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Frederico Pieruccini-Faria PhD Yanina Sarquis-Adamson PhD Ivan Anton-Rodrigo MD Alicia Noguerón-García MD Nick W. Bray MSc Richard Camicioli MD Susan W. Muir-Hunter PT PhD Mark Speechley PhD Bill McIlroy PhD Manuel Montero-Odasso MD PhD AGSF 《Journal of the American Geriatrics Society》2020,68(3):576-584
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Timothy W. Farrell MD AGSF Lauren E. Ferrante MD MHS Teneille Brown JD Leslie Francis PhD JD Eric Widera MD Ramona Rhodes MD MPH MSCS AGSF Tony Rosen MD MPH Ula Hwang MD MPH Leah J. Witt MD Niranjan Thothala MD MRCP MBA Shan W. Liu MD SD Caroline A. Vitale MD AGSF Ursula K. Braun MD MPH Caroline Stephens PhD RN GNP-BC Debra Saliba MD MPH AGSF 《Journal of the American Geriatrics Society》2020,68(6):1136-1142
Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately, from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these needs have focused attention on how resources are ultimately allocated and used. Some strategies misguidedly use age as an arbitrary criterion, inappropriately disfavoring older adults. This statement represents the official policy position of the American Geriatrics Society (AGS). It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations to consider when developing strategies for allocating scarce resources during an emergency involving older adults. Members of the AGS Ethics Committee collaborated with interprofessional experts in ethics, law, nursing, and medicine (including geriatrics, palliative care, emergency medicine, and pulmonology/critical care) to conduct a structured literature review and examine relevant reports. The resulting recommendations defend a particular view of distributive justice that maximizes relevant clinical factors and deemphasizes or eliminates factors placing arbitrary, disproportionate weight on advanced age. The AGS positions include (1) avoiding age per se as a means for excluding anyone from care; (2) assessing comorbidities and considering the disparate impact of social determinants of health; (3) encouraging decision makers to focus primarily on potential short-term (not long-term) outcomes; (4) avoiding ancillary criteria such as “life-years saved” and “long-term predicted life expectancy” that might disadvantage older people; (5) forming and staffing triage committees tasked with allocating scarce resources; (6) developing institutional resource allocation strategies that are transparent and applied uniformly; and (7) facilitating appropriate advance care planning. The statement includes recommendations that should be immediately implemented to address resource allocation strategies during COVID-19, aligning with AGS positions. The statement also includes recommendations for post-pandemic review. Such review would support revised strategies to ensure that governments and institutions have equitable emergency resource allocation strategies, avoid future discriminatory language and practice, and have appropriate guidance to develop national frameworks for emergent resource allocation decisions. J Am Geriatr Soc 68:1136–1142, 2020. 相似文献
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Cathy C. Schubert MD AGSF Anthony J. Perkins MS Laura J. Myers PhD Teresa M. Damush PhD Lauren S. Penney PhD Ying Zhang PhD Ashley L. Schwartzkopf MSW Alaina K. Preddie MS Sam Riley BA Tetla Menen BS Dawn M. Bravata MD 《Journal of the American Geriatrics Society》2022,70(12):3598-3609
Background
As the Department of Veterans Affairs (VA) healthcare system seeks to expand access to comprehensive geriatric assessments, evidence-based models of care are needed to support community-dwelling older persons. We evaluated the VA Geriatric Resources for Assessment and Care of Elders (VA-GRACE) program's effect on mortality and readmissions, as well as patient, caregiver, and staff satisfaction.Methods
This retrospective cohort included patients admitted to the Richard L. Roudebush VA hospital (2010–2019) who received VA-GRACE services post-discharge and usual care controls who were potentially eligible for VA-GRACE but did not receive services. The VA-GRACE program provided home-based comprehensive, multi-disciplinary geriatrics assessment, and ongoing care. Primary outcomes included 90-day and 1-year all-cause readmissions and mortality, and patient, caregiver, and staff satisfaction. We used propensity score modeling with overlapping weighting to adjust for differences in characteristics between groups.Results
VA-GRACE patients (N = 683) were older than controls (N = 4313) (mean age 78.3 ± 8.2 standard deviation vs. 72.2 ± 6.9 years; p < 0.001) and had greater comorbidity (median Charlson Comorbidity Index 3 vs. 0; p < 0.001). VA-GRACE patients had higher 90-day readmissions (adjusted odds ratio [aOR] 1.55 [95%CI 1.01–2.38]) and higher 1-year readmissions (aOR 1.74 [95%CI 1.22–2.48]). However, VA-GRACE patients had lower 90-day mortality (aOR 0.31 [95%CI 0.11–0.92]), but no statistically significant difference in 1-year mortality was observed (aOR 0.88 [95%CI 0.55–1.41]). Patients and caregivers reported that VA-GRACE home visits reduced travel burden and the program linked Veterans and caregivers to needed resources. Primary care providers reported that the VA-GRACE team helped to reduce their workload, improved medication management for their patients, and provided a view into patients' daily living situation.Conclusions
The VA-GRACE program provides comprehensive geriatric assessments and care to high-risk, community-dwelling older persons with high rates of satisfaction from patients, caregivers, and providers. Widespread deployment of programs like VA-GRACE will be required to support Veterans aging in place.144.
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Shelly L. Gray PharmD MS AGSF Rachyl Fornaro PharmD Justin Turner PhD BPharm MClinPharm Denise M. Boudreau PhD Robert Wellman MS Cara Tannenbaum MD Zachary A. Marcum PharmD PhD Benjamin Balderson PhD Andrea Cook PhD Anna Liss Jacobsen MA MLS Elizabeth A. Phelan MD MPH 《Journal of the American Geriatrics Society》2023,71(5):1580-1586