Fang M, Daya NR, Jeon Y
… +4 more, Echouffo-Tcheugui JB, Windham BG, Zeger S, Selvin E
J Am Geriatr Soc
· 2026 Mar · PMID 41918315
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BACKGROUND: Comprehensive data on the burden of biochemical hypoglycemia in older adults with type 2 diabetes are lacking. We seek to characterize the burden and risk factors for hypoglycemia detected by continuous gluco...BACKGROUND: Comprehensive data on the burden of biochemical hypoglycemia in older adults with type 2 diabetes are lacking. We seek to characterize the burden and risk factors for hypoglycemia detected by continuous glucose monitoring (CGM) in older adults with type 2 diabetes. METHODS: A cross-sectional analysis of 315 older adults with type 2 diabetes who attended visit 9 of the Atherosclerosis Risk in Communities Study (2021-2022). We examined rates of Level 1 hypoglycemia (< 70 mg/dL) and percentage meeting recommended targets for hypoglycemia (< 1% of time). We identified risk factors for CGM-detected hypoglycemia by comparing the median time spent in hypoglycemia across subgroups. All analyses were stratified by high-risk medication use (insulin/sulfonylureas vs. not). RESULTS: Of the 315 participants with type 2 diabetes (mean age 83 years, 55% women, 41% Black adults), 32.4% were using insulin or sulfonylureas. Among individuals using these high-risk medications, the median time spent in hypoglycemia was 3.4%, and ~66% of participants spent more than 1% of the time with CGM glucose < 70 mg/dL. Hypoglycemic episodes typically occurred overnight and lasted a median of ~1.5 h among individuals using insulin or sulfonylureas. CGM-detected hypoglycemia was low in participants not using high-risk medications (median time spent in hypoglycemia: 0.7%). In unadjusted analyses, cardiovascular disease, cognitive impairment, poor physical functioning, and chronic kidney disease were associated with increased time spent in hypoglycemia, regardless of high-risk medication use. CONCLUSIONS: There may be a substantial burden of unrecognized CGM-detected hypoglycemia in very old adults with type 2 diabetes using high-risk medications in the general population. Hypoglycemia may also be present among persons not on high-risk medication, but the burden is much lower. Further research is needed to clarify the clinical significance of these hypoglycemic episodes.
Mai D, Cher BAY, Lunardi N
… +13 more, Thornton M, Baker JG, Macdonald C, Skinner CS, Brown CJ, Marten EL, Makris K, Heredia MLM, Berger M, Cullum CM, Lee S, Pham TH, Balentine CJ
J Am Geriatr Soc
· 2026 May · PMID 41885347
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BACKGROUND: Use of local anesthesia for inguinal hernia repair in older adults is recommended by society guidelines because of reduced postoperative cognitive dysfunction and improved functional recovery after surgery co...BACKGROUND: Use of local anesthesia for inguinal hernia repair in older adults is recommended by society guidelines because of reduced postoperative cognitive dysfunction and improved functional recovery after surgery compared to general anesthesia. However, in practice, few inguinal hernia repairs in older adults are actually done under local anesthesia. PARTICIPANTS AND SETTING: Key stakeholders involved in inguinal hernia repair at Veterans' Affairs hospital systems including patients, surgeons, anesthesiologists, and hospital leaders. METHODS: We conducted semi-structured interviews and focus groups to identify barriers and facilitators to use of local anesthesia for inguinal hernia repair in older adults. Qualitative data were analyzed using Direct Content Analysis guided by the Capability, Opportunity, and Motivation (COM-B) framework. RESULTS: We interviewed 40 Veterans aged ≥ 65 years who had undergone inguinal hernia repair at 3 hospitals, and we convened focus groups and interviews with 10 surgeons, 9 anesthesiologists, and 7 hospital leaders. We found patients were not consistently offered the opportunity to have shared decision-making conversations about the advantages and disadvantages of local versus general anesthesia because standard pre-operative care workflows did not allow for conversations incorporating perspectives of all stakeholders, especially anesthesiologists. Also, it was difficult to disentangle choice of anesthesia modality from choice of surgical approach. There were entrenched opinions among many surgeons about perceived advantages of minimally invasive surgery, which requires general anesthesia, without regard for the cognitive and recovery benefits of open surgery using local anesthesia. Finally, providers and hospital leaders highlighted how improved protocols for local anesthesia administration, increased buy-in from hospital leadership, and more high-quality evidence in support of local anesthesia were all necessary to increase its use. CONCLUSIONS: The findings serve as a roadmap for a multi-component plan to increase use of local anesthesia for inguinal hernia repair in older adults, with clear advantages for post-operative cognitive and functional recovery.
Bekena S, Singh RK, Zhu Y
… +7 more, Harrison K, Williams JP, Laurido-Soto OJ, Al-Hammadi N, Dickerson A, Carr DB, Babulal GM
J Am Geriatr Soc
· 2026 May · PMID 41884999
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BACKGROUND: Driving supports independence and quality of life in later life but is vulnerable to age-related and/or disease-related decline. While cognitive impairment is a well-recognized risk for unsafe mobility, the c...BACKGROUND: Driving supports independence and quality of life in later life but is vulnerable to age-related and/or disease-related decline. While cognitive impairment is a well-recognized risk for unsafe mobility, the contribution of sensorimotor function is less understood. METHODS: We studied 374 cognitively normal older adults (Clinical Dementia Rating = 0 at baseline) enrolled in the DRIVES Project. A SensoryMotor Impairment Index (SMI) was constructed from six domains (grip strength, gait speed, reaction time, hearing, vision, olfaction) and categorized as 0, 1, 2, or ≥ 3 impairments. Naturalistic driving was continuously monitored using in-vehicle GPS dataloggers between 2019 and 2025. Linear mixed-effects models tested whether longitudinal driving trajectories differed by baseline SMI, adjusting for age, sex, race, education, body mass index, and cognition (Preclinical Alzheimer's Cognitive Composite). RESULTS: At baseline, participants with higher SMI burden were older and had lower cognitive scores (both p < 0.01). Over time, greater sensorymotor impairment was associated with faster declines in driving exposure and spatial range. Compared with SMI = 0, participants with SMI ≥ 3 showed steeper reductions in nighttime trips (-0.050 vs. -0.037 trips/month), long-distance trips (> 20 miles; p < 0.001), and maximum trip distance (p = 0.009), and greater contraction of driving space (entropy and radius of gyration; p < 0.001). Self-reported driving behaviors showed that participants with higher SMI drove fewer days per-week and were more likely to avoid night driving (p < 0.01). Rates of self-reported adverse driving events (e.g., crashes or citations) did not differ significantly across SMI groups, consistent with compensatory self-regulatory behaviors. CONCLUSION: Greater sensorymotor impairment predicts accelerated decline in naturalistic driving among cognitively normal older adults, independent of cognition. A composite SMI may provide a feasible, low-cost approach to identify older drivers at risk for declining mobility and support timely interventions to prolong safe driving.
Hoque A, Cuthel A, Grudzen CR
… +10 more, Shah MN, Brody AA, Fleisher JE, DiMascio-Donohue J, McLain K, Tun LT, Levine J, Goldfeld KS, Chodosh J, ED‐LEAD Investigators
J Am Geriatr Soc
· 2026 Mar · PMID 41882986
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Over 50% of persons living with dementia (PLWD) and their care partners (dyads) visit the emergency department (ED) every year. In the ED, healthcare professionals face complex challenges managing acute issues and sympto...Over 50% of persons living with dementia (PLWD) and their care partners (dyads) visit the emergency department (ED) every year. In the ED, healthcare professionals face complex challenges managing acute issues and symptoms of Alzheimer's disease and Alzheimer's disease-related dementias without provider training or in-ED structures to ensure a successful discharge. While many of these visits are for conditions more suitable for ambulatory care, as many as 50% of PLWD discharged from the ED return within 30 days, suggesting opportunities to improve ED care, and discharge processes. Emergency Care Redesign (ECR) includes intentional workflows where physicians, nurses, and social workers engage in a team-based approach with structured assessments to manage a myriad of potential psychosocial and behavioral issues contributing to the need for ED care. Three core components comprise this evidence-based, efficient pragmatic intervention for PLWD and their care partners: (1) problem identification, (2) problem prioritization, and (3) provision of non-pharmacologic solutions supported by community resources. Although these components are essential to provide optimal ED care and reduce revisits and other adverse outcomes, they require an embedded clinical decision support structure, focused training, and clear workflows. In this paper, we describe the ECR intervention as one of three being implemented in the cluster-randomized multifactorial pragmatic trial, Emergency Departments LEading Transformation of Alzheimer's and Dementia Care (ED-LEAD), designed to improve care for PLWD and their outcomes after discharge home within 15 health systems and 79 EDs across the United States.
Bellantoni J, Katz M, Hayes J
… +8 more, Peng M, Purdy H, Schilling LM, Lum HD, Juarez-Colunga E, Mahi MH, Shanbhag P, Tietz S
J Am Geriatr Soc
· 2026 Jun · PMID 41882824
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BACKGROUND: High utilization of the emergency department (ED) by older adults contributes to adverse health outcomes and increased cost of care. Studies have investigated interventions aimed at reducing low acuity ED vis...BACKGROUND: High utilization of the emergency department (ED) by older adults contributes to adverse health outcomes and increased cost of care. Studies have investigated interventions aimed at reducing low acuity ED visits, with increased primary care accessibility being among the most effective. This paper aims to describe the implementation of a novel acute care clinic model to improve same-day availability for urgent concerns within geriatric primary care. METHODS: We conducted a quasi-experimental difference-in-differences (DID) analysis to evaluate the impact of an Acute Care Clinic (ACC) model implemented within an outpatient geriatrics clinic between March 2022 and August 2023. Patient-level descriptive statistics were used to characterize ACC patients. Clinic-level outcomes were compared between geriatrics clinic patients (including ACC patients) and a reference group of patients who receive primary care at internal medicine clinics within the same health system using monthly aggregated data over a 24-month period (6 months pre- and 18 months post-intervention). RESULTS: There were 1102 ACC visits (764 distinct patients) in the implementation period. ACC patients were more medically complex than both the geriatrics clinic overall and the reference group (average HCC score 2.4). Same-day labs were ordered in 34% of ACC visits and same-day imaging was ordered in 15% of ACC visits. Compared to the reference group, the geriatrics clinic showed a potentially greater reduction in calls escalated due to lack of same-day access (-3.1%; p = 0.08) and a larger increase in same-day scheduling (+2.8%; p = 0.13), though neither reached statistical significance. CONCLUSIONS: An ACC model was successfully implemented within a geriatric primary care clinic and there was a trend toward improvement in same-day clinic access for these medically complex older adults. Further review of patient triage processes, financial impact, and patient satisfaction is needed for program evaluation, refinement, and expansion.
Patterson SE, Biziorek J, Reyes A
… +6 more, Solway E, Kirch M, Singer DC, Strunk SN, Kullgren JT, Roberts JS
J Am Geriatr Soc
· 2026 Mar · PMID 41877313
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BACKGROUND: Rising numbers of older adults will intensify demand for unpaid care from family and friends (caregiving) and quality paid home, assisted living, or nursing home care (long-term care). With growing public des...BACKGROUND: Rising numbers of older adults will intensify demand for unpaid care from family and friends (caregiving) and quality paid home, assisted living, or nursing home care (long-term care). With growing public desire for government support, it is important to explore older Americans (age ≥ 50) views, especially by caregiver status. PARTICIPANTS AND SETTING: Data were collected from the February-March 2024 wave of the University of Michigan National Poll on Healthy Aging (NPHA), a nationally representative survey of community-dwelling U.S. adults age ≥ 50 (n = 3216). METHODS: We conducted a cross-sectional study using weighted regression models to examine older Americans' (1) views on who should primarily pay for caregiving (government, family/older adults, or others), (2) concerns about older adults in their community being able to access quality long-term care, and (3) concerns about long-term care costs. The key predictor was whether the respondent was a caregiver of an adult ≥ age 65. RESULTS: Opinions on who should primarily pay for caregiving were evenly split between government (45%) and older adults and their families (45%). Caregivers were less likely to favor older adults and their families bearing primary financial responsibility relative to the government (RRR 0.68, p < 0.01). Most older Americans were somewhat or very concerned about quality long-term care access (80%) and costs (88%), and caregivers were more likely to be concerned about both access (b = 1.73, p < 0.001) and costs (b = 1.44, p < 0.01) than noncaregivers. CONCLUSIONS: Most older Americans are concerned about access to long-term care and costs, yet remain divided on who primarily should pay for caregiving costs. Caregivers are both more concerned about long-term care access and more likely to support the government's primary responsibility for caregiving costs than noncaregivers. Policymakers should consider more options for access to affordable, high-quality long-term care, and financial supports for caregivers.
Chen BG, Recker A, Baier RR
… +3 more, Reddy A, Gifford DR, Kissam SM
J Am Geriatr Soc
· 2026 May · PMID 41877293
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BACKGROUND: Collaboration between providers and investigators can maximize the impact of research in post-acute and long-term care settings, including skilled nursing facilities (SNFs). Involving SNF providers in researc...BACKGROUND: Collaboration between providers and investigators can maximize the impact of research in post-acute and long-term care settings, including skilled nursing facilities (SNFs). Involving SNF providers in research from the inception can help ensure that investigators are answering practical, clinically relevant questions that are important and actionable. Here we summarize the results from the iterative approach we took to identify research priorities from the perspective of SNF operators, administrators, and clinicians (collectively, providers) to accelerate improvement in post-acute and long-term care. METHODS: Using surveys, town hall meetings, and individual idea submissions, we solicited providers' perceptions on the most critical priorities for research on long-term care practices to improve resident outcomes. RESULTS: We identified six key research categories of interest to providers: medication management, medical equipment utilization, disease management, infection prevention and control, staff education, and new models of care practices. Providers emphasized emerging priorities such as behavioral health, infection control, and technological innovations, reflecting significant changes in long-term care after the COVID-19 pandemic. Providers also stressed the importance of understanding the effectiveness of interventions and different care practices, despite the potential for such research to require more resources than are often available to either providers or researchers alone. CONCLUSIONS: The research categories, topics, and examples of interest that we captured highlight the need for pragmatic, provider-informed research that can translate into improved care.
J Am Geriatr Soc
· 2026 Jun · PMID 41858054
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With better understanding of the pathologic processes of Alzheimer's disease, diagnostic methods have been developed to focus on specific biomarkers of disease detectable on brain imaging, cerebral spinal fluid, and, mor...With better understanding of the pathologic processes of Alzheimer's disease, diagnostic methods have been developed to focus on specific biomarkers of disease detectable on brain imaging, cerebral spinal fluid, and, more recently, plasma. Although these tests do not establish a diagnosis of dementia, which requires a clinical evaluation, they can more precisely identify whether Alzheimer's disease is a contributing cause. The recent FDA approval of two blood-based biomarkers and the availability of others, including direct-to-consumer tests, has led to the potential for widespread use in primary and specialty care. However, the currently available blood-based biomarkers are more highly correlated with amyloid brain PET scans, which are less specific for symptomatic Alzheimer's disease, than with p-tau brain PET scans, which are strongly associated with changes in cognition. The value of a positive or negative blood-based biomarker depends on the test characteristics (e.g., sensitivity and specificity) of the specific test as well as the prevalence of the disease in the population. Clinicians ordering blood-based biomarkers must decide their value in the care of individual patients and be prepared to interpret the test results to their patients.
Rosenberg M, Cenzer I, Smith AK
… +1 more, Kotwal AA
J Am Geriatr Soc
· 2026 Mar · PMID 41858045
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BACKGROUND: Loneliness (subjective feeling of lacking connection) and social isolation (objective deficit in number of relationships or contact with others) are common at the end-of-life and can be detrimental to quality...BACKGROUND: Loneliness (subjective feeling of lacking connection) and social isolation (objective deficit in number of relationships or contact with others) are common at the end-of-life and can be detrimental to quality of life. Investigating the association between symptoms and end-of-life loneliness and social isolation could help inform targeted interventions. METHODS: We used nationally-representative, cross-sectional Health and Retirement Study data, including adults > 50 years old (N = 2385) who died while enrolled. Respondents self-reported on validated loneliness and social isolation measures within 1 year of death; 12 physical and psychological symptoms were determined via after-death interviews with proxies. We use multivariable logistic regression to determine the adjusted probability of end-of-life loneliness or social isolation by each symptom, adjusting for socio-demographic covariates. RESULTS: Respondents were on average 76 years old, 50% female, 82% identified as White, 10% Black, and 5% Latino. Loneliness was more common among the following symptoms (p < 0.05): pain (30% vs. 20%), depression (35% vs. 18%), fatigue (29% vs. 22%), drowsiness (32% vs. 25%), and agitation (38% vs. 24%). Social isolation was more common in decedents who had difficulty breathing (22% vs. 14%, p = 0.03), drowsiness (30% vs. 17%, p = 0.006), and persistent cough (24% vs. 15%, p = 0.007). CONCLUSIONS: In the last year of life, multiple psychosocial symptoms were associated with experiences of loneliness whereas physical symptoms were associated more with social isolation. While these relationships are complex, addressing the social sequela of physical and psychological symptoms may be an opportunity to improve overall well-being at the end-of-life.
Hu Z, Raji MA, Shan Y
… +3 more, Tzeng HM, O'Mahony S, Kuo YF
J Am Geriatr Soc
· 2026 May · PMID 41845865
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BACKGROUND: Advance care planning (ACP) allows older adults to document preferences for future medical care, but uptake remains limited and unequal, especially among those with mild cognitive impairment (MCI) or Alzheime...BACKGROUND: Advance care planning (ACP) allows older adults to document preferences for future medical care, but uptake remains limited and unequal, especially among those with mild cognitive impairment (MCI) or Alzheimer's disease and related dementias (ADRD). Since 2016, ACP discussions can be billed during the Medicare annual wellness visit (AWV), creating a policy-supported opportunity for timely ACP engagement. PARTICIPANTS AND SETTING: We studied 959,405 Medicare beneficiaries aged ≥ 68 years newly diagnosed with MCI or ADRD in 2018, using national claims data. METHODS: We conducted a retrospective cohort study with 1:1 propensity score matching to compare beneficiaries with and without AWV receipt in 2018. Cox proportional hazards models with death as a competing risk estimated associations between AWV and ACP initiation over 4 years. Sensitivity analyses included censoring rules and time-dependent modeling. Subgroup analyses assessed variation by cognitive stage, race/ethnicity, sex, region, and education. RESULTS: Among 118,174 beneficiaries who received an AWV, 27.62% initiated ACP within 4 years compared with 17.46% of nonrecipients (HR, 1.86; 95% CI, 1.84-1.89). Most ACP uptake among AWV recipients occurred on the same day as the visit (9.00%), with modest increases thereafter. Sensitivity analyses confirmed stronger associations when accounting for continued AWV use (HR, 2.51; 95% CI, 2.46-2.56) and with time-dependent modeling (HR, 2.27; 95% CI, 2.27-2.31). The positive association between AWV and ACP was consistent across subgroups and particularly strong among Hispanic beneficiaries and those in nonmetropolitan areas. CONCLUSIONS: AWV receipt was associated with significantly earlier and greater ACP initiation among older adults with MCI or ADRD. Incorporating ACP into AWV workflows could enhance timely engagement, reduce disparities, and strengthen alignment of care with patient preferences. System-level interventions and clinician training may further increase same-day ACP uptake.
Dalsania KA, Ménard A, Sundararaman S
… +18 more, Rahgozar A, de Lima S, Lu X, Al-Ali A, Singh K, Hakimjavadi R, Yan H, Sethuram C, Bergman H, LaPlante J, McIsaac D, Rahimi SA, Sourial N, Thandi M, Wong S, Liddy C, Bandeen-Roche K, Karunananthan S
J Am Geriatr Soc
· 2026 Mar · PMID 41845582
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BACKGROUND: Early identification and management of frailty are crucial, yet its detection in early stages remains difficult for clinicians. Artificial intelligence (AI) has emerged as a promising tool in healthcare. Howe...BACKGROUND: Early identification and management of frailty are crucial, yet its detection in early stages remains difficult for clinicians. Artificial intelligence (AI) has emerged as a promising tool in healthcare. However, the absence of a standard frailty definition and diversity of AI methods create a need for a comprehensive review. This study examines the clinical tools and conceptual frameworks used as reference standards in training AI algorithms for frailty identification and management, describes current AI methods, and explores the engagement of knowledge users in developing and evaluating these technologies. METHODS: A scoping review was conducted following the Arksey and O'Malley framework, enhanced by Levac et al. and the Joanna Briggs Institute. Eight academic databases-Medline, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Ageline, Web of Science, Scopus, and Institute of Electrical and Electronics Engineers Xplore-and one gray literature source-ProQuest Dissertations & Theses Global-were searched. Abstracts and full-text screening and data charting were performed in duplicate. Results were summarized through text and graphical representations. RESULTS: The review included 33 publications, predominantly emerging after 2020. Twenty-three different AI techniques were presented, with standard modeling approaches such as logistic regression and decision trees being most common. Among the 21 distinct reference standards used to train AI models, the Physical Frailty Phenotype was cited most frequently (n = 7). Most AI methods (n = 27) prioritized frailty identification, one addressed frailty management, and five focused on both. None of the papers engaged knowledge users in defining or validating AI tools, and only three studies explored algorithmic biases that could lead to inequities. CONCLUSIONS: Like the broader frailty literature, emerging AI tools lack a consistent definition of frailty, leading to design and implementation inconsistencies. The absence of knowledge user involvement may further limit the clinical relevance and equity of these technologies. TRIAL REGISTRATION: OSF Registries [https://doi.org/10.17605/OSF.IO/T54G8].
J Am Geriatr Soc
· 2026 May · PMID 41839791
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GDF15 signals energetic stress to the brain, leading to unpleasant symptoms as the body conserves and reallocates energy. In conditions such as frailty and cancer, suppression of GDF15 signaling is expected to lead to an...GDF15 signals energetic stress to the brain, leading to unpleasant symptoms as the body conserves and reallocates energy. In conditions such as frailty and cancer, suppression of GDF15 signaling is expected to lead to an improvement in symptoms, but potentially at the cost of long-term health and survival.
J Am Geriatr Soc
· 2026 Jun · PMID 41834078
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Cannabis use in older adults may have a broad range of effects in older adults impacting Mind, Mobility, Medications, Multi-complexity, and what Matters Most.Cannabis use in older adults may have a broad range of effects in older adults impacting Mind, Mobility, Medications, Multi-complexity, and what Matters Most.
J Am Geriatr Soc
· 2026 Jun · PMID 41833559
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BACKGROUND: While fans are recommended for cooling at temperatures ≤ 40°C, the extent to which ceiling fans mitigate perceptual and physiological strain in older adults exposed to warm indoor environments (~31°C [87.8°F]...BACKGROUND: While fans are recommended for cooling at temperatures ≤ 40°C, the extent to which ceiling fans mitigate perceptual and physiological strain in older adults exposed to warm indoor environments (~31°C [87.8°F]) remains unclear. METHODS: This follow-up analysis of our randomized study used validated questionnaires to evaluate effects of ceiling fans on self-reported heat-related symptoms (68-item Environmental Symptoms Questionnaire; ESQ-IV) and mood-state (40-item Profile of Mood States questionnaire; POMS-40) in bed-resting older adults during indoor overheating (8 h; 31°C (87.8°F), 45% relative humidity). Twenty participants (median age [interquartile range]: 71 [68-73] years; 12 females) completed two sessions with a ceiling fan set to 0 m/s (control) or ~1.5 m/s (fan). Perceptual outcomes (ESQ-IV, POMS-40) were assessed pre-exposure and at end heating. Cumulative physiological strain was assessed using area-under-the-curve (AUC) values for core temperature and heart rate over hours 0-8. End heating perceptual scores were evaluated using linear mixed-effects models adjusted for pre-exposure scores and fan condition (with/without each physiological strain index). RESULTS: Core temperature and heart rate increased 0.15 [0.06, 0.24]°C (0.27 [0.11, 0.43]°F; p = 0.003), and 1.5 [0.5, 3.4] bpm (p = 0.135) per hour, respectively, with no-fan compared with fan use. After adjusting for core temperature AUC (p = 0.233), total symptom scores were 1.3-fold [1.1, 1.7] higher with no-fan (p = 0.015). Heart rate AUC did not modify this effect (p = 0.215); however, greater heart rate AUC was independently associated with higher symptom scores (p = 0.042). Mood disturbance did not differ between fan conditions and was not significantly associated with physiological strain markers (all p ≥ 0.187). CONCLUSIONS: Ceiling fans alone do not fully mitigate perceptual or physiological strain in older adults exposed to prolonged indoor overheating. Nonetheless, a "fan-first" strategy integrating fan use with ambient cooling may offer an accessible, energy-efficient approach to enhance heat-health protection in this population. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06142890.
Keshwani S, Park H, Lo-Ciganic WH
… +3 more, Fillingim RB, Morris EJ, Smith SM
J Am Geriatr Soc
· 2026 May · PMID 41833532
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BACKGROUND: In older adults with osteoarthritis (OA) and hypertension (HTN), analgesic use may elevate blood pressure and cardiovascular risk. Whether comorbid HTN influences initial analgesic choice remains unclear; we...BACKGROUND: In older adults with osteoarthritis (OA) and hypertension (HTN), analgesic use may elevate blood pressure and cardiovascular risk. Whether comorbid HTN influences initial analgesic choice remains unclear; we examined initial analgesic use in Medicare beneficiaries with incident OA, comparing those with and without HTN. METHODS: We conducted a retrospective cohort study using 2011-2022 nationally representative Medicare beneficiaries (≥ 65 years) with incident OA who initiated an analgesic within 30 days of diagnosis and had continuous enrollment for ≥ 365 days prior through ≥ 30 days post-index. Patients with baseline HTN were classified as OA + HTN; others as OA-only. We assessed overall analgesic trends using the Cochran-Armitage test and evaluated differences by HTN status using logistic regression with year as an interaction term. For stratified analyses by joint type, we applied weighted logistic regression. RESULTS: Among 179,033 beneficiaries (mean age 75 ± 7.3 years; 62.7% women; 80.7% White), 57.1% had baseline HTN. Overall, the most commonly initiated analgesic classes were intra-articular injections (30.3%), and oral NSAIDs only (28.2%). Notable changes from 2012 to 2022 were increase in topical NSAIDs use (3.1%-5.7%) and decrease in opioid combination use (25.4%-13.9%), with no significant trend differences by HTN status. In joint-specific analyses, OA + HTN versus OA-only showed no differences in odds of initiating oral opioids (OR: 0.97, 95% CI: 0.92-1.03), intra-articular injections (OR: 1.01, 95% CI: 0.96-1.07) or topical NSAIDs (OR: 0.88, 95% CI: 0.78-1.01) versus oral NSAIDs. CONCLUSION: Baseline HTN did not influence the choice of initial analgesic in incident OA patients. Safer, evidence-based alternatives are needed for older adults with comorbid HTN.