BACKGROUND: Caregiver burden at the onset of acute Hospital-at-Home (HaH) episodes, particularly in programs where caregiver availability is required for admission, remains insufficiently characterized in real-world sett...BACKGROUND: Caregiver burden at the onset of acute Hospital-at-Home (HaH) episodes, particularly in programs where caregiver availability is required for admission, remains insufficiently characterized in real-world settings. PARTICIPANTS AND SETTING: Caregivers of patients admitted to an acute HaH program within Clalit Health Services, Northern District, Israel, between 2023 and 2024. METHODS: We conducted a cross-sectional observational study of 125 caregivers assessed within the first 48 h of the HaH episode. Caregiver burden was measured using the Caregiver Strain Index (CSI; range 0-13), with high burden defined as CSI ≥ 7. Structured telephone interviews collected caregiver demographics, caregiving context, health-related quality of life (EQ-5D-5L; UK value set), resilience (CD-RISC-2), and perceived social support. Associations with high burden were examined using bivariate analyses and hierarchical logistic regression. RESULTS: High caregiver burden was present in 77 caregivers (61.6%) within the first 48 h of the HaH episode. Prior caregiving experience was more prevalent among caregivers with high burden than among those with low burden (97.4% vs. 50.0%, p < 0.001). High burden was also associated with anxiety/depression on the EQ-5D-5L (63.6% vs. 29.2%, p < 0.001), lower resilience (52.0% vs. 79.2%, p = 0.002), and lower perceived social support (59.7% vs. 83.3%, p = 0.006). In multivariable analysis, perceived social support (OR 0.22, 95% CI 0.06-0.74) and high resilience (OR 0.33, 95% CI 0.11-0.95) were associated with lower odds of high burden, whereas paid caregiver assistance was associated with higher odds of high burden (OR 5.23, 95% CI 1.17-23.37). CONCLUSIONS: High caregiver burden is common at the onset of acute HaH care. These exploratory findings suggest that caregiver vulnerability at admission is related to pre-existing caregiving context and psychosocial resources, supporting systematic caregiver assessment early in the HaH episode to identify individuals who may benefit from targeted support.
BACKGROUND: Homebound older adults represent a high-risk, high-needs population characterized by significant clinical and sociodemographic heterogeneity. Little is known about how such heterogeneity shapes care needs and...BACKGROUND: Homebound older adults represent a high-risk, high-needs population characterized by significant clinical and sociodemographic heterogeneity. Little is known about how such heterogeneity shapes care needs and utilization patterns. We characterized utilization patterns among distinct subgroups of homebound older adults and examined associations between levels of outpatient care and emergency department (ED) utilization. PARTICIPANTS AND SETTING: We used nationally representative data from the National Health and Aging Trends Study (NHATS) linked to Medicare Fee-For-Service (FFS) claims from 2011 to 2019 and 2021-2023 to examine trends among homebound older adults ages 70 or older. METHODS: In this retrospective observational study, we characterized utilization patterns among distinct subgroups of homebound older adults identified using latent class analysis (LCA). We then used multivariable regression to examine associations between level of outpatient utilization and probability of both any ED visit and any potentially avoidable ED visit identified using Ambulatory Care Sensitive Conditions (ACSC). We adjusted for other indicators of ED use and access to care (i.e., self-reported health, rurality, and disease burden). RESULTS: There was a total of 2202 person-year observations across 1343 unique homebound individuals. The LCA identified four subgroups of homebound older adults: functional independence; dementia; multimorbidity; and dementia plus multimorbidity. There were significant differences in levels of ambulatory and acute care utilization between subgroups. Regression analyses did not show evidence to support the conventional wisdom that inability to access ambulatory care leads to more avoidable ED visits among the homebound older adult population. CONCLUSIONS: Heterogeneity among the homebound older adult population shapes care needs that in turn influence utilization patterns. Understanding these dynamics is crucial to targeting interventions like home-based primary care to the highest risk groups while tailoring care to individual needs.
Franssen IS, de Jong MJ, Visseren L
… +9 more, Teerds D, Hellenbrand D, Henskens Y, Spronk H, Janssen DJA, Braeken DCW, van Kuijk SMJ, Winckers K, Magdelijns FJH
BACKGROUND: Direct oral anticoagulants (DOACs) are prescribed using fixed dosing regimens, despite limited evidence on their pharmacokinetic behavior in nursing home residents. PARTICIPANTS AND SETTING: One hundred nursi...BACKGROUND: Direct oral anticoagulants (DOACs) are prescribed using fixed dosing regimens, despite limited evidence on their pharmacokinetic behavior in nursing home residents. PARTICIPANTS AND SETTING: One hundred nursing home residents are receiving apixaban, rivaroxaban, dabigatran, or edoxaban in multiple long-term care facilities in the Netherlands. METHODS: In this prospective observational study, DOAC peak levels were measured 2-4 h post-dose during routine laboratory testing. Levels were classified as below, within, or above the expected on-therapy range. Logistic regression analyses identified factors associated with peak levels outside the expected on-therapy range. RESULTS: Overall, 40% of residents had DOAC peak levels outside the expected on-therapy range; 32% were above and 8% were below. In univariable analyses, above-range levels were associated with lower renal function, apixaban use, and history of myocardial infarction, but none remained independently associated after multivariable adjustment. Below-range levels were associated with preserved renal function and rivaroxaban use; analyses for below-range levels were limited to univariable analyses due to the small number of events. CONCLUSION: A substantial proportion of nursing home residents exhibited DOAC peak levels outside the expected on-therapy range despite guideline-concordant dosing. These findings highlight the complexity of anticoagulant management in frail older adults residing in long-term care and support the need for careful clinical reassessment of DOAC therapy in this population.
BACKGROUND: As the number of Americans living with dementia increases, healthcare delivery systems face increasing pressure to provide dementia-care services to improve patient and family outcomes. The primary care nurse...BACKGROUND: As the number of Americans living with dementia increases, healthcare delivery systems face increasing pressure to provide dementia-care services to improve patient and family outcomes. The primary care nurse practitioner (NP) workforce is critical to dementia care; however, many NPs practice in environments that lack organizational attributes needed to maximize their contributions. We examined the associations between the NP practice environment and key indicators of workforce sustainability-burnout, job satisfaction, and intent to leave. PARTICIPANTS AND SETTING: We conducted a national cross-sectional survey of NPs providing care to patients with dementia in 2021-2023. A total of 968 NPs across 847 practices completed the survey. On average, NPs were 47.5 years old, female (84.2%), and White (83.6%). METHODS: The NP practice environment was measured using four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). Multivariable regression models assessed the relationship between practice environment and NP workforce outcomes. RESULTS: Overall, 92.0% of NPs were satisfied with their jobs, 35.8% experienced burnout, and 21.3% reported intent to leave their job in the coming year. Higher NP-PCOCQ subscale scores were associated with better NP outcomes. For example, one standard deviation (SD) increase in Professional Visibility score was associated with 28% lower prevalence of burnout (Prevalence Ratio [PR] = 0.72, p < 0.001); one SD increase in the NP-Administration Relations and NP-Physician Relations scores was associated with 9% and 7% higher prevalence of job satisfaction (PR = 1.09, p < 0.001; PR = 1.07, p < 0.001), and one SD increase in the Independent Practice and Support score was associated with 29% lower prevalence of intent to leave (PR = 0.71; p < 0.001). CONCLUSIONS: Enhancements to the practice environment that promote NP role visibility, independent practice, and collegial relationships could increase job satisfaction, reduce burnout, and expand primary care capacity to care for patients with dementia.
Hayes CA, Li Y, Jing B
… +3 more, Graham LA, Dave C, Odden MC
J Am Geriatr Soc
· 2026 Jun · PMID 42378629
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BACKGROUND: Anticholinergic exposure is common in nursing homes; however, the true burden may be underestimated, particularly due to over-the-counter agents such as first-generation antihistamines that are not consistent...BACKGROUND: Anticholinergic exposure is common in nursing homes; however, the true burden may be underestimated, particularly due to over-the-counter agents such as first-generation antihistamines that are not consistently captured in prior claims-based studies. This gap limits accurate characterization of anticholinergic use and its clinical implications in older adults. PARTICIPANTS AND SETTING: Veterans aged ≥ 65 years with stays ≥ 90 days (N = 45,183) residing in US Department of Veterans Affairs (VA) Community Living Centers (CLC). This study is a secondary data analysis of residents identified during fiscal years 2007-2019. METHODS: True anticholinergic exposure through barcode-based medication administration dispensing records allowed daily measurement of anticholinergic exposure, with follow-up extending from admission to discharge, death, or April 1, 2025. Anticholinergic medication use was defined as use ≥ 4 days per week during the CLC stay. Drugs were identified using VA classifications aligned with the 2023 American Geriatrics Society Beers Criteria and grouped into nine anticholinergic classes. Outcomes included prevalence, duration, and number of anticholinergic drug classes used; patterns by dementia status; and temporal trends over time. RESULTS: Among 45,183 CLC residents, 33.4% (n = 15,074) used anticholinergic medications. Residents with dementia (n = 20,254) showed substantial exposure to neuropsychiatric anticholinergics, including second-generation antipsychotics (30.6%) and antiparkinsonian agents (10.1%). First-generation antihistamine use remained high in this group (29.5%). Residents without dementia (n = 24,929) more frequently received antihistamines (34.4%), bladder antimuscarinics (23.7%), and skeletal muscle relaxants (11.1%). From FY2007-2019, anticholinergic use declined modestly, with decreases in antihistamines (12.1%-8.8%), antidepressants (6.8%-3.5%), and antiemetic/antivertigo agents (5.2%-1.2%). Most residents used a single anticholinergic class, increasing from 75.5% to 82.2% over time. CONCLUSIONS: Although some anticholinergic classes may be clinically necessary, our findings highlight potentially underrecognized and modifiable sources of exposure, particularly first-generation antihistamines, underscoring the need for deprescribing efforts.
Liang S, Bai L, Yang G
… +7 more, Chen Z, Wei Y, Wei Y, Lv Y, Huang Z, Huang Y, Lu K
J Am Geriatr Soc
· 2026 Jun · PMID 42378627
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BACKGROUND: Restrictive transfusion (Hb < 7 g/dL) is recommended for most perioperative patients, but the optimal threshold for those with cardiovascular disease or Hb 7-10 g/dL remains uncertain. The Perioperative Trans...BACKGROUND: Restrictive transfusion (Hb < 7 g/dL) is recommended for most perioperative patients, but the optimal threshold for those with cardiovascular disease or Hb 7-10 g/dL remains uncertain. The Perioperative Transfusion Trigger Score (POTTS), which integrates adrenaline requirement, FiO, temperature, and angina history, may standardize decisions and safely reduce transfusions in older non-cardiac surgery patients. METHODS: This multicenter RCT in two Chinese hospitals randomized patients ≥ 60 years undergoing non-cardiac surgery 1:1 to POTTS or control. POTTS = 6 plus points for adrenaline, FiO (to maintain SpO ≥ 95%), core temperature, and angina; transfusion when Hb < POTTS. Control followed 2012 AABB guideline (Hb < 7 always transfuse; > 10 not; 7-10 physician discretion). PRIMARY OUTCOME: proportion receiving allogeneic RBC transfusion during perioperative period (ITT population). RESULTS: 253 patients (mean age 72.3 years; 67.6% women) were randomized (May 2023-Sept 2025). Baseline Hb similar (median 9.60 vs. 9.50 g/dL). In ITT, transfusion required in 24.00% (30/125) of POTTS vs. 35.94% (46/128) of control (p = 0.038). Transfusion volume did not differ significantly (median 2.50 vs. 3.00 units, p = 0.520). Overall complication rates: 12.80% vs. 8.59% (p = 0.279); one death in control group (0.85%). No significant differences in specific complications. CONCLUSION: In patients ≥ 60 years undergoing non-cardiac surgery, POTTS-guided transfusion significantly reduced the proportion of patients transfused without increasing complications. TRIAL REGISTRATION: This study was registered at http://www.chictr.org.cn (#ChiCTR2300071739).
Wang J, Shen JY, Yu F
… +14 more, Simmons SF, Mixon AS, Nathan K, Moskow MS, Brasch JD, Norton SA, Heffner KL, Jiang Y, Seshadri S, Patel N, Song L, Zorek JA, Lam C, Caprio TV
J Am Geriatr Soc
· 2026 Jun · PMID 42378625
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BACKGROUND: Multimorbidity affects most older adults in home health care (HHC), leading to inappropriate polypharmacy and increased risks for adverse outcomes. While deprescribing can mitigate these risks, fragmented com...BACKGROUND: Multimorbidity affects most older adults in home health care (HHC), leading to inappropriate polypharmacy and increased risks for adverse outcomes. While deprescribing can mitigate these risks, fragmented communication during hospital-to-home transitions remains a major barrier. This study explored stakeholder perspectives on using telehealth to facilitate deprescribing for older adults with multimorbidity while receiving post-acute HHC. METHODS: We conducted semi-structured interviews with 44 stakeholders across 12 U.S. states, including 14 HHC patients and 30 clinicians (physicians, nurse practitioners, pharmacists, and HHC nurses). Guided by the socioecological model of deprescribing, interviews explored factors across individual, interpersonal, organizational, and societal levels associated with telehealth use in deprescribing. Analysis followed a phased, iterative approach with independent double-coding and interprofessional team consensus to ensure credibility. RESULTS: Findings categorized telehealth as a promising tool to align medications with the "4Ms" (Medications, Mentation, Mobility, and What Matters) through goal-concordant deprescribing. At the individual level, stakeholders noted that telehealth readiness depended on patient cognition and digital literacy. At the interpersonal level, telehealth facilitated real-time multidisciplinary "virtual huddles" that reduced communication delays but could occasionally overwhelm patients and may be logistically challenging to schedule. Organizational barriers included reimbursement constraints and complex synchronous scheduling. Societal factors include equitable access for rural or low-income populations, populations who may benefit the most from telehealth-enabled deprescribing due to challenges in accessing care. Stakeholders emphasized a hybrid approach which pairs virtual prescriber consultation with in-home support of a clinician to provide context and assist with implementation for patient-centered deprescribing. CONCLUSIONS: Telehealth can support goal-concordant deprescribing during post-acute care transitions in HHC. A hybrid model, one that combines remote prescriber consultations with in-home clinician support, is the preferred approach to bridge coordination gaps. To maximize impact, future efforts are needed to improve reimbursement, infrastructure, and scheduling to integrate telehealth into routine deprescribing workflows.
J Am Geriatr Soc
· 2026 Jun · PMID 42378392
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BACKGROUND: Parkinson's disease is the second most common neurodegenerative disorder globally. Despite growing attention to palliative care in Parkinson's disease, little is known about what constitutes a "good death" fr...BACKGROUND: Parkinson's disease is the second most common neurodegenerative disorder globally. Despite growing attention to palliative care in Parkinson's disease, little is known about what constitutes a "good death" from the perspective of people living with Parkinson's disease (PLwPD). OBJECTIVE: To explore the meaning of a good death for PLwPD. METHODS: In this cross-sectional multicentre qualitative study, we conducted semi-structured interviews with 30 PLwPD recruited through purposive sampling from four geriatric and neurology outpatient clinics between May 2021 and December 2022. Transcripts were analyzed using inductive thematic analysis. The process involved independent coding and iterative discussions grounded in a constructionist paradigm. RESULTS: The sample was diverse in terms of race, gender, age, religious affiliation, educational background, and disease stage. We identified two major themes related to the participants' last days of life: Fears and Coping. Reported fears included experiencing disability, pain and discomfort, fear of feeling shame, fear of being a burden, fear of being abandoned and left helpless. Coping was a multidimensional theme, comprising the relational experience of feeling well cared for (defined by being valued, receiving clear and honest communication, and being treated with love and kindness) alongside the active strategies of finding opportunities for joy and drawing on religiosity and spirituality. Religiosity/spirituality appeared as a key factor in emotional regulation, fostering a sense of purpose and acceptance in the face of death. CONCLUSION: Our findings suggest that improving palliative care for PLwPD requires an approach that actively addresses specific fears and strengthens the multiple dimensions of coping, which include fostering opportunities for joy, supporting spirituality, and enhancing the relational experience of feeling well cared for. This study illuminates often-overlooked aspects of care and provides a basis for the development of person-centered interventions aimed at enhancing the quality of dying-and of life-in this population.
J Am Geriatr Soc
· 2026 Jun · PMID 42348329
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BACKGROUND: Residents with obesity in US nursing homes (NHs) present challenges for facilities, as these individuals often require specialized assistance and resources. However, recent trends, geographic variation, and N...BACKGROUND: Residents with obesity in US nursing homes (NHs) present challenges for facilities, as these individuals often require specialized assistance and resources. However, recent trends, geographic variation, and NH characteristics related to the prevalence of obesity in NHs are understudied. We examined national trends in prevalence of Class 2-3 (moderate-to-severe) obesity in NHs over a 13-year period, geographic variation in trends, and facility characteristics associated with high prevalence. METHODS: Prevalence of moderate-to-severe obesity in NHs was defined as the proportion of residents with body mass index (BMI) ≥ 35 kg/m. Annual average prevalences were calculated across NHs between 2011 and 2023 and changes in state-level prevalence were analyzed over the study period. Lastly, resident and facility characteristics associated with NHs in the top quartile of prevalence in 2023 were examined. RESULTS: The sample included 16,886 NHs in 49 states. Mean prevalence increased from 26.5% in 2011 to 30.5% in 2023, a 15% relative increase, with substantial state variation. All states experienced increases in prevalence with Idaho exhibiting the largest increase of 34% (9.9 percentage points (pp); from 29.1% to 39.0%) and New York experiencing the smallest of 5.8% (1.4 pp; from 24.0% to 25.4%). Compared to NHs in the lowest quartile of prevalence, those in the highest quartile had younger residents on average (75.2 vs. 78.3; p < 0.001), lower proportions of non-White residents (18.1% vs. 30.6%; p < 0.001), and higher shares covered by Medicaid (65.7% vs. 61.2%; p < 0.001). NHs in the highest quartile also had lower occupancy rates (73.1% vs. 79.4%; p < 0.001), and were more likely to be part of a multi-facility chain (64.6% vs. 52.8%; p < 0.001) and in a rural area (39.2% vs. 13.8%: p < 0.001). CONCLUSIONS: Our findings indicate continued increases in the prevalence of moderate-to-severe obesity in NHs with large variation across states and potential disparities associated with income and rurality.
Das S, Shukla S, Aadityan R
… +8 more, Skender K, Sukumaran D, Cherian JJ, Bhatta M, Pathak A, Panda S, Tripathi SK, Lundborg CS
J Am Geriatr Soc
· 2026 Jun · PMID 42339921
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OBJECTIVE: Medication management in older adults with multimorbidity and polypharmacy is inherently challenging. This umbrella review consolidates evidence on interventions aimed at mitigating these challenges to promote...OBJECTIVE: Medication management in older adults with multimorbidity and polypharmacy is inherently challenging. This umbrella review consolidates evidence on interventions aimed at mitigating these challenges to promote safe and effective medication use. METHODS: This was an umbrella review. A systematic search was conducted on PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL until 2024 to find relevant systematic reviews of interventions to improve medication management among older adults aged ≥ 60 years (PROSPERO ID: CRD42024607956). Eligible systematic reviews focused on pharmacist-led reviews, deprescribing protocols, educational programs, clinical decision support systems (CDSS), and community-based initiatives. Data were extracted, and methodological quality was evaluated using the AMSTAR-2 tool. Descriptive statistics were applied, and the credibility of the evidence was determined. Outcomes included medication optimization, clinical, healthcare utilization and cost, and acceptability of the intervention among physicians and patients. RESULTS: Seventy-one systematic reviews with > 1.5 million cumulative participants were included. According to the AMSTAR-2 assessment, the included systematic reviews demonstrated variable methodological quality, with many rated as moderate to high risk of bias. Pharmacist-led reviews and deprescribing interventions both indicated significant improvement in medication appropriateness. Multidisciplinary approaches and CDSS could improve adherence and prescribing practices. Improvements in clinical outcomes, such as quality of life, cognitive function, and mortality, were inconsistent. Economic evaluations showed mixed results. Implementation challenges were identified, including scalability and resource allocation. Evidence was convincing in reducing the number of medications, inappropriate prescribing, and falls. CONCLUSIONS: Pharmacist-led and multidisciplinary medication reviews showed the most consistent benefits, improving medication appropriateness and reducing falls and unplanned healthcare use. Interventions like education, policy and guideline measures, and community-based strategies demonstrated mixed or modest effects, often limited to adherence or prescribing quality. Overall evidence strength was limited by methodological heterogeneity. Future high-quality, context-specific research with standardized outcomes is needed in this regard.
J Am Geriatr Soc
· 2026 Jun · PMID 42333887
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BACKGROUND: More than one in four older adults experience a fall each year. While exercise programs are effective in reducing fall-related injuries (FRI), participation remains low due to access barriers. The primary aim...BACKGROUND: More than one in four older adults experience a fall each year. While exercise programs are effective in reducing fall-related injuries (FRI), participation remains low due to access barriers. The primary aim of this study was to evaluate whether older adults who registered for Nymbl, a self-guided, asynchronous, balance application, were associated with fewer FRIs as compared to age-similar individuals non-registrants. METHODS: This retrospective cohort study used data from Kaiser Permanente Colorado, linked to Nymbl registration and usage records based on patient name and demographic information between February 2018 and September 2024. The cohort included individuals aged 60 and older with continuous health plan enrollment for 12 months before and after Nymbl registration (or a randomly assigned index date). Logistic regression models with inverse probability of treatment weighting estimated the association between Nymbl registration and FRIs during the 12-month follow-up, stratified by history of FRIs. Marginal effects reported the absolute risk difference associated with Nymbl registration. Secondary analyses examined dose-response associations of Nymbl usage and whether the association of Nymbl was additive to participation in other exercise programs. RESULTS: We identified 3735 individuals who registered for Nymbl and 114,219 age-eligible non-registrants. Among individuals with a prior FRI, Nymbl registration was associated with a 3.83 percentage point reduction in acute FRIs; however, no significant association was estimated for individuals without a baseline FRI. Secondary analysis indicated that at least five sessions were required to achieve a meaningful reduction in FRIs, and associations were limited to those not already participating in other exercise programs. CONCLUSION: Findings from this study suggest that asynchronous, self-guided balance applications may reduce FRIs among older adults with a history of falls who are not otherwise engaged in structured exercise programs. Remotely delivered fall prevention programs may help overcome access barriers and can be used to supplement in-person and guided exercise programs.
Hou Y, Naik AD, Joynt Maddox KE
… +1 more, Johnston KJ
J Am Geriatr Soc
· 2026 Jun · PMID 42325019
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BACKGROUND: The guiding an improved dementia experience (GUIDE) model is a nationwide payment model launched in 2024 to test monthly dementia care management payment as a tool to improve care and outcomes for Medicare fe...BACKGROUND: The guiding an improved dementia experience (GUIDE) model is a nationwide payment model launched in 2024 to test monthly dementia care management payment as a tool to improve care and outcomes for Medicare fee-for-service beneficiaries with dementia and their caregivers. GUIDE requires participating practices to provide comprehensive dementia services, including care assessment and coordination, caregiver support, and respite services. This study assessed baseline billing patterns for GUIDE-required services among eligible physician group practices prior to GUIDE implementation. METHODS: Using 2022 Medicare clinician and practice data, we identified a national sample of eligible physician group practices for GUIDE, defined as having at least one dementia-proficient clinician. Among eligible practices, we examined the variation in their billing patterns for GUIDE-required services under the Medicare fee-for-service fee schedule. We identified and decomposed practice-level factors predictive of billing for any GUIDE services and assessed the association between these factors and service volume. RESULTS: Among 4737 eligible practices, 60% billed for GUIDE-required services; however, these services were substantially underused by dementia-proficient clinicians. Practices billing for more required services under fee-for-service were larger, more likely to participate in other risk-based payment models, such as accountable care organizations, but had smaller dementia caseload shares and served patients with lower overall clinical risks. CONCLUSIONS: Before GUIDE implementation, billing for required services varied substantially across eligible practices and was underused by dementia-proficient clinicians. These baseline differences may help explain early participation patterns and inform future evaluations of whether GUIDE incentives build capacity for delivering comprehensive dementia care.
Lee YH, Kim JS, Yoon SY
… +8 more, Jeong KH, Chung BH, Na KR, Lee DR, Yang J, Kim MS, Hwang HS, KOTRY study group
J Am Geriatr Soc
· 2026 Jun · PMID 42322201
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BACKGROUND: Although kidney transplantation (KT) is associated with survival benefit compared with dialysis, even in older patients with end-stage kidney disease (ESKD), the magnitude of this benefit, non-mortality outco...BACKGROUND: Although kidney transplantation (KT) is associated with survival benefit compared with dialysis, even in older patients with end-stage kidney disease (ESKD), the magnitude of this benefit, non-mortality outcomes, and residual complications remain unclear. Comparisons with patients diagnosed with non-dialysis-dependent chronic kidney disease (CKD) can better clarify these issues. METHODS: Older KT recipients and patients with CKD were enrolled from a prospective nationwide database (N = 817) and the National Health Insurance Service-Senior Cohort Database (N = 14,185), respectively. A 1:1 matching was performed. All-cause mortality, cardiovascular events, progression to ESKD, infection-related hospitalizations, and cancer were compared. RESULTS: Each group comprised 802 matched patients; 115 deaths, 25 cardiovascular events, 40 ESKD events, and 288 infection-related hospitalizations occurred over a median follow-up period of 88 months. Cumulative incidences of mortality and cardiovascular events were comparable between groups, whereas progression to ESKD and infection-related hospitalizations were higher in older KT recipients than in patients with CKD. In multivariable Cox analysis, older KT recipients had similar risks of all-cause mortality (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.33-1.01) and cardiovascular events (1.31, 0.42-4.05) to older patients with CKD but had increased risks of progression to ESKD (3.51, 1.07-11.5) and infection-related hospitalizations (3.91, 2.66-5.74). HR of incident cancer was similar between groups (1.35, 0.75-2.46). CONCLUSIONS: Older KT recipients did not demonstrate increased risks of all-cause mortality, cardiovascular events, or incident cancer compared with the matched CKD population but had higher risks of kidney failure and infection-related hospitalization.
J Am Geriatr Soc
· 2026 Jun · PMID 42321013
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BACKGROUND: Racial disparities in end-of-life (EOL) care persist, yet the role of caregiver availability in shaping these inequities remains poorly understood. We examined whether caregiver availability modifies racial d...BACKGROUND: Racial disparities in end-of-life (EOL) care persist, yet the role of caregiver availability in shaping these inequities remains poorly understood. We examined whether caregiver availability modifies racial differences in perceived EOL care quality and tested the hypothesis that Black older adults without caregivers face compounded disadvantages in EOL care. METHODS: We analyzed data from 2228 non-Hispanic White and Black decedents (weighted N = 10.1 million) from the 2017-2024 National Health and Aging Trends Study. Proxy respondents completed Last Month of Life interviews. Outcomes included overall care quality ratings and receipt of help managing pain, breathing difficulties, and anxiety/sadness. Survey-weighted logistic regression models assessed associations between caregiver availability and outcomes, adjusting for demographic, clinical, and functional characteristics. Interaction terms examined joint effects of race and caregiver availability. RESULTS: Black decedents were less likely than White decedents to receive excellent/very good care (64.9% vs. 77.8%; p < 0.001) and help with anxiety (28.2% vs. 38.7%; p < 0.001). A significant race-caregiver interaction suggested intersectional disadvantage: compared with White decedents with caregivers, Black decedents without caregivers had the lowest odds of excellent/very good care (OR = 0.36; 95% CI, 0.19-0.67). Black decedents with caregivers also had reduced odds (OR = 0.52; 95% CI, 0.36-0.76) despite receiving more caregiving hours (7.0 vs. 3.4 h/week; p = 0.005). CONCLUSIONS: Black older adults without caregivers had the worst observed EOL care quality. Caregiver presence was associated with narrower but persistent racial differences, suggesting structural factors that may attenuate the benefits of caregiving for Black older adults. Policy interventions designed to provide culturally responsive support to minority caregivers may help reduce racial disparities in EOL care quality.
Parikh RR, Wolf JM, Shetty NU
… +6 more, Pillai AA, Langworthy BW, Fabius CD, Giordano S, Jutkowitz E, Shippee T
J Am Geriatr Soc
· 2026 Jun · PMID 42319287
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BACKGROUND: Long-term services and supports (LTSS) serve > 9 million adults in the United States. We examined prevalence and quality of life (QoL)-related outcomes of consumer-reported unmet LTSS needs in publicly-funded...BACKGROUND: Long-term services and supports (LTSS) serve > 9 million adults in the United States. We examined prevalence and quality of life (QoL)-related outcomes of consumer-reported unmet LTSS needs in publicly-funded LTSS. METHODS: We pooled cross-sectional data from the 2016-2017, 2017-2018, 2018-2019, 2021-2022, and 2022-2023 National Core Indicators-Aging and Disability Adult Consumer Surveys. We included 61,829 adults (34% with age < 65 years; 66% female; 27 states). Survey weights generated population-representative estimates. We ascertained unmet LTSS needs by response to: "Do the long-term care services you receive meet your current needs and goals?" (dichotomized- yes vs. no). We estimated weighted prevalence of unmet LTSS needs overall and across subpopulations, and examined associations with two self-reported QoL-related outcomes (dichotomized- yes/no): (1) being active in community; (2) satisfied with how one spends one's day. Prevalence ratios (PRs) were estimated using weighted Poisson regression with robust variance estimators, adjusting for demographics, health and functional status, multimorbidity, funding program, residence setting, state, and survey year. RESULTS: Among respondents, 18,004 (weighted-estimate, 29%) reported unmet LTSS needs. Prevalence of unmet needs varied across sociodemographic strata, care settings (higher in community-based than in residential-care settings), and funding programs (lower in PACE than in Medicaid programs). Individuals with unmet needs were significantly less likely to report being active in the community (PR, 0.65; 95% CI, 0.62-0.68) and satisfied with how they spend their day (PR, 0.62; 95% CI, 0.60-0.64). Post hoc analyses revealed potential dose-response associations between increasing degree of unmet LTSS needs and outcomes. CONCLUSIONS: Consumer-reported unmet LTSS needs are frequent, vary greatly across care settings and funding programs, and are associated with poorer QoL-related outcomes; highlighting substantial system-level gaps in the fragmented LTSS landscape and the need for coordinated investments and structural reforms to better meet the needs of individuals relying on these services.