes clinical inertia. CONCLUSIONS: The application of a behavioral health model to deprescribing communication highlights the importance of addressing capability, opportunity, and motivation in behavior change. Developing communication strategies that address these three components may enhance the effectiveness of deprescribing interventions.
Qian Y, Gettel C, Su J
… +5 more, Grogan EFL, Cohen I, Rothenberg C, Chen X, Hwang U
J Am Geriatr Soc
· 2026 May · PMID 41937389
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BACKGROUND: Since 2018, the Geriatric Emergency Department (GED) Accreditation Program has recognized Emergency Departments (EDs) that provide high-quality care tailored to older adults. GEDs have expanded rapidly across...BACKGROUND: Since 2018, the Geriatric Emergency Department (GED) Accreditation Program has recognized Emergency Departments (EDs) that provide high-quality care tailored to older adults. GEDs have expanded rapidly across the United States in recent years, but little is known about how GED care is associated with patient outcomes, including hospital admissions and subsequent mortality. METHODS: We used the 2018-2021 Health and Retirement Study (HRS)-Medicare linked data of adults aged ≥ 65 years. We supplemented these data with the American College of Emergency Physicians (ACEP) GED accreditation list and American Hospital Association (AHA) data. Receipt of acute care in a GED was defined as having an ED visit at a GED. Patient-level analyses were conducted using each individual's most recent ED visit. Multivariable logistic regression models were used to estimate associations between receipt of acute care in a GED and outcomes of hospital admission and 30-day mortality, adjusting for patient demographics, socioeconomic status, health conditions, ED visit severity, and hospital-level characteristics. RESULTS: Among 4563 older adults who had an ED visit, 270 (5.9%) received acute care in GEDs and 4293 (94.1%) received non-GED care. Compared with those treated in non-GEDs, patients treated in GEDs had significantly lower odds of hospital admission (OR, 0.61; 95% CI, 0.42-0.87; p < 0.01) and 30-day mortality (OR, 0.62; 95% CI, 0.40-0.96; p < 0.05). Subgroup analyses showed that the association with admission was more pronounced among adults aged 65-80 years (OR, 0.43; 95% CI, 0.24-0.76; p < 0.01) and non-Hispanic White individuals (OR, 0.51; 95% CI, 0.34-0.78). An association with lower mortality was observed among non-Hispanic White individuals (OR, 0.51; 95% CI, 0.30-0.87; p < 0.05). CONCLUSIONS: GED care was associated with lower odds of hospital admissions and 30-day mortality among older adults. Broader implementation may expand the reach of GED programs across diverse populations.
Isai A, Matai L, Bronskill SE
… +13 more, Feng P, Fu L, Hahn-Goldberg S, Humphries J, Huynh T, Li Z, McQuire T, Recknagel J, Rochon PA, Stall NM, Wang X, Yu C, Savage RD
J Am Geriatr Soc
· 2026 Jun · PMID 41933493
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BACKGROUND: Multimorbidity, ≥ 2 chronic conditions as per the World Health Organization, can complicate aging in place and lead to earlier transitions to nursing homes. To inform supportive service intervention planning...BACKGROUND: Multimorbidity, ≥ 2 chronic conditions as per the World Health Organization, can complicate aging in place and lead to earlier transitions to nursing homes. To inform supportive service intervention planning in naturally occurring retirement communities (NORCs), which are areas where large proportions of older adults reside, we examined clustering patterns of specific chronic conditions among NORC residents. METHODS: We conducted a cross-sectional analysis of a population-based cohort of community-dwelling NORC residents aged ≥ 66 years as of January 1, 2022, in Ontario, Canada. A provincial NORC registry of high-rise buildings was linked with individual-level health administrative records by postal code to identify NORC residents. Multimorbidity (≥ 2 of 17 measured chronic conditions), sociodemographic, clinical, and health service use (HSU) characteristics in NORC residents were assessed. Baseline descriptive statistics of the NORC cohort were compared by multimorbidity status, overall, and by sex, using standardized differences (STD). Latent class analysis (LCA) identified groups (known as classes) with similar patterns of co-occurring chronic conditions. RESULTS: Among 200,565 older NORC residents (63% female, 89% in urban settings), 84% lived with multimorbidity. Multimorbid residents were older (mean 78 vs. 74 years; STD 0.58) and more had low-income status (19% vs. 9%; STD 0.27) than non-multimorbid counterparts. LCA resulted in a 6-class solution. Class 1 (13% of the cohort with multimorbidity) was characterized by conditions including osteoarthritis, osteoporosis, cancer, and mood disorders, class 2 (36%) by hypertension, osteoarthritis, osteoporosis, cancer, and mood disorders, class 3 (23%) by diabetes, class 4 (10%) by cardiovascular conditions, class 5 (8%) by respiratory conditions, and class 6 (10%) contained above average prevalences for 16 conditions and had increased HSU, including unscheduled emergency visits (48%). CONCLUSION: Findings suggest a substantial burden of multimorbidity in NORC residents and reinforce the importance of designing programs in NORCs to help older adults with multimorbidity age in place.
Thorpe JM, Tran KA, Aspinall SL
… +8 more, Feder SL, Kaufman BG, Kutney-Lee A, Mor MK, Schleiden LJ, Sileanu FE, Thorpe CT, Van Houtven CH
J Am Geriatr Soc
· 2026 May · PMID 41925169
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BACKGROUND: Discontinuation of medications with limited benefits (LBM) in patients nearing the end of life can reduce burden, adverse events, and costs, and enhance quality of life. However, most research on end-of-life...BACKGROUND: Discontinuation of medications with limited benefits (LBM) in patients nearing the end of life can reduce burden, adverse events, and costs, and enhance quality of life. However, most research on end-of-life prescribing has focused on nursing homes or hospice settings. AIMS: To describe the prevalence of LBM use and discontinuation or deintensification over the last year of life in community-dwelling older veterans with advanced life-limiting conditions. DESIGN: Retrospective, national cohort study of U.S. veteran decedents (≥ 65 years) with advanced life-limiting conditions who died between October 2016 and September 2017. SETTING: Community-residing, non-hospice older veterans. LBM users were identified using consensus-based criteria and assessed for discontinuation over the last year of life. We estimated LBM discontinuation rate ratios using multivariable robust Poisson regression. RESULTS: Among 37,193 decedents (mean age 78 years), 73% were on at least one LBM (e.g., statins, oral antidiabetics, antihypertensives, antithrombotics, anti-ulcer, or antidementia drugs) entering the last year (baseline). Of these baseline LBM users, 22.0% experienced at least one LBM discontinuation over their final year. Veterans residing in more rural counties had lower LBM discontinuation rates than those in large metropolitan counties. Discontinuation rates were also higher in the Midwest or South compared to the Northeast or West. Veterans with documented clinical indicators of limited life expectancy (e.g., pressure ulcers, malnutrition) or those receiving specialty palliative care, were more likely to have LBMs discontinued. CONCLUSION: Among community-dwelling older veterans in their final year of life, 73% were receiving at least one LBM at the start of that year, and 78% of these individuals continued LBM use until death. These rates parallel those reported in long-term care populations and underscore the need for community-based healthcare providers to routinely screen for LBMs and support appropriate medication discontinuation in older patients with advanced illnesses and limited life expectancy.
J Am Geriatr Soc
· 2026 May · PMID 41919946
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BACKGROUND: Remaining socially active may be especially critical for quality of life as death approaches, as it affords access to necessary support, health advice, a sense of autonomy, and personal resources (e.g., copin...BACKGROUND: Remaining socially active may be especially critical for quality of life as death approaches, as it affords access to necessary support, health advice, a sense of autonomy, and personal resources (e.g., coping, resilience) that shape end-of-life experiences. We aimed to examine (a) how older adults' engagement in social activities changes during the years before death, and (b) whether trajectories of engagement in these activities differ depending on physical and cognitive function. PARTICIPANTS AND SETTING: We analyzed 22,993 annual observations from 4667 participants in the National Health and Aging Trends Study (NHATS), a U.S. nationally-representative, longitudinal study of Medicare recipients aged 65 and older who died between 2012 and 2024. METHODS: We used logistic growth curve models to test how participation in each of 5 activities-visiting with family or friends, religious service attendance, organized group activities, going out for enjoyment, and volunteering-changed over the 13 years prior to death. Key predictors included physical and cognitive function. RESULTS: Findings indicated that older adults' participation in all 5 social activities declined during this final period of the life course, with considerable variation across activities. There was strong evidence that physical and cognitive function affected initial levels of participation, but minimal evidence that physical or cognitive function affected trajectories of decline. CONCLUSIONS: Community-based interventions to improve physical accessibility and dementia awareness may be important avenues for supporting social activity engagement among people in the last stage of life, particularly among older adults living independently in their communities.
Yu J, Zhang H, Wu Y
… +10 more, Wen K, Strobel S, Elman A, Jeng P, Baek D, Zhang Y, Gassoumis Z, Bao Y, Pillemer K, Rosen T
J Am Geriatr Soc
· 2026 Apr · PMID 41919448
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BACKGROUND: Elder mistreatment is associated with adverse health outcomes and increased Emergency Department (ED) and hospital utilization patterns in the period surrounding initial mistreatment identification. Less is k...BACKGROUND: Elder mistreatment is associated with adverse health outcomes and increased Emergency Department (ED) and hospital utilization patterns in the period surrounding initial mistreatment identification. Less is known about outpatient primary care utilization, but it has been hypothesized that elder mistreatment victims may use this care less frequently than other older adults due to isolation and poor connection to outpatient providers. METHODS: We used multiple measures of outpatient primary utilization patterns including fractured care (continuity of care index (COCI) and usual provider of care (UPC) index) in the 360 days before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. RESULTS: This study included 114 cases and 410 controls. Median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. During the 720 days surrounding mistreatment identification, cases were more likely to have had at least one outpatient primary care visit (adjusted odds ratio [AOR], 2.05 [95% CI, 1.12-3.73]; p = 0.02) and visits to multiple primary care providers (AOR, 1.51 [95% CI, 0.99-2.29]; p = 0.05). In unadjusted and adjusted models, both COCI and UPC were significantly lower in cases than controls during the 360 days prior to identification but not in the 360 days post-identification or when examining the entire 720 days. More cases received both outpatient primary care and ED/hospital care during the 720 days (58.8% vs. 33.7%; p < 0.001). CONCLUSION: Contrary to hypotheses, older adults experiencing mistreatment were not less likely to use outpatient primary care than other older adults during the period surrounding mistreatment. Additional research is needed to examine potential explanations and explore opportunities to improve detection and intervention in primary care.
BACKGROUND: While the role of social determinants of health (SDH) in physical health is well known, their longitudinal contribution to depressive symptoms in chronically ill adults remains understudied. Understanding how...BACKGROUND: While the role of social determinants of health (SDH) in physical health is well known, their longitudinal contribution to depressive symptoms in chronically ill adults remains understudied. Understanding how socioeconomic disadvantage compounds the psychological burden of chronic disease may inform preventive psychiatry in aging populations. OBJECTIVE: This study examined whether key SDH were associated with the incidence of depressive symptoms among older adults with chronic disease across Europe. METHODS: Using data from waves 1-9 of the Survey of Health, Ageing and Retirement in Europe (SHARE), 12,319 adults aged ≥ 50 years with at least one chronic condition and without depression at baseline were included. Incident depressive symptoms were defined as a EURO-D score ≥ 4 during follow-up. SDH included education, employment, income, and living arrangements. Cox proportional hazards models estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI), controlling for age, sex, smoking, physical activity, BMI, country, and chronic disease. RESULTS: During a median follow-up of 3 years, 3668 new clinically relevant depressive symptom cases occurred. Compared to high education, middle and low education were linked to 15% (HR = 1.15; 95% CI: 1.04-1.27) and 36% higher risk (HR = 1.36; 95% CI: 1.24-1.50). Low income was linked to 10% higher risk (HR = 1.10; 95% CI: 1.02-1.19), and economic inactivity to 17% higher risk (HR = 1.17; 95% CI: 1.08-1.26). CONCLUSION: Socioeconomic disadvantages, reflected in lower education, income, and employment, were associated with a higher incidence of depressive symptoms. Addressing these inequalities within integrated chronic disease and mental-health care may help prevent late-life depression.
Tan ZS, Qureshi N, Sicotte NL
… +10 more, Hirsch D, Escovedo C, Spivack E, Nasmyth MC, Gonzales M, Kremen SA, Nuckols TK, Mafi J, McFadden J, Roberts PR
J Am Geriatr Soc
· 2026 Jun · PMID 41919357
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BACKGROUND: Dementia and cognitive impairment are common among hospitalized older adults yet frequently go unrecognized, contributing to poorer outcomes and disparities in care. Systematic inpatient cognitive screening r...BACKGROUND: Dementia and cognitive impairment are common among hospitalized older adults yet frequently go unrecognized, contributing to poorer outcomes and disparities in care. Systematic inpatient cognitive screening remains rare in U.S. hospitals. We evaluated the feasibility, reach, and screening outcomes of a hospital-wide, multicomponent inpatient cognitive screening program integrating an electronic health record (EHR) dementia diagnosis algorithm with nurse-administered brief cognitive assessments (4AT and AD8) among adults aged ≥ 65 years. METHODS: We conducted an observational study across eight inpatient medical and surgical units in a large academic medical center, implementing systematic screening for previously diagnosed dementia and newly detected cognitive impairment from June 2023 to November 2024. Screening activity and screening positivity were assessed overall and across sociodemographic and clinical subgroups. Logistic regression models examined factors associated with screening completion and positive findings. RESULTS: Among 11,180 hospitalizations between June 2023 and August 2024, 83.3% were screened; 18.0% had previous dementia diagnoses, 4.3% screened positive for potential dementia, and 9.0% for cognitive impairment. Older adults (age 85+) and Black patients (37.5% vs. 26.7%) were more likely to screen positive for potential dementia than younger or White patients. Screening completion rates were high and largely consistent across demographic groups, with minimal evidence of new disparities introduced by the screening process. CONCLUSION: Inpatient cognitive screening is feasible and increases detection of potential dementia. This approach promoted more consistent detection in dementia diagnosis and can potentially improve hospital care and outcomes for older adults with dementia or cognitive impairment.
Davidson HE, Han LF, Sillman EA
… +7 more, Perez I, Simonson RB, Neary MP, Willame C, El Khoury AC, McConeghy K, Gravenstein S
J Am Geriatr Soc
· 2026 Jun · PMID 41918347
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BACKGROUND: Invasive Escherichia coli disease (IED) causes significant morbidity, but little is known about its characteristics in nursing home (NH) populations. PARTICIPANTS AND SETTING: Adult long-stay NH residents wit...BACKGROUND: Invasive Escherichia coli disease (IED) causes significant morbidity, but little is known about its characteristics in nursing home (NH) populations. PARTICIPANTS AND SETTING: Adult long-stay NH residents with electronic health record (EHR) evidence of a positive E. coli infection from Medicare-certified skilled nursing facilities between 2017 and 2023 (excluding 2020-2021). METHODS: This retrospective case validation study collected NH EHR data on demographics, case definition, hospitalizations, emergency visits, antibiotic use, and discharge status. Each resident's NH Minimum Data Set assessment closest to the date of qualifying E. coli culture (QEC) was also reviewed. Our IED case definition combines E. coli culture confirmation from urine or blood with clinical signs consistent with invasive disease (i.e., sepsis) within 72 h. RESULTS: Among 90 IED cases, 77.8% were female, 73.3% white, and 70% dually eligible for Medicare and Medicaid. Most cases (85.7%) were admitted from acute care facilities. Over 90% of cases were confirmed from urine specimens alone, only 7.7% from blood cultures. Sepsis was documented in 54.4% of cases, with 33.3% specifically classified as "sepsis due to E. coli ." End-organ dysfunction impacted 28% of patients, with acute kidney injury (15.6%) being most common. Over one-third (36.7%) were hospitalized within 30 days of diagnosis. Substantial antibiotic resistance was observed, with 61.5% of isolates resistant to ampicillin and over half resistant to fluoroquinolones. Urological risk factors included neurogenic bladder (20%) and obstructive uropathy (14%). Common comorbidities were hypertension (70%), diabetes (51.1%), and depression (47.8%). CONCLUSION: The results of this study indicate that NH residents who develop IED incur high rates of sepsis, hospitalization, and antibiotic resistance, highlighting the importance of improved laboratory reporting systems and thorough specimen collection to enhance earlier diagnosis and treatment of E. coli infections that can progress to this life-threatening disease.