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Journal of the American Geriatrics Society

Impact factor: 3.978 5-Year impact factor: 4.625 Print ISSN: 0002-8614 Online ISSN: 1532-5415 Publisher: Wiley Blackwell (Blackwell Publishing)

Subject: Gerontology

Most recent papers:

  • Imputation of Gait Speed for Noncompleters in the 400‐Meter Walk: Application to the Lifestyle Interventions for Elders Study.
    Haiying Chen, Walter T. Ambrosius, Terrence E. Murphy, Roger Fielding, Marco Pahor, Adam Santanasto, Catrine Tudor‐Locke, W. Jack Rejeski, Michael E. Miller,.
    Journal of the American Geriatrics Society. September 08, 2017
    When a 400‐m walk test with time constraint (in 15 minutes) is administered, analysis of the associated 400‐m gait speed can be challenging because some older adults are unable to complete the distance in time (noncompleters). A simplistic imputation method is to calculate the observed speeds of the noncompleters as the partially completed distance divided by the corresponding amount of elapsed time as an estimate of gait speed over the full 400‐m distance. This common practice has not been validated to the best of our knowledge. We propose a Bayesian multiple imputation (MI) method to impute the unobserved 400‐m gait speed for noncompleters. Briefly, MI is performed under the assumption that the unobserved 400‐m gait speed of noncompleters is left‐censored from a normal distribution. We illustrate the application of the Bayesian MI method using longitudinal data collected from the Lifestyle Interventions for Elders (LIFE) study. A simulation study was performed to assess the bias in estimation of the mean 400‐m gait speed using both methods. The results indicate that the simplistic imputation method tends to overestimate the population mean, whereas the Bayesian MI method yields minimal bias as the sample size increases.
    September 08, 2017   doi: 10.1111/jgs.15078   open full text
  • The Age‐Friendly Health System Imperative.
    Terry Fulmer, Kedar S. Mate, Amy Berman.
    Journal of the American Geriatrics Society. September 06, 2017
    The unprecedented changes happening in the American healthcare system have many on high alert as they try to anticipate legislative actions. Significant efforts to move from volume to value, along with changing incentives and alternative payment models, will affect practice and the health system budget. In tandem, growth in the population aged 65 and older is celebratory and daunting. The John A. Hartford Foundation is partnering with the Institute for Healthcare Improvement to envision an age‐friendly health system of the future. Our current prototyping for new ways of addressing the complex and interrelated needs of older adults provides great promise for a more‐effective, patient‐directed, safer healthcare system. Proactive models that address potential health needs, prevent avoidable harms, and improve care of people with complex needs are essential. The robust engagement of family caregivers, along with an appreciation for the value of excellent communication across care settings, is at the heart of our work. Five early‐adopter health systems are testing the prototypes with continuous improvement efforts that will streamline and enhance our approach to geriatric care.
    September 06, 2017   doi: 10.1111/jgs.15076   open full text
  • Geriatrics Literature 2016 Year in Review.
    Kaitlin Willham, Kenneth Covinsky, Eric Widera.
    Journal of the American Geriatrics Society. September 05, 2017
    We present 10 of the most effective articles from 2016 in geriatric medicine. They address wide‐ranging topics including the use of antipsychotics for delirium in palliative care, fall prevention and mobility interventions, efficacy and potential risks of testosterone, cranberry capsules and their effect on bacteriuria and pyuria, beta‐blockers after acute myocardial infarction in a nursing home population, the effect of a healthy lifestyle on disability, a goals‐of‐care intervention in individuals with advanced dementia, the benefits of regional anesthesia in hip repair, and mindfulness in chronic pain management.
    September 05, 2017   doi: 10.1111/jgs.15064   open full text
  • Aging Research: Collaborations Forge a Promising Future.
    Melinda S. Kelley, Marie A. Bernard, Richard J. Hodes.
    Journal of the American Geriatrics Society. August 30, 2017
    The National Institute on Aging (NIA), one of 27 institutes and centers at the National Institutes of Health (NIH), was founded in 1974 to conduct and support research on aging and the health and well‐being of older people. The Institute's interests span the fundamental processes that contribute to aging and their impact on systems; diseases and conditions for which aging is a risk factor; and interventions that may prevent, delay, or treat these conditions or otherwise contribute to an extension of healthy, active years of life. Multiple fruitful research collaborations within and outside the federal government, spanning the breadth of the Institute's research activities, have marked NIA's growth over the past 40 years, as well as its current areas of ongoing research. This article discusses several highlights of these collaborations, including the Health and Retirement Study, geroscience research, falls injury prevention in elderly adults, and implementation of the National Plan to Address Alzheimer's Disease, from the perspective of past accomplishments and trends for the future.
    August 30, 2017   doi: 10.1111/jgs.15052   open full text
  • Prevention of Alzheimer's Disease: Lessons Learned and Applied.
    James E. Galvin.
    Journal of the American Geriatrics Society. August 02, 2017
    Alzheimer's disease (AD) affects more than 5 million Americans, with substantial consequences for individuals with AD, families, and society in terms of morbidity, mortality, and healthcare costs. With disease‐modifying treatment trials unsuccessful at the present time and only medications to treat symptoms available, an emerging approach is prevention. Advances in diagnostic criteria, biomarker development, and greater understanding of the biophysiological basis of AD make these initiatives feasible. Ongoing pharmacological trials using anti‐amyloid therapies are underway in sporadic and genetic forms of AD, although a large number of modifiable risk factors for AD have been identified in observational studies, many of which do not appear to exert effects through amyloid or tau. This suggests that prevention studies focusing on risk reduction and lifestyle modification may offer additional benefits. Rather than relying solely on large‐sample, long‐duration, randomized clinical trial designs, a precision medicine approach using N‐of‐1 trials may provide more‐rapid information on whether personalized prevention plans can improve person‐centered outcomes. Because there appear to be multiple pathways to developing AD, there may also be multiple ways to prevent or delay the onset of AD. Even if these precision approaches alone are not successful in preventing AD, they may greatly improve the likelihood of amyloid‐ or tau‐specific therapies to reach their endpoints by reducing comorbidities. Keeping this in mind, dementia may be a disorder that develops over a lifetime, with individualized ways to build a better brain as we age.
    August 02, 2017   doi: 10.1111/jgs.14997   open full text
  • Robert L. Kane, MD (1940–2017).
    James T. Pacala, Joseph G. Ouslander, Debra Saliba.
    Journal of the American Geriatrics Society. July 07, 2017
    There is no abstract available for this paper.
    July 07, 2017   doi: 10.1111/jgs.14934   open full text
  • “Urinary Tract Infection”—Requiem for a Heavyweight.
    Thomas E. Finucane.
    Journal of the American Geriatrics Society. May 19, 2017
    “Urinary tract infection” (“UTI”) is an ambiguous, expansive, overused diagnosis that can lead to marked, harmful antibiotic overtreatment. “Significant bacteriuria,” central to most definitions of “UTI,” has little significance in identifying individuals who will benefit from treatment. “Urinary symptoms” are similarly uninformative. Neither criterion is well defined. Bacteriuria and symptoms remit and recur spontaneously. Treatment is standard for acute uncomplicated cystitis and common for asymptomatic bacteriuria, but definite benefits are few. Treatment for “UTI” in older adults with delirium and bacteriuria is widespread but no evidence supports the practice, and expert opinion opposes it. Sensitive diagnostic tests now demonstrate that healthy urinary tracts host a ubiquitous, complex microbial community. Recognition of this microbiome, largely undetectable using standard agar‐based cultures, offers a new perspective on “UTI.” Everyone is bacteriuric. From this perspective, most people who are treated for a “UTI” would probably be better off without treatment. Elderly adults, little studied in this regard, face particular risk. Invasive bacterial diseases such as pyelonephritis and bacteremic bacteriuria are also “UTIs.” Mindful decisions about antibiotic use will require a far better understanding of how pathogenicity arises within microbial communities. It is likely that public education and meaningful informed‐consent discussions about antibiotic treatment of bacteriuria, emphasizing potential harms and uncertain benefits, would reduce overtreatment. Emphasizing the microbiome's significance and using the term “urinary tract dysbiosis” instead of “UTI” might also help and might encourage mindful study of the relationships among host, aging, microbiome, disease, and antibiotic treatment.
    May 19, 2017   doi: 10.1111/jgs.14907   open full text
  • Geriatrics‐for‐Specialists Initiative: An Eleven‐Specialty Collaboration to Improve Care of Older Adults.
    Andrew G. Lee, John A. Burton, Nancy E. Lundebjerg.
    Journal of the American Geriatrics Society. May 17, 2017
    In the early 1990s, visionary leaders at the American Geriatrics Society and The John A. Hartford Foundation recognized that the marked and growing shortage of geriatrics healthcare professionals would lead to a U.S. healthcare system ill prepared to provide optimal care for the ever‐increasing number of older Americans. Led by the late Dennis W. Jahnigen, MD, they set forth a plan to address this shortage by collaborating with surgical and related medical specialists to create a series of programs to foster the highest quality care of older adults. Their unique programmatic vision was that every physician, not just geriatricians, would have basic knowledge and skills in geriatric care, because geriatricians cannot and should not meet the need alone.
    May 17, 2017   doi: 10.1111/jgs.14963   open full text
  • Meeting the Need for Training in Geriatrics: The Geriatrics Education for Specialty Residents Program.
    Myron Miller, Ronnie A. Rosenthal.
    Journal of the American Geriatrics Society. May 17, 2017
    The imperative created by increasing numbers of aging Americans coupled with increasing longevity has generated recognition and acceptance within american medicine that education, from medical school through postgraduate training through continuing medical education, must include appropriate knowledge and skills in aging and geriatrics to provide for effective care of older adults. Such education and training is necessary not only for traditional primary care providers, but also for specialty physicians, including those in most surgical specialties and in related fields such as anesthesiology, emergency medicine and physical medicine and rehabilitation. To fill this demand, the American Geriatrics Society Geriatrics for Specialist Initiative established the Geriatrics Education for Specialty Residents Program (GSR). This article reviews the process by which the GSR created a dynamic cohort of geriatric surgical educators and researchers who in turn created a vibrant body of educational tools and scientific works that continue to advance the cause of improving medical care of older adults.
    May 17, 2017   doi: 10.1111/jgs.14966   open full text
  • Expanding the Field of Surgical Researchers: The Jahnigen Career Development Award.
    Stacie Deiner.
    Journal of the American Geriatrics Society. May 17, 2017
    Under a long‐standing collaboration with the John A. Hartford Foundation (JAHF), the Atlantic Philanthropies (AP), and specialty societies in 10 targeted specialties, the American Geriatrics Society (AGS) has been working to improve quality of care provided to older adults by surgical and related medical specialists. To support and nurture future academic leaders, the Geriatrics‐for‐Specialists Initiative (GSI) established the Dennis W. Jahnigen Career Development Scholar Award (JCDA) program in 2002, with AP joining JAHF as a core funder of the awards in 2003. Commencing in 2011, the National Institute on Aging (NIA) launched the Grants for Early Medical/Surgical Specialists’ Transition to Aging Research (GEMSSTAR) program, using an RO3 mechanism. Recipients of the JCDA and the GEMSSTAR are provided with 2 years of research support and networking opportunities with other scholars; 79 JCDA and 26 surgical and related medical specialty GEMSSTAR scholars have been funded through these award mechanisms, with AGS, JAHF, and surgical and related medical specialty societies providing matching support for 20 of the GEMSSTAR scholars for leadership development programs. One of the primary criteria for judging the overall success of the program was eventual transition of the award to a federally funded program, which was achieved when NIA launched the GEMSSTAR program in 2011.
    May 17, 2017   doi: 10.1111/jgs.14967   open full text
  • Alzheimer's Disease: Individuals, Dyads, Communities, and Costs.
    Christopher M. Callahan.
    Journal of the American Geriatrics Society. May 05, 2017
    Alzheimer's disease and related dementias (ADRD) affect over 5 million Americans. Over a typical disease course of 5–10 years, family caregivers provide the majority of the day‐to‐day hands‐on on care for persons with dementia. Most caregivers enter this complex role with little training and inadequate household resources and they are tasked to navigate a fragmented health care system as well as a patchwork of community services. Our nation can and should do more to help family caregivers provide care in the home to their loved ones who suffer from dementia. We will all benefit if we design and implement a better system of care for persons with dementia. We will benefit financially as a nation, we will benefit morally as a community, and in case we have forgotten, we stand to benefit ourselves as we age and face our own aging brain. Building a system of care requires excellent science and engineering, but we also need creative approaches that design systems of care that are available nationwide because they are scalable and affordable. Most importantly, families need our help now. We need to move faster.
    May 05, 2017   doi: 10.1111/jgs.14808   open full text
  • Paper Abstract.

    Journal of the American Geriatrics Society. April 26, 2017
    There is no abstract available for this paper.
    April 26, 2017   doi: 10.1111/jgs.14915   open full text
  • Studies of Physician‐Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review.
    Jamie M. Cohen, Jan Blustein, Barbara E. Weinstein, Hannah Dischinger, Scott Sherman, Corita Grudzen, Joshua Chodosh.
    Journal of the American Geriatrics Society. April 24, 2017
    Hearing loss is remarkably prevalent in the geriatric population: one‐quarter of adults aged 60–69 and 80% of adults aged 80 years and older have bilateral disabling loss. Only about one in five adults with hearing loss wears a hearing aid, leaving many vulnerable to poor communication with healthcare providers. We quantified the extent to which hearing loss is mentioned in studies of physician‐patient communication with older patients, and the degree to which hearing loss is incorporated into analyses and findings. We conducted a structured literature search within PubMed for original studies of physician‐patient communication with older patients that were published since 2000, using the natural language phrase “older patient physician communication.” We identified 409 papers in the initial search, and included 67 in this systematic review. Of the 67 papers, only 16 studies (23.9%) included any mention of hearing loss. In six of the 16 studies, hearing loss was mentioned only; in four studies, hearing loss was used as an exclusion criterion; and in two studies, the extent of hearing loss was measured and reported for the sample, with no further analysis. Three studies examined or reported on an association between hearing loss and the quality of physician‐patient communication. One study included an intervention to temporarily mitigate hearing loss to improve communication. Less than one‐quarter of studies of physician‐elderly patient communication even mention that hearing loss may affect communication. Methodologically, this means that many studies may have omitted an important potential confounder. Perhaps more importantly, research in this field has largely overlooked a highly prevalent, important, and remediable influence on the quality of communication.
    April 24, 2017   doi: 10.1111/jgs.14860   open full text
  • Integrating Frailty Research into the Medical Specialties—Report from a U13 Conference.
    Jeremy Walston, Thomas N. Robinson, Susan Zieman, Frances McFarland, Christopher R. Carpenter, Keri N. Althoff, Melissa K. Andrew, Caroline S. Blaum, Patrick J. Brown, Brian Buta, E. Wesley Ely, Luigi Ferrucci, Kevin P. High, Stephen B. Kritchevsky, Kenneth Rockwood, Kenneth E. Schmader, Felipe Sierra, Kaycee M. Sink, Ravi Varadhan, Arti Hurria.
    Journal of the American Geriatrics Society. April 19, 2017
    Although the field of frailty research has expanded rapidly, it is still a nascent concept within the clinical specialties. Frailty, conceptualized as greater vulnerability to stressors because of significant depletion of physiological reserves, predicts poorer outcomes in several medical specialties, including cardiology, human immunodeficiency virus care, and nephrology, and in the behavioral and social sciences. Lack of a consensus definition, proliferation of measurement tools, inadequate understanding of the biology of frailty, and lack of validated clinical algorithms for frail individuals hinders incorporation of frailty assessment and frailty research into the specialties. In 2015, the American Geriatrics Society, the National Institute on Aging (NIA), and the Alliance for Academic Internal Medicine held a conference for awardees of the NIA‐sponsored Grants for Early Medical/Surgical Specialists Transition into Aging Research program to review the current state of knowledge regarding frailty in the subspecialties and to highlight examples of integrating frailty research into the medical specialties. Research questions to advance frailty research into specialty medicine are proposed.
    April 19, 2017   doi: 10.1111/jgs.14902   open full text
  • A National Survey on the Effect of the Geriatric Academic Career Award in Advancing Academic Geriatric Medicine.
    Kevin T. Foley, Clare C. Luz, Katherine V. Hanson, Yuning Hao, Elisia M. Ray.
    Journal of the American Geriatrics Society. April 18, 2017
    A workforce that understands principles of geriatric medicine is critical to addressing the care needs of the growing elderly population. This will be impossible without a substantial increase in academicians engaged in education and aging research. Limited support of early‐career clinician–educators is a major barrier to attaining this goal. The Geriatric Academic Career Award (GACA) was a vital resource that benefitted 222 junior faculty members. GACA availability was interrupted in 2006, followed by permanent discontinuation after the Geriatrics Workforce Education Program (GWEP) subsumed it in 2015, leaving aspiring clinician–educators with no similar alternatives. GACA recipients were surveyed in this cross‐sectional, multimethod study to assess the effect of the award on career development, creation and dissemination of educational products, funding discontinuation consequences, and implications of program closure for the future of geriatric health care. Uninterrupted funding resulted in fulfillment of GACA goals (94%) and overall career success (96%). Collectively, awardees reached more than 40,700 learners. Funding interruption led to 55% working additional hours over and above an increased clinical workload to continue their GACA‐related research and scholarship. Others terminated GACA projects (36%) or abandoned academic medicine altogether. Of respondents currently at GWEP sites (43%), only 13% report a GWEP budget including GACA‐like support. Those with GWEP roles attributed their current standing to experience gained through GACA funding. These consequences are alarming and represent a major setback to academic geriatrics. GACA's singular contribution to the mission of geriatric medicine must prompt vigorous efforts to restore it as a distinct funding opportunity.
    April 18, 2017   doi: 10.1111/jgs.14884   open full text
  • Components of Comprehensive and Effective Transitional Care.
    Mary D. Naylor, Elizabeth C. Shaid, Deborah Carpenter, Brianna Gass, Carol Levine, Jing Li, Ann Malley, Kathleen McCauley, Huong Q. Nguyen, Heather Watson, Jane Brock, Brian Mittman, Brian Jack, Suzanne Mitchell, Becky Callicoatte, John Schall, Mark V. Williams.
    Journal of the American Geriatrics Society. April 03, 2017
    Transitional care (TC) has received widespread attention from researchers, health system leaders, clinicians, and policy makers as they attempt to improve health outcomes and reduce preventable hospital readmissions, yet little is known about the critical elements of effective TC and how they relate to patients’ and caregivers’ needs and experiences. To address this gap, the Patient‐Centered Outcomes Research Institute (PCORI) funded a national study, Achieving patient‐centered Care and optimized Health In care transitions by Evaluating the Value of Evidence (Project ACHIEVE). A primary aim of the study is the identification of TC components that yield desired patient and caregiver outcomes. Project ACHIEVE established a multistakeholder workgroup to recommend essential TC components for vulnerable Medicare beneficiaries. Guided by a review of published evidence, the workgroup identified and defined a preliminary set of components and then analyzed how well the set aligned with real‐world patients' and caregivers' experiences. Through this process, the workgroup identified eight TC components: patient engagement, caregiver engagement, complexity and medication management, patient education, caregiver education, patients' and caregivers' well‐being, care continuity, and accountability. Although the degree of attention given to each component will vary based on the specific needs of patients and caregivers, workgroup members agree that health systems need to address all components to ensure optimal TC for all Medicare beneficiaries.
    April 03, 2017   doi: 10.1111/jgs.14782   open full text
  • Recent Literature Update on Medication Risk in Older Adults, 2015–2016.
    Michael J. Koronkowski, Todd P. Semla, Kenneth E. Schmader, Joseph T. Hanlon.
    Journal of the American Geriatrics Society. March 28, 2017
    Medications can pose considerable risk in older adults. This article annotates four articles addressing this concern from 2016. The first provides national data on the use of specific prescription, over‐the‐counter and dietary supplements in older adults and their change over time. The second discusses the opportunity of deprescribing ineffective/unnecessary stool softeners (i.e., docusate) routinely given to older hospital patients. The third national study examines common adverse drug events in older emergency room patients. Finally, a study published demonstrating a potential association between melatonin and fractures is discussed. This manuscript is intended to provide a narrative review of key publications in medication safety for clinicians and researchers committed to improving medication safety in older adults.
    March 28, 2017   doi: 10.1111/jgs.14887   open full text
  • John A. Hartford Foundation Centers of Excellence Program: History, Impact, and Legacy.
    David B. Reuben, Daniel B. Kaplan, Odette Willik, Nora O Brien‐Suric.
    Journal of the American Geriatrics Society. March 17, 2017
    The John A. Hartford Foundation (JAHF) created the Centers of Excellence in Geriatric Medicine and Geriatric Psychiatry in 1988 with the goal of establishing academic training environments to increase geriatrics‐trained faculty. The initiative identified medical schools with the necessary components for training academic geriatricians. JAHF grants provided the resources to create a cadre of physicians whose research, teaching and practice leads to substantial contributions in geriatrics. Results from two evaluations show that the program has successfully increased geriatrics‐prepared faculty who have achieved promotion and institutional retention, success in winning competitive research grants, and positions of leadership. The initiative strengthened the national network of geriatrics programs and served as a major driver of increased prestige for the fields of geriatric medicine and psychiatry.
    March 17, 2017   doi: 10.1111/jgs.14852   open full text
  • Medicare Access and CHIP Reauthorization Act: What do Geriatrics Healthcare Professionals Need to Know About the Quality Payment Program?
    Kathleen T. Unroe, Peter A. Hollmann, Alanna C. Goldstein, Michael L. Malone.
    Journal of the American Geriatrics Society. March 17, 2017
    Commencing in 2017, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 will change how Medicare pays health professionals. By enacting MACRA, Congress brought an end to the (un)sustainable growth rate formula while also setting forth a vision for how to transform the U.S. healthcare system so that clinicians deliver higher‐quality care with smarter spending by the Centers for Medicare and Medicaid Services (CMS). In October 2016, CMS released the first of what stakeholders anticipate will be a number of (annual) rules related to implementation of MACRA. CMS received extensive input from stakeholders including the American Geriatrics Society. Under the Quality Payment Program, CMS streamlined multiple Medicare value‐based payment programs into a new Merit‐based Incentive Payment System (MIPS). CMS also outlined how it will provide incentives for participation in Advanced Alternative Payment Models (called APMs). Although Medicare payments to geriatrics health professionals will not be based on the new MIPS formula until 2019, those payments will be based upon performance during a 90‐day period in 2017. This article defines geriatrics health professionals as clinicians who care for a predominantly older adult population and who are eligible to bill under the Medicare Physician Fee Schedule. Given the current paucity of eligible APMs, this article will focus on MIPS while providing a brief overview of APMs.
    March 17, 2017   doi: 10.1111/jgs.14765   open full text
  • Creating A Nationwide Nonpartisan Initiative for Family Caregivers in Political Party Platforms.
    Ben Scribner, Joanne Lynn, Victoria Walker, Les Morgan, Anne Montgomery, Elizabeth Blair, Davis Baird, Barbara Goldschmidt, Naomi Kirschenbaum.
    Journal of the American Geriatrics Society. March 10, 2017
    Policymakers have been slow to support family caregivers, and political agendas mostly fail to address the cost burdens, impact on employment and productivity, and other challenges in taking on long‐term care tasks. This project set out to raise policymakers’ awareness of family caregivers through proposals to Republican and Democratic party platforms during the 2016 political season. The Family Caregiver Platform Project (FCPP) reviewed the state party platform submission process for Democratic and Republican parties in all 50 states and the District of Columbia. We built a website to make each process understandable by caregiver advocates. We designed model submissions to help volunteers tailor a proposal and recruited caregiver advocates participating in their state process. Finally, we mobilized a ground operation in many states and followed the progress of submissions in each state, as well as the formation of the national platforms. In 39 states, at least one party, Republican or Democrat, hosted a state party platform process. As of September 2016 FCPP volunteers submitted proposals to 29 state parties in 22 states. Family caregiver language was added to eight state party platforms, one state party resolution, two bipartisan legislative resolutions, and one national party platform. The FCPP generated a non‐partisan grassroots effort to educate and motivate policymakers to address caregiving issues and solutions. Democratic party leaders provided more opportunities to connect with political leaders, with seven Democratic parties and one Republican party, addressing family caregiver issues in their party platforms.
    March 10, 2017   doi: 10.1111/jgs.14814   open full text
  • American Geriatrics Society Policy Priorities for New Administration and 115th Congress.
    Nancy E. Lundebjerg, Peter Hollmann, Michael L. Malone,.
    Journal of the American Geriatrics Society. March 03, 2017
    This paper is a statement of the American Geriatrics Society's (AGS) core policy priorities and the Society's positions on federal programs and policies that support older Americans as articulated to the new administration. Among the AGS priorities discussed in this paper are health reform, Medicare, and Medicaid. The AGS is committed to leveraging its expertise to inform regulatory and legislative policy proposals.
    March 03, 2017   doi: 10.1111/jgs.14854   open full text
  • The Evolving Health Policy Landscape and Suggested Geriatric Tenets to Guide Future Responses.
    Robert L. Kane, Debra Saliba, Peter Hollmann.
    Journal of the American Geriatrics Society. March 03, 2017
    We cannot view the future of healthcare but we can sense that big changes are afoot. Many revolve around the plans to “repeal and replace” the Affordable Care Act. We speculate on some potential areas of change in the context of a set of tenets about what care for older persons should address.
    March 03, 2017   doi: 10.1111/jgs.14849   open full text
  • Geriatric Cardiology Mini‐Focus Issue: Call for Papers.

    Journal of the American Geriatrics Society. February 15, 2017
    There is no abstract available for this paper.
    February 15, 2017   doi: 10.1111/jgs.14601   open full text
  • Advancing the Neurophysiological Understanding of Delirium.
    Mouhsin M. Shafi, Emiliano Santarnecchi, Tamara G. Fong, Richard N. Jones, Edward R. Marcantonio, Alvaro Pascual‐Leone, Sharon K. Inouye.
    Journal of the American Geriatrics Society. February 06, 2017
    Delirium is a common problem associated with substantial morbidity and increased mortality. However, the brain dysfunction that leads some individuals to develop delirium in response to stressors is unclear. In this article, we briefly review the neurophysiologic literature characterizing the changes in brain function that occur in delirium, and in other cognitive disorders such as Alzheimer's disease. Based on this literature, we propose a conceptual model for delirium. We propose that delirium results from a breakdown of brain function in individuals with impairments in brain connectivity and brain plasticity exposed to a stressor. The validity of this conceptual model can be tested using Transcranial Magnetic Stimulation in combination with Electroencephalography, and, if accurate, could lead to the development of biomarkers for delirium risk in individual patients. This model could also be used to guide interventions to decrease the risk of cerebral dysfunction in patients preoperatively, and facilitate recovery in patients during or after an episode of delirium.
    February 06, 2017   doi: 10.1111/jgs.14748   open full text
  • Aging, the Medical Subspecialties, and Career Development: Where We Were, Where We Are Going.
    Arti Hurria, Kevin P. High, Lona Mody, Frances McFarland Horne, Marcus Escobedo, Jeffrey Halter, William Hazzard, Kenneth Schmader, Heidi Klepin, Sei Lee, Una E. Makris, Michael W. Rich, Stephanie Rogers, Jocelyn Wiggins, Rachael Watman, Jennifer Choi, Nancy Lundebjerg, Susan Zieman.
    Journal of the American Geriatrics Society. January 16, 2017
    Historically, the medical subspecialties have not focused on the needs of older adults. This has changed with the implementation of initiatives to integrate geriatrics and aging research into the medical and surgical subspecialties and with the establishment of a home for internal medicine specialists within the annual American Geriatrics Society (AGS) meeting. With the support of AGS, other professional societies, philanthropies, and federal agencies, efforts to integrate geriatrics into the medical and surgical subspecialties have focused largely on training the next generation of physicians and researchers. They have engaged several subspecialties, which have followed parallel paths in integrating geriatrics and aging research. As a result of these combined efforts, there has been enormous progress in the integration of geriatrics and aging research into the medical and surgical subspecialties, and topics once considered to be geriatric concerns are becoming mainstream in medicine, but this integration remains a work in progress and will need to adapt to changes associated with healthcare reform.
    January 16, 2017   doi: 10.1111/jgs.14708   open full text
  • Geriatric Cardiology Mini‐Focus Issue: Call for Papers.

    Journal of the American Geriatrics Society. December 20, 2016
    There is no abstract available for this paper.
    December 20, 2016   doi: 10.1111/jgs.14774   open full text
  • Decision‐Making Regarding Mammography Screening for Older Women.
    Mara A. Schonberg.
    Journal of the American Geriatrics Society. December 05, 2016
    The population is aging, and breast cancer incidence increases with age, peaking between the ages of 75 and 79. However, it is not known whether mammography screening helps women aged 75 and older live longer because they have not been included in randomized controlled trials evaluating mammography screening. Guidelines recommend that older women with less than a 10‐year life expectancy not be screened because it takes approximately 10 years before a screen‐detected breast cancer may affect an older woman's survival. Guidelines recommend that clinicians discuss the benefits and risks of screening with women aged 75 and older with a life expectancy of 10 years or longer to help them elicit their values and preferences. It is estimated that two of 1,000 women who continue to be screened every other year from age 70 to 79 may avoid breast cancer death, but 12% to 27% of these women will experience a false‐positive test, and 10% to 20% of women who experience a false‐positive test will undergo a breast biopsy. In addition, approximately 30% of screen‐detected cancers would not otherwise have shown up in an older woman's lifetime, yet nearly all older women undergo treatment for these breast cancers, and the risks of treatment increase with age. To inform decision‐making, tools are available to estimate life expectancy and to educate older women about the benefits and harms of mammography screening. Guides are also available to help clinicians discuss stopping screening with older women with less than a 10‐year life expectancy. Ideally, screening decisions would consider an older woman's life expectancy, breast cancer risk, and her values and preferences.
    December 05, 2016   doi: 10.1111/jgs.14503   open full text
  • AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults.
    Timothy W. Farrell, Eric Widera, Lisa Rosenberg, Craig D. Rubin, Aanand D. Naik, Ursula Braun, Alexia Torke, Ina Li, Caroline Vitale, Joseph Shega,.
    Journal of the American Geriatrics Society. November 22, 2016
    In this position statement, we define unbefriended older adults as patients who: (1) lack decisional capacity to provide informed consent to the medical treatment at hand; (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so; and (3) lack family, friends or a legally authorized surrogate to assist in the medical decision‐making process. Given the vulnerable nature of this population, clinicians, health care teams, ethics committees and other stakeholders working with unbefriended older adults must be diligent when formulating treatment decisions on their behalf. The process of arriving at a treatment decision for an unbefriended older adult should be conducted according to standards of procedural fairness and include capacity assessment, a search for potentially unidentified surrogate decision makers (including non‐traditional surrogates) and a team‐based effort to ascertain the unbefriended older adult's preferences by synthesizing all available evidence. A concerted national effort is needed to help reduce the significant state‐to‐state variability in legal approaches to unbefriended patients. Proactive efforts are also needed to identify older adults, including “adult orphans,” at risk for becoming unbefriended and to develop alternative approaches to medical decision making for unbefriended older adults. This document updates the 1996 AGS position statement on unbefriended older adults.
    November 22, 2016   doi: 10.1111/jgs.14586   open full text
  • Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside‐to‐Bench Conference on Sleep, Circadian Rhythms, and Aging: New Avenues for Improving Brain Health, Physical Health, and Functioning.
    Constance H. Fung, Michael V. Vitiello, Cathy A. Alessi, George A. Kuchel,.
    Journal of the American Geriatrics Society. November 14, 2016
    The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its eighth Bedside‐to‐Bench research conference, entitled “Sleep, Circadian Rhythms, and Aging: New Avenues for Improving Brain Health, Physical Health and Functioning,” October 4 to 6, 2015, in Bethesda, Maryland. Part of a conference series addressing three common geriatric syndromes—delirium, sleep and circadian rhythm (SCR) disturbance, and voiding dysfunction—the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these three geriatric syndromes. The conference provided a forum for discussing current sleep, circadian rhythm, and aging research; identifying gaps in knowledge; and developing a research agenda to inform future investigative efforts. The conference also promoted networking among developing researchers, leaders in the field of SCR and aging, and National Institutes of Health program personnel.
    November 14, 2016   doi: 10.1111/jgs.14493   open full text
  • Applying the Systolic Blood Pressure Intervention Trial Results to Older Adults.
    Mark A. Supiano, Jeff D. Williamson.
    Journal of the American Geriatrics Society. November 07, 2016
    The Systolic Blood Pressure Intervention Trial (SPRINT;, NCT01206062) was stopped early because of significantly lower risk of cardiovascular disease in participants randomized to a systolic blood pressure target of 120 mmHg (intensive) than in those randomized to 140 mmHg (standard). The cardiovascular outcome benefit was also identified in subjects aged 75 and older assigned to the intensive arm—34% lower than in the standard arm—in addition to 33% lower all‐cause mortality at 3.14 years of follow‐up. These beneficial outcomes held in older participants characterized as frail or with impaired gait speed. This article addresses several questions that need to be considered in applying the SPRINT results to the clinical care of older adults: Why are the SPRINT results discordant from those of epidemiological studies? Do the SPRINT findings generalize to the frail, older adults that I care for? Were there more adverse events in the intensive treatment group? What about cognitive and kidney outcomes? What are future considerations, and how low should we go?
    November 07, 2016   doi: 10.1111/jgs.14681   open full text
  • Knowledge Gaps in Cardiovascular Care of Older Adults: A Scientific Statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society: Executive Summary.
    Michael W. Rich, Deborah A. Chyun, Adam H. Skolnick, Karen P. Alexander, Daniel E. Forman, Dalane W. Kitzman, Mathew S. Maurer, James B. McClurken, Barbara M. Resnick, Win K. Shen, David L. Tirschwell.
    Journal of the American Geriatrics Society. September 27, 2016
    The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older. Despite the effect of CVD on quality of life, morbidity, and mortality in older adults, individuals aged 75 and older have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older adults with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in nursing homes and assisted living facilities. As a result, current guidelines are unable to provide evidence‐based recommendations for diagnosis and treatment of older adults typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence‐based decision‐making, and recommend future research to close existing knowledge gaps. To achieve these objectives, a detailed review was conducted of current American College of Cardiology/American Heart Association (ACC/AHA) and American Stroke Association (ASA) guidelines to identify content and recommendations that explicitly targeted older adults. A pervasive lack of evidence to guide clinical decision‐making in older adults with CVD was found, as well as a paucity of data on the effect of diagnostic and therapeutic interventions on outcomes that are particularly important to older adults, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population‐based studies and clinical trials that include a broad spectrum of older adults representative of those seen in clinical practice and that incorporate relevant outcomes important to older adults in the study design. The results of these studies will provide the foundation for future evidence‐based guidelines applicable to older adults and enhance person‐centered care of older individuals with CVD in the United States and around the world.
    September 27, 2016   doi: 10.1111/jgs.14576   open full text
  • Geriatric Cardiology Mini‐Focus Issue: Call for Papers.

    Journal of the American Geriatrics Society. September 16, 2016
    There is no abstract available for this paper.
    September 16, 2016   doi: 10.1111/jgs.14676   open full text
  • Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000–2015.
    Thomas T. Yoshikawa, Joseph G. Ouslander, William B. Applegate.
    Journal of the American Geriatrics Society. August 24, 2016
    There is no abstract available for this paper.
    August 24, 2016   doi: 10.1111/jgs.14492   open full text
  • Use and Interpretation of Propensity Scores in Aging Research: A Guide for Clinical Researchers.
    Dae Hyun Kim, Carl F. Pieper, Ali Ahmed, Cathleen S. Colón‐Emeric.
    Journal of the American Geriatrics Society. August 22, 2016
    Observational studies are an important source of evidence for evaluating treatment benefits and harms in older adults, but lack of comparability in the outcome risk factors between the treatment groups leads to confounding. Propensity score (PS) analysis is widely used in aging research to reduce confounding. Understanding the assumptions and pitfalls of common PS analysis methods is fundamental to applying and interpreting PS analysis. This review was developed based on a symposium of the American Geriatrics Society Annual Meeting on the use and interpretation of PS analysis in May 2014. PS analysis involves two steps: estimation of PS and estimation of the treatment effect using PS. Typically estimated from a logistic model, PS reflects the probability of receiving a treatment given observed characteristics of an individual. PS can be viewed as a summary score that contains information on multiple confounders and is used in matching, weighting, or stratification to achieve confounder balance between the treatment groups to estimate the treatment effect. Of these methods, matching and weighting generally reduce confounding more effectively than stratification. Although PS is often included as a covariate in the outcome regression model, this is no longer a best practice because of its sensitivity to modeling assumption. None of these methods reduce confounding by unmeasured variables. The rationale, best practices, and caveats in conducting PS analysis are explained in this review using a case study that examined the effective of angiotensin‐converting enzyme inhibitors on mortality and hospitalization in older adults with heart failure.
    August 22, 2016   doi: 10.1111/jgs.14253   open full text
  • Introduction to Abstracts to be Presented at the Fifth Chinese Congress on Gerontology and Health Industry.
    Sean X. Leng, Xiao‐Ying Li.
    Journal of the American Geriatrics Society. August 19, 2016
    There is no abstract available for this paper.
    August 19, 2016   doi: 10.1111/jgs.14565   open full text
  • Mainstream or Extinction: Can Defining Who We Are Save Geriatrics?
    Mary Tinetti.
    Journal of the American Geriatrics Society. June 28, 2016
    There is no abstract available for this paper.
    June 28, 2016   doi: 10.1111/jgs.14181   open full text
  • Projected Savings and Workforce Transformation from Converting Independence at Home to a Medicare Benefit.
    Bruce Kinosian, George Taler, Peter Boling, Dan Gilden,.
    Journal of the American Geriatrics Society. May 31, 2016
    The Independence at Home (IAH) Demonstration Year 1 results have confirmed earlier studies that showed the ability of home‐based primary care (HBPC) to improve care and lower costs for Medicare's frailest beneficiaries. The first‐year report showed IAH savings of 7.7% for all programs and 17% for the nine of 17 programs that surpassed the 5% mandatory savings threshold. Using these results as applied to the Medicare 5% claims file, the effect of expanding HBPC to the 2.2 million Medicare beneficiaries who are similar to IAH demonstration participants was projected. Total savings ranged from $12 billion to $53 billion depending on the speed and extent of dissemination of HBPC among this IAH‐like population. Using a fixed growth rate, as hospitalists experienced in their first decade, 35% coverage would be achieved at the end of 10 years, with total 10‐year savings through IAH reaching $37.5 billion and $17.3 billion accruing to the Centers for Medicare and Medicaid Services as a net reduction in overall expenditures, with $12.6 billion from Medicare Parts A and B savings.
    May 31, 2016   doi: 10.1111/jgs.14176   open full text
  • Midlife Occupational Physical Activity and Risk of Disability Later in Life: National Health and Aging Trends Study.
    Celestin Missikpode, Yvonne L. Michael, Robert B. Wallace.
    Journal of the American Geriatrics Society. May 05, 2016
    Objectives To determine whether midlife occupational physical activity (PA) is associated with disability in older adults and to test disease as a mediating variable. Design Cross‐sectional study. Setting National Health and Aging Trends Study. Participants Individuals aged 65 and older (N = 7,307). Measurements Participants were classified as to occupational PA levels by linking information from the Occupational Information Network database using standard occupation codes. Disability outcomes and covariates were obtained through in‐person interviews. Logistic regression models were used to examine the association between occupational PA and disability. Structural equation modeling (SEM) was fitted to examine the mediating effect of disease. Results Occupations with high physically demands were associated with greater decline in functional capacity later in life. Individuals with occupations with high and very high PA were less likely to be able to perform activities of daily living than those with occupations with low PA. SEM showed that occupational PA has a very strong direct effect on disability (P < .001) and has an indirect effect on disability through disease (P = .003). The population attributable fraction for high occupational PA was 11%. Conclusion Higher midlife occupational PA levels were significantly associated with poorer ability to perform activities of daily living in older age. Performing the optimal level of occupational PA may be instrumental in reducing disability later in life.
    May 05, 2016   doi: 10.1111/jgs.14083   open full text
  • Position Statement on Interdisciplinary Team Training in Geriatrics: An Essential Component of Quality Health Care for Older Adults.

    Journal of the American Geriatrics Society. April 16, 2014
    Interdisciplinary team training (IDT) is an important component of ensuring quality geriatric care delivery, which can be complex and time intensive, requiring coordination of many medical, psychosocial, and therapeutic interventions and professionals. The Partnership for Health in Aging (PHA), a loose coalition of more than 30 organizations representing healthcare professionals who care for older adults supported by the American Geriatrics Society, identified IDT training in geriatrics as a priority area in addressing the geriatrics workforce shortage described in the 2008 Institute of Medicine report, Retooling for An Aging America: Building the Health Care Workforce. A PHA Workgroup on Interdisciplinary Team Training in Geriatrics was convened to review the literature focused on geriatrics IDT training and to develop a position statement that would inform and influence groups involved in the development and expansion of academic and continuing education programs in IDT training, including professional associations, credentialing and licensing bodies, accreditation organizations, and university administrators. There are significant challenges to expanding the development and implementation of geriatrics IDT training for health professionals, and such training will be successful only with substantial and sustained advocacy from the above professional groups.
    April 16, 2014   doi: 10.1111/jgs.12822   open full text
  • American Geriatrics Society Identifies Another Five Things That Healthcare Providers and Patients Should Question.

    Journal of the American Geriatrics Society. February 27, 2014
    Since 2012, the American Geriatrics Society (AGS) has also been collaborating with the American Board of Internal Medicine (ABIM) Foundation, joining its “Choosing Wisely” campaign on two separate lists of Five Things Healthcare Providers and Patients Should Question. The campaign is designed to engage healthcare organizations and professionals, individuals, and family caregivers in discussions about the safety and appropriateness of medical tests, medications, and procedures. Participating healthcare providers are asked to identify five things—tests, medications, or procedures—that appear to harm rather than help. Providers then share this information in a published article about these things on the ABIM campaign's website ( The first AGS list was published in February 2013.
    February 27, 2014   doi: 10.1111/jgs.12770   open full text
  • Erratum.

    Journal of the American Geriatrics Society. November 19, 2008
    There is no abstract available for this paper.
    November 19, 2008   doi: 10.1111/j.1532-5415.2008.02088.x   open full text
  • Erratum.

    Journal of the American Geriatrics Society. November 19, 2008
    There is no abstract available for this paper.
    November 19, 2008   doi: 10.1111/j.1532-5415.2008.02050.x   open full text