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Background: Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well‐being and independence. Objective: To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: Empowering People to Independence in COPD). Design: Multiphase study guided by Baltes Theory of Successful Aging and the 5Ms Framework: Phase 1: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. Phase 2: Rapid qualitative analysis. Phase 3: Intervention mapping and refinement. Setting: Ambulatory, virtual. Participants: Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders. Results: NGT sessions were conducted by constituency group with 37 participants (n = 7 patients, n = 6 family caregivers, n = 8 clinic staff, n = 9 clinicians, n = 7 health system leaders) (Phase 1). Participants generated 92 statements across five themes (Phase 2): (1) "Barriers to care", (2) "Family caregiver needs", (3) "Functional status and mobility issues", (4) "Illness understanding", and (5) "COPD care complexities". Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized "Functional status and mobility issues", family caregivers prioritized "Family caregiver needs", and clinicians and health system leaders prioritized "COPD care complexities". Intervention mapping (Phase 3) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities. Conclusions: Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, emerged as patient prioritized challenges. Implications: Patient‐centered interventions for older adults with COPD must account for their prioritized functional and supplemental oxygen needs and explore diverse constituent perspectives to facilitate intervention enrichment. [ABSTRACT FROM AUTHOR]

This editorial comments on the article by Clocchiatti‐Tuozzo et al. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug–drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review and deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, and reduce PIM prescriptions. This systematic review and meta‐analysis of experimental and observational studies aimed to evaluate the impact of different medication review and deprescribing interventions in hospitalized older patients. Methods: Experimental and observational prospective cohort studies evaluating the clinical effects of medication review and deprescribing strategies in older hospitalized patients were searched in the bibliographic databases, PubMed, Embase, and Scopus, from inception until January 8, 2024. A narrative synthesis of the results was provided, along with a meta‐analysis of dichotomous data (i.e., re‐hospitalizations and mortality). Results: Overall, 21 randomized controlled trials, 7 non‐randomized interventional studies, and 2 prospective cohort studies were included in the systematic review. Of these, 14 (46.7%) assessed medication appropriateness as the primary outcome, while the remaining evaluated clinical outcomes (e.g., length of hospital stay, hospital readmissions, emergency department visits, and incidence of ADRs) and/or quality of life. The meta‐analysis revealed a slight but statistically significant 8% reduction in hospital readmissions (HR: 0.92; 95% CI: 0.85–0.99) following medication review and deprescribing, but no significant impact on mortality (HR: 0.98; 95% CI: 0.96–1.00). Of the 30 included studies, 21 were considered at high risk of bias, mostly due to potential deviations from intended interventions and randomization processes. The remaining nine studies had "some concerns" (eight studies) or were considered at "low" risk of bias (one study). Conclusion: Medication review and deprescribing are associated with potential benefits in reducing hospital readmission rates among hospitalized older patients, particularly through the reduction of PIM prescriptions. The integration of thorough medication review and deprescribing protocols in hospital settings may improve post‐discharge outcomes and reduce overall healthcare costs. [ABSTRACT FROM AUTHOR]

Beta amyloid PET scans are a minimally invasive biomarker that may inform Alzheimer's disease (AD) diagnosis. The Caregiver's Reactions and Experience (CARE) study, an IDEAS supplement, aimed to understand experiences of PET scan recipients and their care partners regarding motivations for scans, reporting and interpreting results, and impact of results. Patients with mild cognitive impairment or dementia who agreed to join the CARE‐IDEAS study and their care partners participated in a baseline survey and follow‐up survey approximately 18 months later, supplemented by in‐depth qualitative interviews with subsets of participants. Patients who received scans and volunteered for follow‐up research were more likely to be male, better educated, and have higher income than the general population. Survey information was merged with Medicare data. This article integrates findings from several CARE‐IDEAS publications and provides implications for practice and research. Although most participants accurately reported scan results, they were often confused about their meaning for prognosis. Some participants reported distress with results, but there were no significant changes in measured depression, burden, or economic strain over time. Many respondents desired more information about prognosis and supportive resources. Scan results were not differentially associated with changes in service use over time. Findings suggest a need for carefully designed and tested tools for clinicians to discuss risks and benefits of scans and their results, and resources to support patients and care partners in subsequent planning. Learning of scan results provides a point‐of‐contact that should be leveraged to facilitate shared decision‐making and person‐centered longitudinal AD care. [ABSTRACT FROM AUTHOR]

The article presents insights on the U.S. Health Resources and Services Administration Geriatrics Workforce Enhancement Program (GWEP) special supplement. It stresses the need for all GWEP recipients to have at least three partner types, academia, primary care clinical sites, and community-based organization. It notes on the efforts of GWEP recipients continuously update their educational methods and develop new ways to educate primary care providers about older adults.

The article shares strategies associated with reengineering the core functionalities of an electronic health record (EHR) system of a Kentucky geriatric-focused primary care (PC) clinic. It notes that the strategy necessitated a shift from traditional roles of geriatrician-led PC to team-based PC. It states that the success of the strategy relied on comprehensive education for team members on age-friendly health care.

Count Neipperg (1775–1829), the morganatic husband of Maria Luigia of Habsburg, Napoleon's former wife, presented with typical heart failure symptoms and died of bilateral bronchopneumonia. Neipperg's case is an example of the conflict in the medical field, which led to the birth of modern evidence‐based medicine (EBM), and although Neipperg died almost 200 years ago, his case presents the same critical issues that more complex geriatric patients face today. First, the attending physicians provided divergent opinions without reaching an agreement. For example, Francesco Rossi correctly diagnosed heart disease by evaluating the patient's signs and symptoms, a clinical approach that is an early example of modern EBM. By contrast, Giacomo Tommasini made a misdiagnosis based on the philosophical principles of John Brown's vitalist theory, as reworded by Giovanni Rasori. Second, Tommasini's medical report also includes evidence of the Geriatric 5Ms for older patient care, such as multi‐complexity, multimorbidity, medication, mobility, and the mind. Moreover, both physicians considered “what matters most” for the patient and his family. Third, the Count's status and political role were identified as the social and structural determinants of health (SSDoH) and used to justify the exceptional intensity of the health care provided. Subsequently, the ante litteram application of EBM and a clinical evaluation based on Geriatrics 5Ms principles anticipate current multidisciplinary management focused on the patient rather than a single disease. The systematic revision of past clinical cases not examined before could open new windows in the dissemination of the geriatric methodology and discipline. [ABSTRACT FROM AUTHOR]

The article presents a study which developed a 5Ms-based geriatric assessment (GA) SmartPhrase, incorporating feedback from an informal resident focus group at the University of Pennsylvania. Topics discussed include trainee survey demographics, faculty survey results, and key elements to successfully implement a GA SmartPhrase for educational purposes.

This editorial comments on the article by Shwayder et al. [ABSTRACT FROM AUTHOR]

The article discusses the substantial risk and impact of Medicaid disenrollment among enrollees older than 65 or with disabilities and recommend reforms to help these individuals maintain continuous Medicaid coverage. Topics include risk and consequences of Medicaid disenrollment faced by non-modified adjustment gross income (non-MAGI), factor that would improve the Medicaid redetermination process for people with vision and hearing disabilities, and ease asset testing for non-MAGI enrollees.

This editorial comments on the article by Trivedi et al. [ABSTRACT FROM AUTHOR]

BackgroundLittle is known about how to best communicate with older adults about dietary behaviors and related factors in complex chronic disease care. Photo-based communication could promote efficient information exchange and activate patients to effectively communicate their lived experiences. We conducted a pilot study to assess the feasibility and acceptability of a photo-based patient-clinician communication intervention to promote dietary discussions in geriatric primary care.MethodsOlder adult patients with 2+ concurrent chronic conditions received in-person training on photo-taking with a smartphone before taking photos in response to the prompt, "What aspects of your everyday life affect what you eat and how much you have to eat?" Patients then shared photos and their narratives with their primary care clinician during a clinic visit. Patients and clinicians completed separate audio-recorded post-visit interviews to assess perspectives on the intervention. Interview transcripts were analyzed using a thematic analysis approach.ResultsFourteen patient-clinician dyads completed the study. All except one patient-clinician dyad (93%) completed the intervention as trained. 93% of patients and 86% of clinicians reported that they would "definitely" or "probably" be willing to engage in a future visit with photo-sharing. Patients and clinicians shared similar perspectives on how sharing of photos during the visit enhanced communication and information exchange about dietary practices and other health-related factors, influenced clinical recommendations made during the visits, and strengthened the patient-clinician relationship.ConclusionIncorporation of a photo-based patient-clinician communication intervention to promote discussions regarding diet and other health-related factors could be a patient-centered strategy to help deliver comprehensive geriatric primary care.

The concept of trauma and traumatic stress and its impact on health and mental health has been studied for nearly half a century. Trauma‐informed care (TIC) is person‐centered care designed and delivered based on knowledge of the ubiquity of trauma. It requires building an understanding of the role that trauma plays in the lives and health outcomes of survivors. In doing so, it helps promote physical, psychological, and emotional safety for both clinicians and patients. Trauma and traumatic events are cumulative over the lifespan, and individuals who have experienced trauma are at higher risk for re‐traumatization and poorer health outcomes. TIC approaches have been applied in many healthcare settings successfully; however, to date, there have not been any recommendations made about applying these approaches to care of homebound older adults, even though it may be surmised that this population is at an especially high risk for prior trauma and entering a person's safe space could be especially sensitive for trauma survivors. This paper serves to provide specific recommendations for applying a trauma‐informed approach to a home visit and provides recommendations to home‐based primary care groups and health systems about implementing universal trauma‐informed care to homebound older adults. [ABSTRACT FROM AUTHOR]

In response to some of the challenges that have been articlulated about the future of Geriatrics, we describe a more positive view and value proposition for the field. Health professionals with specific training in Geriatrics are a natural fit for a variety of roles in value‐based care (VBC) programs and health systems. These roles include serving as educators for primary care health professionals and specialists in person‐centered care of older adults, serving as consultants on geriatric conditions and syndromes in a co‐management model of care, becoming effective leaders in VBC programs and health systems, and conducting quality improvement initiatives to build on the evidence‐base for the management of common conditions in the older population. We further recommend that VBC programs and systems support Centers of Excellence or Institutes to implement these strategies within and Age‐Friendly, learning system approach. See related articles by Chad Boult, Colenda and Applegate, and Ross et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: To assess performance of the American College of Surgeons Geriatric Surgery Verification (GSV) Program preoperative communication standards in older patients undergoing high risk spine surgery. Methods: We performed an external validation of a natural language processing (NLP) method for identifying documentation meeting GSV communication standards. We then applied this method to a retrospective cohort of patients aged 65 and older who underwent spinal fusion procedures between January 2018–December 2020 in a large healthcare system in Massachusetts. Our primary outcome of interest was fulfillment of GSV communication domains: overall health goals, treatment goals, and patient‐centered outcomes. Factors associated with the fulfillment of at least one domain were assessed using Poisson regression to adjust for confounding. Results: External validation of the NLP method had a sensitivity of 88.6% and specificity of 99.0%. Our study population included 1294 patients, of whom only 0.8% (n = 10) patients contained documentation of all three GSV domains, and 33.7% (n = 436) had documentation fulfilling at least one GSV domain. The GSV domain with lowest frequency of documentation was overall health goals, with only 35 (2.7%) of patients meeting this requirement. Adjusted analysis suggested that patients with a Charlson comorbidity score of one or more had higher fulfillment of GSV criteria (CCI 1–3: prevalence rate ratio (PRR) 1.8, 95% confidence interval (CI) 1.5–2.1; CCI >3: PRR 1.5, 95% CI 1.2–1.9). Conclusion: A paucity of geriatric patients undergoing spine surgery had preoperative documentation consistent with GSV standards. Given that spine surgery is one of the highest risk surgeries in older adults and GSV standards are relevant to all surgical specialties, wider promulgation of these standards is warranted. [ABSTRACT FROM AUTHOR]

The article evaluates the interuniversity geriatric case competition established by the Geriatric Workforce Enhancement Programs (GWEP) of Saint Louis University (SLU) and the University of Minnesota (UMN) to help students gain geriatric competencies. A 22-item rubric was used by the judges to rate presentations. It notes that the competitions provided novel and engaging interprofessional learning activities for health professional students, coaches, and judges.

Acute Care for Elders (ACE) units reduce hospital‐associated delirium, functional decline, and lengths of stay. However, establishing and sustaining such units have proven difficult. There are only 43 ACE units among the >3500 hospitals in the United States. This study describes an iterative quality improvement process, which allowed us to establish and sustain an ACE unit care model in a modern academic hospital. This continuous process was centered on implementing the key principles of the ACE unit model of care: patient‐centered care assessments, medical care review, specialized prepared environment, early mobilization, physical therapy, and early planning for discharge to home. Quality of care and patient outcomes data for older adults admitted to our ACE unit includes mortality index (observed/expected) consistently <1 (FY22 = 0.86), 30‐day readmission rate of <10% (FY22 9.31%), and length of stay index of ~1 (FY22 1.07). We describe how work on our ACE unit has led to hospital‐wide initiatives, including dementia‐friendly hospital certification. Our hope is that others can use this process to enhance the dissemination of the ACE unit model of care. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the relationship between the perception of patient-centered healthcare experiences of patients with and without hearing loss and whether race is a factor in said perceptions. The research used data from the Health & Retirement Study (HRS) among aging and retired adult individuals in the U.S. Also cited is the link between hearing loss and perceived suboptimal patient-centered care.

Background: Frailty has emerged as an important prognostic marker of increased mortality after cardiac surgery, but its association with quality of life (QoL) and patient‐centered outcomes is not fully understood. We sought to evaluate the association between frailty and such outcomes in older patients undergoing cardiac surgery. Methods: This systematic review included studies evaluating the effect of preoperative frailty on QoL outcomes after cardiac surgery amongst patients 65 years and older. The primary outcome was patient's perceived change in QoL following cardiac surgery. Secondary outcomes included residing in a long‐term care facility for 1 year, readmission in the year following the intervention, and discharge destination. Screening, inclusion, data extraction, and quality assessment were performed independently by two reviewers. Meta‐analyses based on the random‐effects model were conducted. The evidential quality of findings was assessed with the GRADE profiler. Results: After the identification of 3105 studies, 10 observational studies were included (1580 patients) in the analysis. Two studies reported on the change in QoL following cardiac surgery, which was higher for patients with frailty than for patients without. Preoperative frailty was associated with both hospital readmission (pooled odds ratio [OR] 1.48 [0.80–2.74], low GRADE level) as well as non‐home discharge (pooled OR 3.02 [1.57–5.82], moderate GRADE level). Conclusion: While evidence in this field is limited by heterogeneity of frailty assessment and non‐randomized data, we demonstrated that baseline frailty may possibly be associated with improved QoL, but with increased readmission as well as discharge to a non‐home destination following cardiac surgery. These patient‐centered outcomes are important factors when considering interventional options for older patients. Study Registration: OSF registries (https://osf.io/vm2p8). [ABSTRACT FROM AUTHOR]

Chronic musculoskeletal (MSK) pain remains a leading cause of disability and functional impairment among older adults and is associated with substantial societal and personal costs. Chronic pain is particularly challenging to manage in older adults because of multimorbidity, concerns about treatment‐related harm, as well as older adults' beliefs about pain and its management. This narrative review presents data on nine high‐quality, peer‐reviewed clinical trials published primarily over the past two years that focus on MSK pain management in older adults, of which four were comprehensively reviewed. These studies address contributors to knee osteoarthritis (OA) pain (insomnia), provide evidence for digital delivery or artificial intelligence driven behavioral interventions and potentially more efficient/equally effective modes of delivering glucocorticoids for OA; each of the selected studies have potential for scalability and meaningful impact in the care of older adults. [ABSTRACT FROM AUTHOR]

Background: Depression affected 5.7% of people aged 60 years and over prior to the pandemic and has increased by approximately 28%. The aim of this study is to identify and describe factors associated with depressive symptoms, the diagnostic assessment instruments and interventions used to evaluate and treat depression in adults aged 60 years and older since the onset of the COVID‐19 pandemic. Methods: Four electronic databases were systematically searched to identify eligible studies published since the beginning of the COVID‐19 pandemic. A total of 832 articles were screened, of which 53 met the inclusion criteria. Results: Factors contributing to depressive symptoms in older adults prior to the pandemic were grouped into the following categories: sociodemographic characteristics (i.e., being female); loneliness and weak social support; limitations in daily functioning, physical activity and neurocognitive impairment; and clinical factors. The following groups of factors directly related to the pandemic were found: stress‐related factors and feelings or worries related to the pandemic; information access (e.g., receiving news about COVID‐19 through the media); factors directly related to COVID‐19 (e.g., having infected acquaintances); and factors related to the measures that were taken to reduce the spread of COVID‐19 (e.g., confinement measures). The most frequently used instrument to assess depressive symptoms was the Geriatric Depression Scale Short Form (GDS‐SF). Four studies implemented interventions during the pandemic that led to significant reductions in depressive symptoms and feelings of loneliness. Conclusions: Improved understanding of pandemic‐associated risk factors for depression can inform person‐cantered care. It is important continued mental healthcare for depression for older adults throughout crises, such as the COVID‐19 pandemic. Remote delivery of mental healthcare represents an important alternative during such times. It is crucial to address depression in older adults (which often causes disability), since the pandemic situation has increased depressive symptoms in this population. [ABSTRACT FROM AUTHOR]

Background: We set out to identify empirically‐derived health status classes of older adults with diabetes based on clusters of comorbid conditions which are associated with future complications. Methods: We conducted a cohort study among 105,786 older (≥65 years of age) adults with type 2 diabetes enrolled in an integrated healthcare delivery system. We used latent class analysis of 19 baseline comorbidities to derive health status classes and then compared incident complication rates (events per 100 person‐years) by health status class during 5 years of follow‐up. Complications included infections, hyperglycemic events, hypoglycemic events, microvascular events, cardiovascular events, and all‐cause mortality. Results: Three health status classes were identified: Class 1 (58% of the cohort) had the lowest prevalence of most baseline comorbidities, Class 2 (22%) had the highest prevalence of obesity, arthritis, and depression, and Class 3 (20%) had the highest prevalence of cardiovascular conditions. The risk for incident complications was highest for Class 3, intermediate for Class 2 and lowest for Class 1. For example, the age, sex and race‐adjusted rates for cardiovascular events (per 100 person‐years) for Class 3, Class 2 and Class 1 were 6.5, 2.3, and 1.6, respectively; 2.1, 1.2, 0.7 for hypoglycemia; and 8.0, 3.8, and 2.3 for mortality. Conclusions: Three health status classes of older adults with diabetes were identified based on prevalent comorbidities and were associated with marked differences in risk of complications. These health status classes can inform population health management and guide the individualization of diabetes care. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of advance care planning (ACP). Topics include definition of ACP, rates of ACP among racially or ethnically minoritized populations and those with limited health literacy, and possible reasons for disparities that persist for lesbian, gay, bisexual, transgender, queer, intersexual, asexual, homeless, and incarcerated populations.

This editorial comments on the article by Mao et al. [ABSTRACT FROM AUTHOR]

Background: Although advance care planning (ACP) for persons with dementia (PWD) can promote patient‐centered care by aligning future healthcare with patient values, few PWD have documented ACPs for reasons incompletely understood. The objective of this paper is to characterize the perceived value of, barriers to, and successful strategies for completing ACP for PWD as reported by frontline clinicians. Methods: Qualitative study using semi‐structured interviews (August 2018–December 2019) with clinicians (physicians, nurse practitioners, nurses, social workers) at 11 US health systems. Interviews asked clinicians about their approaches to ACP with PWDs, including how ACP was initiated, what was discussed, how carepartners were involved, how decision‐making was approached, and how decision‐making capacity was assessed. Results: Of 75 participating generalist and specialty clinicians from across the United States, 61% reported conducting ACP with PWD, of whom 19% conducted ACP as early as possible with PWD. Three themes emerged: value of early ACP preserves PWD's autonomy in cases of differing PWD carepartner values, acute medical crises, and clinician paternalism; barriers to ACP with PWD including the dynamic and subjective assessment of patient decision‐making capacity, inconsistent awareness of cognitive impairment by clinicians, and the need to balance patient and family carepartner involvement; and strategies to support ACP include clarifying clinicians' roles in ACP, standardizing clinicians' approach to PWD and their carepartners, and making time for ACP and decision‐making assessments that allow PWD and carepartner involvement regardless of the patients' capacity. Conclusions: Clinicians found early ACP for PWD valuable in promoting patient‐centered care among an at‐risk population. In sharing their perspectives on conducting ACP for PWD, clinicians described challenges that are amenable to changes in training, workflow, and material support for clinician time. Clinical practices need sustainable scheduling and financial support models. [ABSTRACT FROM AUTHOR]

The article presents a study which aimed to understand from clinicians and older adults ways to optimize a proposed home-based deprescribing intervention that focuses on tailoring medications based on patient's daily and life goals. Topics include clinicians included in the study, daily activities/goals for older adults, and the need to identify older adults prototypes and design flexible deprescribing interventions that can target a broad range of older adults for maximum impact.

Background: Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents' home time, a patient‐centered outcome. Methods: Medicare beneficiaries who entered AL communities in 2018 were identified. The main outcome is resident home time in the year following AL admission, calculated as the percentage of time spent at home (i.e., not in institutional care setting) per day being alive. Additional outcomes are the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. AL online Google reviews for 2013–2017 were linked to 2018–2019 Medicare data. AL average rating score (ranging 1–5) and rating status (no‐rating, low‐rating, and high‐rating) were generated using Google reviews. Linear regression models and propensity score weighting were used to examine the association between online reviews and outcomes. The study sample included 59,831 residents in 12,143 ALs. Results: Residents were predominately older (average 81.2 years), non‐Hispanic White (90.4%), and female (62.9%), with 17% being dually eligible for Medicare and Medicaid. From 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one‐unit increase in the AL's average online rating was associated with an increase in residents' risk‐adjusted home time by 0.33 percentage points (p < 0.001). Compared with residents in ALs without ratings, residents in high‐rated ALs (average rating ≥4.4) had a 0.64 pp (p < 0.001) increase in home time. Conclusions: Higher online rating scores were positively associated with residents' home time, while the absence of ratings was associated with reduced home time. Our results suggest that online reviews may be a quality signal with respect to home time. See related Editorial by David et al. [ABSTRACT FROM AUTHOR]

Background: Health status is increasingly recognized as an important patient‐centered outcome after acute myocardial infarction (AMI). Yet drivers of decline in health status after AMI remain largely unknown in older adults. We sought to develop and validate a predictive risk model for health status decline among older adult survivors of AMI. Methods: Using data from a prospective cohort study conducted from 2013 to 2017 of 3041 patients age ≥75 years hospitalized with acute myocardial infarction at 94 U.S. hospitals, we examined a broad array of demographic, clinical, functional, and psychosocial variables for their association with health status decline, defined as a decrease of ≥5 points in the Short Form‐12 (SF‐12) physical component score from hospitalization to 6 months post‐discharge. Model selection was performed in logistic regression models of 20 imputed datasets to yield a parsimonious risk prediction model. Model discrimination and calibration were evaluated using c‐statistics and calibration plots, respectively. Results: Of the 2571 participants included in the main analyses, 30% of patients experienced health status decline from hospitalization to 6 months post‐discharge. The risk model contained 14 factors, 10 associated with higher risk of health status decline (age, pre‐existing AMI, pre‐existing cancer, pre‐existing COPD, pre‐existing diabetes, history of falls, presenting Killip class, acute kidney injury, baseline health status, and mobility impairment) and four associated with lower risk of health status decline (male sex, higher hemoglobin, receipt of revascularization, and arrhythmia during hospitalization). The model displayed good discrimination (c‐statistic = 0.74 in validation cohort) and calibration (p > 0.05) in both development and validation cohorts. Conclusions: We used split sampling to develop and validate a risk model for health status decline in older adults after hospitalization for AMI and identified several risk factors that may be modifiable to mitigate the threat of this important patient‐centered outcome. External validation of this risk model is warranted. [ABSTRACT FROM AUTHOR]

Background: Most older adults hospitalized with COVID-19 survive their acute illness. The impact of COVID-19 hospitalization on patient-centered outcomes, including physical function, cognition, and symptoms, is not well understood. To address this knowledge gap, we collected longitudinal data about these issues from a cohort of older survivors of COVID-19 hospitalization. Methods: We undertook a prospective study of community-living persons age ≥ 60 years who were hospitalized with COVID-19 from June 2020–June 2021. A baseline interview was conducted during or up to 2 weeks after hospitalization. Follow-up interviews occurred at one, three, and six months postdischarge. Participants completed comprehensive assessments of physical and cognitive function, symptoms, and psychosocial factors. An abbreviated assessment could be performed with a proxy. Additional information was collected from the electronic health record. Results: Among 341 participants, the mean age was 71.4 (SD 8.4) years, 51% were women, and 37% were of Black race or Hispanic ethnicity. Median length of hospitalization was 8 (IQR 6–12) days. All but 4% of participants required supplemental oxygen, and 20% required care in an intensive care unit or stepdown unit. At enrollment, nearly half (47%) reported at least one preexisting disability in physical function, 45% demonstrated cognitive impairment, and 67% were pre-frail or frail. Participants reported a mean of 9 of 14 (SD 3) COVID-19-related symptoms. At the six-month follow-up interview, more than a third of participants experienced a decline from their pre-hospitalization function, nearly 20% had cognitive impairment, and burdensome symptoms remained highly prevalent. Conclusions: We enrolled a diverse cohort of older adults hospitalized with COVID-19 and followed them after discharge. Functional decline was common, and there were high rates of persistent cognitive impairment and symptoms. Future analyses of these data will advance our understanding of patient-centered outcomes among older COVID-19 survivors. [ABSTRACT FROM AUTHOR]

New efforts have begun to transform healthcare to focus on patient-centered care. Such efforts will be facilitated by eliciting, operationalizing, and measuring the attainment of patient-identified goals of healthcare. This article describes a practical approach to goal setting and measurement that can be used in efforts to implement patient-centered care.

The article discusses U.S. nursing home (NH) reform based on the National Academies of Sciences, Engineering, and Medicine (NASEM) report in 2023. Topics covered include integration of resident and family experience into measures of NH quality, design of private bedrooms and smaller units, and Medicaid payment accuracy. Also noted are such report limitations as the absence of a vision for NHs in the future, and of inputs on post acute care, and on the status of the certified nursing assistant.

The article discusses issues and recommendations from the National Academies of Sciences, Engineering, and Medicine (NASEM) report as of 2023. Topics covered include care delivery, quality measurement, and quality improvement in nursing homes, and the goals of person-centered care, testing existing and emergent models of care, and expanding quality measurement. Also noted is using quality improvement methods to facilitate the adoption of evidence-based practices.

Older adults are characterized by profound clinical heterogeneity. When designing and delivering interventions, there exist multiple approaches to account for heterogeneity. We present the results of a systematic review of data‐driven, personalized interventions in older adults, which serves as a use case to distinguish the conceptual and methodologic differences between individualized intervention delivery and precision health‐derived interventions. We define individualized interventions as those where all participants received the same parent intervention, modified on a case‐by‐case basis and using an evidence‐based protocol, supplemented by clinical judgment as appropriate, while precision health‐derived interventions are those that tailor care to individuals whereby the strategy for how to tailor care was determined through data‐driven, precision health analytics. We discuss how their integration may offer new opportunities for analytics‐based geriatric medicine that accommodates individual heterogeneity but allows for more flexible and resource‐efficient population‐level scaling. [ABSTRACT FROM AUTHOR]

Introduction: Medication reconciliation, a technique that assists in aligning a care team's understanding of an individual's true medication regimen, is vital to optimize medication use and prevent medication errors. Historically, most medication reconciliation research has focused on institutional settings and transitional care, with comparatively little attention given to medication reconciliation in community settings. To optimize medication reconciliation for community‐dwelling older adults, healthcare professionals and older adults must be engaged in co‐designing processes that create sustainable approaches. Methods: Academic researchers, older adults, and community‐ and health system‐based healthcare professionals engaged in a participatory process to better understand medication reconciliation barriers and co‐design solutions. The initiative consisted of two participatory research approaches: (1) Sparks Innovation Studios, which synthesized professional expertise and opinions, and (2) a Community Consultation Studio with older adults. Input from both groups informed a list of possible solutions and these were ranked based on evaluative criteria of feasibility, person‐centeredness, equity, and sustainability. Results: Sparks Innovation Studios identified a lack of ownership, fragmented healthcare systems, and time constraints as the leading barriers to medication reconciliation. The Community Consultation Studio revealed that older adults often feel dismissed in medical encounters and perceive poor communication with and among providers. The Community Consultation Studio and Sparks Innovation Studios resulted in four highly‐ranked solutions to improve medication reconciliation: (1) support for older adults to improve health literacy and ownership; (2) ensuring medication indications are included on prescription labels; (3) trainings and incentives for front‐line staff in clinic settings to become champions for medication reconciliation; and (4) electronic health record improvements that simplify active medication lists. Conclusion: Engaging community representatives with academic partners in the research process enhanced understanding of community priorities and provided a practical roadmap for innovations that have the potential to improve the well‐being of community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend a comprehensive geriatric assessment (CGA) for the management of older adults with cancer. We evaluated the effect of CGA conducted by a geriatric oncology service (GOS) on the management of older adults with cancer. We also queried patients about their perceptions of the value of this process. Methods: This was a prospective quality assessment study of 498 consecutive older adults with cancer who were referred to the GOS from May 2020 through December 2021. Treating physicians requested a consultation and the GOS conducted a CGA and assessed patient preferences. The GOS provided recommendations on cancer treatment and geriatric interventions. Patient perspectives on the consultation were evaluated using collaboRATE and modified Patient Assessment of Care for Chronic Conditions (PACIC) subscales. Results: A 10‐item frailty index based on a CGA (FI‐CGA‐10) [Oncologist, 26, e1751 (2021)] in the 498 patients showed that 19% of patients were fit, 40% pre‐frail, and 41% frail. Prior to CGA the intent of the proposed cancer treatment was curative in 56% (n = 280), life‐extending in 40% (n = 201), and palliative in 3.4% (n = 17). After a CGA consultation, a cancer treatment decision was changed in 45% of patients. The intent of treatment after the CGA consultation was curative in 45%, life‐extending in 34%, and palliative in 21%. At least one referral to relevant disciplines was recommended for 88% of patients and was implemented in 43%. As part of the GOS consultation educational support was provided to 97% of patients. Based on the collaboRATE and PACIC tools, patients perceived the GOS consultation positively and helpful for facilitating shared decision‐making and patient‐centered care. Conclusion: Our institutional experience demonstrated the valuable effect of the CGA consultation on oncologic decision‐making and geriatric interventions in a patient‐centered manner. See related Editorial by Fernandes Dos Santos Hughes et al. in this issue. [ABSTRACT FROM AUTHOR]

This editorial comments on the article by Elliot et al. in this issue. [ABSTRACT FROM AUTHOR]

ObjectivesTo develop a process of goal-setting and measurement of goal attainment in a dementia care management program.DesignObservational.SettingDementia care management program in an urban academic medical center.ParticipantsPersons with dementia (N=101) and their caregivers; nurse practitioner dementia care managers (N=5).InterventionSpecification of a personalized health goal and action plan and measurement of goal attainment using goal attainment scaling in a clinical care visit.MeasurementsGoal attainment at 6 and 12 months; focus groups of 5 dementia care managers.ResultsEighty-four percent of participant goals were nonmedical, 47% were related to quality of life, and 29% were caregiver support goals. Eighty-eight percent of participants felt that the goal they set was meaningful and 74% that the goal-setting process captured something different from usual care, and 85% found the process helpful in planning for future care. At 6 months, 74% of dyads had achieved or exceeded their expected level of goal attainment. Dementia care managers felt that the goal-setting process improved their understanding of what was most important to the patient, helped set expectations about disease progression and care needs, and provided positive reinforcement when goals were accomplished and an opportunity for revision when goals were not met.ConclusionGoal setting using goal attainment scaling can be incorporated into the care of persons with dementia to establish and attain person-centered goals. Research is needed to further develop personalized goal attainment as an outcome measure for dementia care. J Am Geriatr Soc 66:2120-2127, 2018.

Background: Eliciting life stories is an important component of person‐centered care that may aid in understanding how an individual's unique background and narrative impacts their health. Such life stories, especially when gathered from older military Veterans, may include traumatic events, raising the urgency that clinicians be prepared to provide care that is trauma‐informed and ensure Veteran's experiences are acknowledged and treated effectively. Methods: We examined the prevalence and type of potentially traumatic and/or adverse life events spontaneously shared by 231 older Veterans participating in a life story intervention while receiving care within the U.S. Veterans Health Administration system. Veteran life stories were extracted from the electronic medical record and deductive qualitative content analysis was used to code potentially traumatic or adverse life experiences based on a codebook adapted from the Brief Trauma Questionnaire and Adverse Childhood Experience questionnaire. Results: A majority (71.0%) of Veterans described at least one traumatic disclosure in their life story. Among narratives with a disclosure of any type, more than half (53.0%) included descriptions of combat trauma, 21.5% noted a history of life‐threatening illness, and 9.5% reported having been in a serious accident. Fewer noted adverse childhood experiences (19.5%). Conclusions: Elicitation of life stories among older Veterans may advance person‐centered care and life stories frequently include disclosure of potentially traumatic and/or adverse life events. These findings underscore the normative experience of traumatic events among older Veterans and highlight the importance of developing age‐sensitive trauma‐informed care competencies. [ABSTRACT FROM AUTHOR]

Background: Patients with Alzheimer's Disease and Related Dementias (ADRD) undergoing inpatient procedures represent a population at elevated risk for adverse outcomes including postoperative complications, mortality, and discharge to a higher level of care. Outcomes may be particularly poor in patients with ADRD undergoing high‐risk procedures. We sought to determine traditional (e.g., 30‐day mortality) and patient‐centered (e.g., discharge disposition) outcomes in patients with ADRD undergoing high‐risk inpatient procedures. Methods: This retrospective cohort study analyzed electronic health records linked to fee‐for‐service Medicare claims data at a tertiary care academic health system. All patients from a large multi‐hospital health system undergoing high‐risk inpatient procedures from October 1, 2015 to September 30, 2017 with continuous Medicare Parts A and B enrollment in the 12 months prior to and 90 days following the procedure were included. Results: This study included 6779 patients. 536 (7.9%) had ADRD. A multivariable analysis of outcomes demonstrated higher risks for postoperative complications (OR 1.49, 95% CI 1.23–1.81) and 90‐day mortality (OR 1.44 [95% CI 1.09–1.91]) in patients with ADRD compared to those without. Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.70, 95% CI 1.32–2.18) and only 37.3% of patients admitted from home were discharged to home. Conclusions: Compared to those without ADRD, patients living with ADRD undergoing high‐risk procedures have poor traditional and patient‐centered outcomes including increased risks for 90‐day mortality, postoperative complications, longer hospital lengths of stay, and discharge to a higher level of care. These data may be used by patients, their surrogates, and their physicians to help align surgical decision‐making with health care goals. [ABSTRACT FROM AUTHOR]

This Editorial comments on the article by Wong et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: Most patients living with serious illness value spending time at home. Emerging data suggest that days alive and at home (DAH) may be a useful metric, however more research is needed. We aimed to assess the concurrent validity of DAH with respect to clinically significant changes in patient‐ and caregiver‐reported outcomes (PROs). Methods: We drew data from a study that compared two models of home‐based palliative care among seriously ill patients and their caregivers in two Kaiser Permanente regions (Southern California and Northwest). We included participants aged 18 years or older (n = 3533) and corresponding caregivers (n = 463). We categorized patients and caregivers into three groups based on whether symptom burden (Edmonton Symptom Assessment System, ESAS) or caregiving preparedness (Preparedness for Caregiving Scale, CPS) showed improvements, deterioration, or no change from baseline to 1 month later. We measured DAH across four time windows: 30, 60, 90, and 180 days, after admission to home palliative care. We used two‐way ANOVA to compare DAH across the PRO groups. Results: Adjusted pairwise comparisons showed that DAH was highest for patients whose ESAS scores improved or did not change compared with those with worsening symptoms. Although the mean differences ranged from less than a day to about 3 weeks, none exceeded 0.3 standard deviations. ESAS change scores had weak negative correlations (r = −0.11 to −0.21) with DAH measures. CPS change scores also showed weak, positive correlations (r = 0.23–0.24) with DAH measures. Conclusion: DAH measures are associated, albeit weakly, with clinically important improvement or maintenance of patient symptom burden in a diverse, seriously ill population. See related article by Freed et al. and editorial by Ankuda et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: Rejection of care (RoC) occurs when persons living with dementia (PLWD) withstand or oppose the efforts of their caregiver. Improvements in hospital dementia care are needed, and one way to address this need is by identifying factors that lead to RoC, particularly those that are modifiable. Elderspeak communication is an established antecedent to RoC among PLWD in nursing homes. The purpose of this study was to extend these results to acute care settings by determining the impact of elderspeak communication by nursing staff on RoC by hospitalized PLWD. Methods: Care encounters between nursing staff and PLWD were audio‐recorded, transcribed verbatim, and coded for semantic, pragmatic, and prosodic features of elderspeak. RoC behaviors was scored in real‐time using the Resistiveness to Care Scale. A Bayesian repeated‐measures hurdle model was used to evaluate the association between elderspeak and both the presence and severity of RoC. Results: Eighty‐eight care encounters between 16 PLWD and 53 nursing staff were audio‐recorded for elderspeak and scored for RoC. Nearly all (96.6%) of the encounters included some form of elderspeak. Almost half of the care encounters (48.9%) included RoC behaviors. A 10% decrease in elderspeak was associated with a 77% decrease in odds of RoC (OR = 0.23, 95% CI = 0.03, 0.68) and a 16% decrease (eβ= 0.84, CI = 0.73, 0.96) in the severity of RoC. A one‐unit decrease in pain severity was associated with 73% reduced odds of RoC (OR = 0.27, CI = 0.12, 0.45) and a 28% decrease (eβ= 0.72, CI = 0.64, 0.80) in the severity of RoC. Conclusions: Both elderspeak by nursing staff and RoC by PLWD are present and pervasive in acute care. Pain and elderspeak are two modifiable factors of RoC in hospitalized PLWD. Person‐centered interventions are needed that address communication practices and pain management for hospitalized PLWD. [ABSTRACT FROM AUTHOR]

The article outlines opportunities for synergy between Age-Friendly Health Systems (AFHS) and Learning Health Systems (LHS) models to improve the quality of care delivered to older adults. It suggests pairing the measurement model of AFHS and data infrastructure principles of LHS. Policy mechanisms that must be explored to overcome barriers to achieving AFHS-LHS integration are suggested including quality metrics, payment models, reimbursement models and investment in electronic health records.

The article discusses the findings of a telephone survey conducted between January-June 2022 which aimed to characterize what matters most to older adults in the postacute or skilled nursing facility setting. Topics covered include how responses were separated into 48 statements and grouped into three overarching categories, several themes revealed by each category, and staff competence and professionalism as the most prevalent themes that mattered most to older patients and their caregivers.

Background: No prior studies have examined the effects of home‐based primary care (HBPC) in persons living with dementia (PLWD), within an ecosystem of serious illness care in an integrated healthcare system. Our objectives were to compare the characteristics of PLWD receiving HBPC and their hospital utilization and end‐of‐life care, with those of a matched comparison group, and to understand the experiences of family caregivers of PLWD receiving HBPC. Methods: This mixed‐methods study used a retrospective observational cohort design with PLWD receiving HBPC (n = 287) from 2015 to 2020 and a strata‐matched comparison group (n = 861), and qualitative phone interviews with 16 HBPC family caregivers in 2020. Inverse probability of treatment weighting propensity score‐adjusted models were used to compare time‐to‐first hospital‐based utilization and, for decedents, home palliative and hospice care and place of death. Care experience was captured through caregiver interviews. Results: Patients receiving HBPC had a similar risk of hospital utilization [adjusted hazard ratio, 1.06 (95% CI: 0.89–1.26), p = 0.51] as a matched non‐HBPC comparison group after a median follow‐up of 199 days. However, HBPC decedents (n = 159) were more likely to receive home palliative care or hospice [rate ratio, RR: 1.23 (95% CI: 1.07–1.42), p < 0.01] and to die at home [RR: 1.66 (95% CI: 1.35–2.05), p < 0.001] than were non‐HBPC decedents (n = 423). Caregivers reported that HBPC provided coordinated, continuous, and convenient care that was aligned with families' priorities and goals; however, some expressed unmet needs, especially for help paying for personal care and medical supplies/equipment, and a desire for clearer communication about program operations and more quality oversight for contract services. Conclusions: Although HBPC for PLWD was associated with a similar risk of hospital utilization compared to a matched non‐HBPC comparison group, HBPC resulted in more patient‐centered end‐of‐life care for decedents. Prospective studies of HBPC that further elicit and address unmet needs are warranted. [ABSTRACT FROM AUTHOR]

Background: With the development of electronic geriatric assessment (GA), recommendations for self‐management can be provided to patients without the presence of health care providers. Our research question was to identify what self‐management interventions can be used by patients to address issues identified in GA and to determine their effect on patient‐centered outcomes such as quality of life, health, mood, cognition, and functional status. Methods: Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database‐specific subject headings and text word searches was used such as self‐management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. Results: Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. Conclusions: Low‐ to moderate‐quality studies show a variety of effective self‐efficacy‐targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long‐term effects, validation, and scalability of these interventions remain largely unknown. [ABSTRACT FROM AUTHOR]

Background: Retirement villages (RVs), also known as continuing care retirement communities, are an increasingly popular housing choice for older adults. The RV population has significant health needs, possibly representing a group with needs in between community‐dwelling older adults and those in long‐term residential care (LTC). Our previous work shows Gerontology Nurse Specialist (GNS)‐facilitated multidisciplinary team (MDT) interventions may reduce hospitalizations from LTC. This study tested whether a similar intervention reduced hospitalizations in RV residents. Methods: Open‐label randomized controlled trial in which 412 older residents of 33 RVs were randomized (1:1) to an MDT intervention or usual care. Setting: RVs across two District Health Boards in Auckland, New Zealand. Residents were eligible if considered high risk of health/functional decline (triggering ≥3 interRAI Clinical Assessment Protocols or needing special consideration identified by GNS). Intervention: GNS‐facilitated MDT intervention, including geriatrician/nurse practitioner and clinical pharmacist, versus usual care. Primary outcome was time from randomization to first acute hospitalization. Secondary outcomes were rate of acute hospitalizations, LTC admission, and mortality. Twelve residents died before randomization; all others (n = 400: MDT intervention = 199; usual care = 201) were included in intention‐to‐treat analyses. Results: Mean (SD) age was 82.2 (6.9) years, 302 (75.5%) were women, and 378 (94.5%) were European. Over median 1.5 years follow‐up, no difference was found in hazard of acute hospitalization between the MDT intervention (51.8%) and usual care (49.3%) groups (Hazard ratio [HR] = 1.01, 95% CI = 0.77–1.34). No difference was found in the incidence rate of acute hospitalizations between the MDT intervention (0.69 per person‐year) and usual care (0.86 per person‐year) groups (incidence rate ratio = 0.81, 95% CI = 0.59–1.10). Similar results were seen for the proportion of residents with LTC transition (HR = 1.18, 95% CI = 0.65–2.11) and mortality (HR = 0.70, 95% CI = 0.36–1.35). Conclusion: Further studies are needed to assess the effects of other patient‐centered interventions and outcomes with adequate primary care integration. [ABSTRACT FROM AUTHOR]