Journal of the American Geriatrics Society
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Randomized Controlled Trial Multicenter Study
Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia.
Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying. ⋯ The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes. J Am Geriatr Soc 68:305-312, 2020.
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Multicenter Study Pragmatic Clinical Trial
GP-Led Deprescribing in Community-Living Older Australians: An Exploratory Controlled Trial.
To assess feasibility, effectiveness, and safety of a multifaceted general practitioner (GP) led intervention to reduce potentially inappropriate polypharmacy in community-living older people. ⋯ The deprescribing intervention appears feasible, was modestly effective, and was not associated with any major safety events. J Am Geriatr Soc 68:403-410, 2020.
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Multicenter Study
Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians.
To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. ⋯ Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39-45, 2019.
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Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies. ⋯ "Limitations in walking half a mile" can be used as a substitute criterion for "low physical activity" in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans. J Am Geriatr Soc 67:2393-2397, 2019.
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Multicenter Study
How Do Frail Medicare Beneficiaries Fare Under Bundled Payments?
Bundled payments are an alternative payment model in which a hospital takes accountability for the costs of a 90-day episode of care. Such models are meant to improve care through better coordination across care settings, but could have adverse consequences for frail adults if they lead to inappropriate cuts in necessary post-acute care. ⋯ While frail patients had higher costs and worse outcomes in general, there was no evidence of changes in access or worsening clinical outcomes in BPCI hospitals for frail patients relative to the nonfrail in hospitals' first year of participation in the program. These findings may be reassuring for policy makers and clinical leaders. J Am Geriatr Soc 67:2245-2253, 2019.