Effects of Nursing Home Changes in Antipsychotic Use on Outcomes Among Residents With Dementia.

Objectives: Little information exists on whether nationwide efforts to reduce antipsychotic use among nursing home (NH) residents with Alzheimer's disease and related dementias improved mortality and hospitalization outcomes for residents. Our objective was to examine the effect of NH decreases in antipsychotic use on outcomes for residents with Alzheimer's disease and related dementias.

Design: Observational nationwide study that emulated a series of cluster randomized trials.

Service Utilization and Consumer-Reported Unmet Needs in Medicaid Home- and Community-Based Services for Older Adults.

Home- and community-based services (HCBS) are increasingly favored over nursing home care by older consumers and by policymakers. Consumer-reported unmet service needs in HCBS are important service quality and person-centeredness indicators. Yet, we know little about consumer-reported unmet needs among HCBS users.

Ongoing evolution of SARS-CoV-2 drives escape from mRNA vaccine-induced humoral immunity.

With the onset of the COVID-19 pandemic 4 years ago, viral sequencing continues to document numerous individual mutations in the viral spike protein across many variants. To determine the ability of vaccine-mediated humoral immunity to combat continued SARS-CoV-2 evolution, we construct a comprehensive panel of pseudoviruses harboring each individual mutation spanning 4 years of the pandemic to understand the fitness cost and resistance benefits of each. These efforts identify numerous mutations that escape from vaccine-induced humoral immunity.

The Social Risk ACTIONS Framework: Characterizing Responses to Social Risks by Health Care Delivery Organizations.

Social risks refer to individuals' social and economic conditions shaped by underlying social determinants of health. Health care delivery organizations increasingly screen patients for social risks given their potential impact on health outcomes. However, it can be challenging to meaningfully address patients' needs.

Radiation Therapy for Heterotopic Ossification: A Systematic Review.

Purpose: Heterotopic ossification (HO) is a benign disorder characterized by ectopic bone formation in soft tissues that can lead to functional loss in patients. We conducted a systematic review of the evidence on the use of radiation therapy (RT) for the prevention or treatment of HO.

Methods And Materials: Literature searches were conducted using Medline (via PubMed), Embase, and ClinicalTrials.

Variation in the time to complete the primary COVID-19 vaccine series by race, ethnicity, and geography among older US adults.

Introduction: Racial and ethnic disparities in COVID-19 vaccine access are well-documented; however, few studies have examined whether racial disparities are modified by other factors, including geographic location and area-level deprivation.

Methods: We conducted an observational study using the COVVAXAGE database. Medicare beneficiaries who received the COVID-19 vaccine primary series (two doses) between 01/01/2021 and 12/31/2021 were included.

Analgesic regimens administered to older adults receiving skilled nursing facility care following hip fracture: a proof-of-concept federated analysis.

Background: Although a majority of patients in the U.S. receive post-acute care in skilled nursing facilities (SNFs) following hip fracture, large-sample observational studies of analgesic prescribing and use in SNFs have not been possible due to limitations in available data sources.

Associations Between Patient/Caregiver Trust in Clinicians and Experiences of Healthcare-Based Discrimination.

Background: Higher trust in healthcare providers has been linked to better health outcomes and satisfaction. Lower trust has been associated with healthcare-based discrimination.

Objective: Examine associations between experiences of healthcare discrimination and patients' and caregivers of pediatric patients' trust in providers, and identify factors associated with high trust, including prior experience of healthcare-based social screening.

Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients.

Background: Social risks (individual social and economic conditions) have been implicated as playing a major role in the opioid epidemic and may be more prevalent in the most medically vulnerable patients. However, the extent to which specific social risks and other patient factors are associated with opioid use among high-risk patients has not been comprehensively assessed.

Objective: To identify patient-reported and electronic health record (EHR)-derived demographic, social, behavioral/psychological, and clinical characteristics associated with opioid use in Veterans Affairs (VA) patients at high risk for hospitalization or death.

Differences in setting of initial dementia diagnosis among fee-for-service Medicare beneficiaries.

Background: Accurate and timely diagnosis of dementia is necessary to allow affected individuals to make informed decisions and access appropriate resources. When dementia goes undetected until a hospitalization or nursing home stay, this could reflect delayed diagnosis or misdiagnosis, and may reflect underlying disparities in healthcare access.

Methods: In this retrospective cohort study, we used 2012-2020 Medicare claims and other administrative data to examine variation in setting of dementia diagnosis among fee-for-service Medicare beneficiaries with an initial claims-based dementia diagnosis in 2016.

Medication Changes Among Older Drivers Involved in Motor Vehicle Crashes.

Importance: Although older adults may use potentially driver-impairing (PDI) medications that can produce psychomotor impairment, little is known about changes to PDI medication use among older adults from the time before to the time after a motor vehicle crash (MVC).

Objective: To quantify use of and changes in PDI medications among older adults before and after an MVC.

Design, Setting, And Participants: This cohort study used linked Medicare claims and police-reported MVC data on 154 096 person-crashes among 121 846 older drivers.

Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care.

Background: Appropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.

Methods: We conducted a retrospective cohort study of older adult U.

Association of nursing home antipsychotic reduction policies with antipsychotic use in community dwellers with dementia.

Background: Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care ("the Partnership") and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.

Variations in antihypertensive medication treatment and blood pressure control among Veterans with HIV and existing hypertension.

Background: Hypertension is a leading risk factor for cardiovascular disease among patients living with HIV (PLWH). Understanding the predictors and patterns of antihypertensive medication prescription and blood pressure (BP) control among PLWH with hypertension (HTN) is important to improve the primary prevention efforts for this high-risk population. We sought to assess important patient-level correlates (eg, race) and inter-facility variations in antihypertension medication prescriptions and BP control among Veterans living with HIV (VLWH) and HTN.

Impact of federal antipsychotic use policy in nursing homes on new diagnoses for approved indications in dementia residents.

Background: Federal policies targeting antipsychotic use among nursing home (NH) residents may have increased reporting of diagnoses for approved uses, including schizophrenia, Tourette's syndrome, and Huntington's Disease (called "exclusionary diagnoses" because they exclude residents from the antipsychotic quality metric). We assessed changes in new exclusionary diagnoses among long-stay NH admissions specifically with dementia following federal policies.

Methods: Retrospective, quarterly, interrupted time-series analysis (2009-2018) of new long-stay NH residents with dementia and no exclusionary diagnoses reported before NH admission.

Concurrent Care and Use of Advanced Cardiac Therapies for Hospitalized Veterans With Heart Failure.

Context: Concurrent care allows patients to receive hospice while continuing disease-directed therapies. This treatment model is available in the Veterans Administration (VA) medical system, but its use in Veterans with heart failure (HF) is unexplored.

Objective: To compare use of advanced HF therapies 30 days posthospitalization in Veterans on hospice versus not on hospice following admission for HF exacerbation.

Initial and Long-Term Prescribing of Opioids and Non-steroidal Anti-inflammatory Drugs Following Total Hip and Knee Arthroplasty.

Introduction: Limited evidence exists on health system characteristics associated with initial and long-term prescribing of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) following total hip and knee arthroplasty (THA/TKA), and if these characteristics differ among individuals based on preoperative NSAID exposure. We identified orthopedic surgeon opioid prescribing practices, hospital characteristics, and regional factors associated with initial and long-term prescribing of opioids and NSAIDs among older adults receiving THA/TKA.

Materials And Methods: This observational study included opioid-naïve Medicare beneficiaries aged ≥65 years receiving elective THA/TKA between January 1, 2014 and July 4, 2017.

Measuring Consumer-Reported Quality of Life Among Recipients of Publicly Funded Home- and Community-Based Services: Implications for Health Equity.

Objectives: Despite an increased policy focused on home- and community-based services (HCBS), little is known about their quality of life (QoL)-a key measure of person-centered care. This paper addresses this gap by measuring consumers' self-reported QoL and identifying factors associated with disparities in QoL.

Methods: We analyzed the 2015-2016 National Core Indicators-Aging and Disability survey for 3426 respondents in Minnesota, using factor analyses to identify latent QoL domains.

Non-benzodiazepine Hypnotics and Police-Reported Motor Vehicle Crash Risk among Older Adults: A Sequential Target Trial Emulation.

Non-benzodiazepine hypnotics ( "Z-drugs") are prescribed for insomnia, but might increase risk of motor vehicle crash (MVC) among older adults through prolonged drowsiness and delayed reaction times. We estimated the effect of initiating Z-drug treatment on the 12-week risk of MVC in a sequential target trial emulation. After linking New Jersey driver licensing and police-reported MVC data to Medicare claims, we emulated a new target trial each week (July 1, 2007 - October 7, 2017) in which Medicare fee-for-service beneficiaries were classified as Z-drug-treated or untreated at baseline and followed for an MVC.

Changes in Physical Function and Physical Therapy Use in Older Veterans Not Infected by CoVID-19 Residing in Community Living Centers during the CoVID-19 Pandemic.

Objectives: Examine physical function change and physical therapy (PT) use in short-stay and long-stay residents not infected by CoVID-19 within Veterans Affairs (VA) Community Living Centers (CLCs).

Design: Retrospective cohort study using Minimum Data Set (MDS) 3.0 assessments.