A Multi-Outcome Prognostic Model for Community-Dwelling Older Adults Admitted to Skilled Nursing Facilities for Post-Acute Care.

Objectives: Nearly 20% of hospitalized older adults are discharged to a skilled nursing facility (SNF) for short-term rehabilitation. Many subsequently experience adverse outcomes, such as hospital readmissions, transitioning to long-term care rather than returning home, or death. To guide shared decision making, we developed a prognostic model for multiple outcomes for older adults admitted to SNFs.

Hospice Use Among Medicare Beneficiaries With Parkinson Disease and Dementia With Lewy Bodies.

Importance: Neurodegenerative disorders are now the most common reason that Medicare beneficiaries enroll in hospice for end-of-life care. People with all-cause dementia have high rates of suboptimal hospice use, but little is known about hospice use patterns in Lewy body disease, which includes both Parkinson disease (PD) and dementia with Lewy bodies (DLB).

Objective: To compare patient characteristics, hospice agency characteristics, and patterns of use for beneficiaries with PD and DLB vs Alzheimer disease (AD).

Mortality and Function After Hip Fracture or Pneumonia in People With and Without Dementia.

Background: The extent to which disruptive surgical or medical events impact mortality and function is critical for anticipatory planning and informing goal-aligned care.

Methods: Using Health and Retirement Study data (2008-2018), we employed propensity score matching to compare the impact of hospitalization for hip fracture (a surgical event) or pneumonia (a medical event) among people with dementia to two groups: (1) people with dementia who did not experience these events; and (2) people without dementia who experienced an event. Dementia status was determined using validated cognitive assessments (Hurd method); hip fracture and pneumonia were identified from Medicare claims.

Mortality and Function After Widowhood Among Older Adults With Dementia, Cancer, or Organ Failure.

Importance: The widowhood effect, in which mortality increases and function decreases in the period following spousal death, may be heightened in older adults with functional impairment and serious illnesses, such as cancer, dementia, or organ failure, who are highly reliant on others, particularly spouses, for support. Yet there are limited data on widowhood among people with these conditions.

Objective: To determine the association of widowhood with function and mortality among older adults with dementia, cancer, or organ failure.

Use of Muscle Relaxants After Surgery in Traditional Medicare Part D Enrollees.

Background: Surgeons have come under increased scrutiny for postoperative pain management, particularly for opioid prescribing. To decrease opioid use but still provide pain control, nonopioid medications such as muscle relaxants are being used, which can be harmful in older adults. However, the prevalence of muscle relaxant prescribing, trends in use over time, and risk of prolonged use are unknown.

Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals.

Importance: More than 70 000 Medicare beneficiaries receive care in long-term acute care hospitals (LTCHs) annually for prolonged acute illness. However, little is known about long-term functional and cognitive outcomes of middle-aged and older adults after hospitalization in an LTCH.

Objective: To describe survival, functional, and cognitive status after LTCH hospitalization and to identify factors associated with an adverse outcome.

Association of Race and Ethnicity With Postoperative Gabapentinoid and Opioid Prescribing Trends for Older Adults.

Background: Disparities in opioid prescribing by race/ethnicity have been described in many healthcare settings, with White patients being more likely to receive an opioid prescription than other races studied. As surgeons increase prescribing of nonopioid medications in response to the opioid epidemic, it is unknown whether postoperative prescribing disparities also exist for these medications, specifically gabapentinoids.

Methods: We conducted a retrospective cohort study using a 20% Medicare sample for 2013-2018.

Trends in the Use of Gabapentinoids and Opioids in the Postoperative Period Among Older Adults.

Importance: In response to the opioid epidemic, recommendations from some pain societies have encouraged surgeons to embrace multimodal pain regimens with the intent of reducing opioid use in the postoperative period, including by prescribing gabapentinoids.

Objective: To describe trends in postoperative prescribing of both gabapentinoids and opioids after a variety of surgical procedures by examining nationally representative Medicare data and further understand variation by procedure.

Design, Setting, And Participants: This serial cross-sectional study of gabapentinoid prescribing from January 1, 2013, through December 31, 2018, used a 20% US Medicare sample.

Effect of the COVID-19 pandemic on meaningful activity engagement in racially and ethnically diverse older adults.

Background: Participation and active engagement in meaningful activities support the emotional and physical well-being of older adults. In 2020, the onset of the COVID-19 pandemic altered lives, including the ability to participate in meaningful activities. This study compared meaningful activity engagement before and at the beginning of the COVID-19 pandemic in a nationally representative, diverse sample >65 years between 2015 and 2020.

Hospice Quality, Race, and Disenrollment in Hospice Enrollees With Dementia.

Racial and ethnic minoritized people with dementia (PWD) are at high risk of disenrollment from hospice, yet little is known about the relationship between hospice quality and racial disparities in disenrollment among PWD. To assess the association between race and disenrollment between and within hospice quality categories in PWD. Retrospective cohort study of 100% Medicare beneficiaries 65+ enrolled in hospice with a principal diagnosis of dementia, July 2012-December 2017.

New psychotropic medication use among Medicare beneficiaries with dementia after hospital discharge.

Background: Hospitalizations among people with dementia (PWD) may precipitate behavioral changes, leading to the psychotropic medication use despite adverse outcomes and limited efficacy. We sought to determine the incidence of new psychotropic medication use among community-dwelling PWD after hospital discharge and, among new users, the proportion with prolonged use.

Methods: This was a retrospective cohort study using a 20% random sample of Medicare claims in 2017, including hospitalized PWD with traditional and Part D Medicare who were 68 years or older.

The epidemiology of preexisting geriatric and palliative conditions in older adults with poor prognosis cancers.

Background: Older patients with poor prognosis cancers have complex needs that can benefit from geriatrics and palliative care principles. Because they are not routinely assessed, the prevalence of preexisting geriatric and palliative conditions in this population is unknown.

Methods: We used the nationally representative Health and Retirement Study (HRS) linked with Medicare claims (1998-2016) to identify adults aged ≥65 years diagnosed with poor prognosis cancers (cancers with a median survival ≤1 year).

Anesthesia Care for Cataract Surgery in Medicare Beneficiaries.

Importance: Cataract surgery in the US is routinely performed with anesthesia care, whereas anesthesia care for other elective, low-risk, outpatient procedures is applied more selectively.

Objective: To identify predictors of anesthesia care in Medicare beneficiaries undergoing cataract surgery and evaluate anesthesia care for cataract surgery compared with other elective, low-risk, outpatient procedures.

Design, Setting, And Participants: This population-based, retrospective observational cohort study included Medicare beneficiaries 66 years or older who underwent cataract surgery in 2017.

Prolonged use of newly prescribed gabapentin after surgery.

Background: Surgeons have made substantial efforts to decrease postoperative opioid prescribing, largely because it can lead to prolonged use. These efforts include adoption of non-opioid pain medication including gabapentin. Like opioids, gabapentin use may be prolonged, increasing the risk of altered mental status and even overdose and death when taken concurrently with opioids.

A national study of disenrollment from hospice among people with dementia.

Background: People with dementia (PWD) are at high risk for hospice disenrollment, yet little is known about patterns of disenrollment among the growing number of hospice enrollees with dementia.

Design: Retrospective, observational cohort study of 100% Medicare beneficiaries with dementia aged 65 and older enrolled in the Medicare Hospice Benefit between July 2012 and December 2017. Outcome measures included hospice-initiated disenrollment for patients whose rate of decline ceased to meet the Medicare hospice eligibility guideline of "expected death within 6 months" (extended prognosis) and patient-initiated disenrollment (revocation).

Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes.

Background: Guidelines discourage sliding scale insulin (SSI) use after the first week of a nursing home (NH) admission. We sought to determine the prevalence of SSI and identify factors associated with stopping SSI or transitioning to another short-acting insulin regimen.

Methods: In an observational study from October 1, 2013, to June 30, 2017 of non-hospice Veterans Affairs NH residents with type 2 diabetes and an NH admission over 1 week, we compared the weekly prevalence of SSI versus two other short-acting insulin regimens - fixed dose insulin (FDI) or correction dose insulin (CDI, defined as variable SSI given alongside fixed doses of insulin) - from week 2 to week 12 of admission.

Incidence of potentially disruptive medical and social events in older adults with and without dementia.

Background: Potentially disruptive medical, surgical, and social events-such as pneumonia, hip fracture, and widowhood-may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community-dwelling people with and without dementia.

Polypharmacy among older adults with dementia compared with those without dementia in the United States.

Background/objectives: In older persons with dementia (PWD), extensive medication use is often unnecessary, discordant with goals of care, and possibly harmful. The objective of this study was to determine the prevalence and medication constituents of polypharmacy among older PWD attending outpatient visits in the United States.

Design: Cross-sectional analysis.

A Novel Method for Identifying a Parsimonious and Accurate Predictive Model for Multiple Clinical Outcomes.

Background And Objective: Most methods for developing clinical prognostic models focus on identifying parsimonious and accurate models to predict a single outcome; however, patients and providers often want to predict multiple outcomes simultaneously. As an example, for older adults one is often interested in predicting nursing home admission as well as mortality. We propose and evaluate a novel predictor-selection computing method for multiple outcomes and provide the code for its implementation.

A Novel Metric for Developing Easy-to-Use and Accurate Clinical Prediction Models: The Time-cost Information Criterion.

Background: Guidelines recommend that clinicians use clinical prediction models to estimate future risk to guide decisions. For example, predicted fracture risk is a major factor in the decision to initiate bisphosphonate medications. However, current methods for developing prediction models often lead to models that are accurate but difficult to use in clinical settings.

Engagement in Meaningful Activities Among Older Adults With Disability, Dementia, and Depression.

This cross-sectional study examines the association between disability, dementia, and depression and engagement in meaningful activities in community-dwelling older adults.

Hypoglycemia in Hospice Patients With Type 2 Diabetes in a National Sample of Nursing Homes.

This retrospective cohort study examines whether patients with type 2 diabetes on hospice are assessed for dysglycemia, receive insulin or oral hypoglycemic medications, or experience hypoglycemia and hyperglycemia in the nursing home setting.

Association of β-Blockers With Functional Outcomes, Death, and Rehospitalization in Older Nursing Home Residents After Acute Myocardial Infarction.

Importance: Although β-blockers are a mainstay of treatment after acute myocardial infarction (AMI), these medications are commonly not prescribed for older nursing home residents after AMI, in part owing to concerns about potential functional harms and uncertainty of benefit.

Objective: To study the association of β-blockers after AMI with functional decline, mortality, and rehospitalization among long-stay nursing home residents 65 years or older.

Design, Setting, And Participants: This cohort study of nursing home residents with AMI from May 1, 2007, to March 31, 2010, used national data from the Minimum Data Set, version 2.