Journal of the American Geriatrics Society (original) (raw)
February 23, 2026: 74(6):1771-1784
Background
Anticholinergic burden refers to the cumulative anticholinergic effect of all medications taken by an individual. Anticholinergic burden scales help identify patients at risk of anticholinergic adverse effects and guide prescribing. However, substantial variation exists between scales, with no gold standard identified. This variability may contribute to inconsistent risk assessment, suboptimal prescribing, and adverse outcomes.
Aim
To systematically review available anticholinergic burden scales and their variability in medication lists, development strategies and scoring methods. As a secondary objective, the clinical outcomes associated with each scale were summarized.
Methods
A systematic search was conducted up to January 2025. Studies proposing novel or updated anticholinergic burden scales were included. Two reviewers independently performed study selection, data extraction, and quality assessment, using a custom tool based on expert consensus and principles of scale development. Findings were narratively synthesized.
Results
From 10,969 identified records, 21 studies met inclusion criteria. Medications included per scale ranged from 27 to 217, with 74% of high-potency drugs scored inconsistently. Variability was influenced by geographical origin and methodology, with literature review followed by expert opinion the most common method of development. Dosage consideration, among others, was inconsistent across scales, affecting clinical relevance. Clinical outcome studies reflected such inconsistencies.
Conclusion
No gold standard anticholinergic burden scale was identified. Scales with broader drug coverage and accounting for individual variability appeared more clinically relevant. This review highlights the need for a clinically accessible, universal scoring system to better address the risks associated with anticholinergic polypharmacy.
February 16, 2026: 74(6):1756-1770
Introduction
The Age-Friendly Health Systems (AFHS) initiative aims to improve care for older adults through the “4Ms” framework: What Matters, Medication, Mentation, and Mobility. Despite national momentum and evidence within individual M domains, limited evidence guides outpatient AFHS implementation of the 4Ms as a set. The objective of this systematic review was to summarize the evidence of the impact of AFHS implementation in outpatient settings.
Methods
We searched Medline, EMBASE, CINAHL, Cochrane, and clinicaltrials.gov from 2015 to November 22, 2024. Comparative studies that implemented all 4Ms in outpatient settings were included. Risk of bias was assessed using questions derived from the Cochrane Risk of Bias tool for RCTs and the Risk of Bias In Non-randomized Studies—of Intervention tool for other study designs, and results were summarized using GRADE methodology.
Results
Twelve US-based studies met inclusion criteria. Overall, implementing AFHS interventions was associated with improved process measures across all 4Ms, though the effectiveness of specific implementation strategies could not be determined. Outcome and structural measures were infrequently reported. Study heterogeneity and poor reporting limited generalizability.
Discussion
Findings underscore the urgent need for standardized, outcomes-oriented AFHS measurement before policy and payment reforms, such as CMS's Age-Friendly Hospital Measure, are expanded into outpatient settings. To advance meaningful transformation, future research must prioritize implementation fidelity, outcome evaluation, and measures that reflect older adults' values and lived experiences.
April 27, 2026: 74(6):1747-1755
Background
Academic medicine programs face compounded challenges from public health crises, health inequities, and evolving federal policies pertaining to Diversity, Equity, and Inclusion (DEI). Older adults and individuals living with serious illness—particularly those from marginalized communities—experienced greater morbidity and mortality during the COVID-19 pandemic and may continue to see disproportionately negative outcomes amid 2025 federal regulatory changes.
Methods
Within a Department of Geriatrics and Palliative Medicine, a DEI initiative evolved into the MOSAIC Council (Mission Oriented Strategies Advancing Inclusive Communities)—reframing its scope, governance, and program activities to preserve psychological safety, engagement, and institutional relevance. MOSAIC and departmental leadership defined the program's mission to: (1) foster a supportive and inclusive learning and work environment, (2) develop responsive approaches to discrimination and bias, and (3) provide accessible resources to support all department members. Activities consisted of lectures, facilitated forums, workshops, and community-building experiences, with ongoing feedback used to guide program refinement.
Results
From 2021 to 2025, MOSAIC demonstrated sustained engagement, delivering more than 140 sessions, consistent attendance, and positive participant feedback. Structural and resilient adaptations included expansion of the champion team, iterative feedback and needs assessments, and prioritization of flexible, community-informed programming. Focus on internal community building and psychological safety supported program growth and resilience and facilitated integration of MOSAIC principles into departmental culture and practices.
Conclusions
MOSAIC demonstrates that internal DEI development in a geriatric and palliative department can be sustained through intentional resilience and adaptive design, despite restrictive policy environments. This model offers a pragmatic framework for academic health programs seeking to improve workforce environment and advance equitable care for older adults and seriously ill populations while navigating evolving regulatory landscapes. Future directions include extending this framework to patient and caregiver communities.
March 25, 2026: 74(6):1738-1746
Background
High utilization of the emergency department (ED) by older adults contributes to adverse health outcomes and increased cost of care. Studies have investigated interventions aimed at reducing low acuity ED visits, with increased primary care accessibility being among the most effective. This paper aims to describe the implementation of a novel acute care clinic model to improve same-day availability for urgent concerns within geriatric primary care.
Methods
We conducted a quasi-experimental difference-in-differences (DID) analysis to evaluate the impact of an Acute Care Clinic (ACC) model implemented within an outpatient geriatrics clinic between March 2022 and August 2023. Patient-level descriptive statistics were used to characterize ACC patients. Clinic-level outcomes were compared between geriatrics clinic patients (including ACC patients) and a reference group of patients who receive primary care at internal medicine clinics within the same health system using monthly aggregated data over a 24-month period (6 months pre- and 18 months post-intervention).
Results
There were 1102 ACC visits (764 distinct patients) in the implementation period. ACC patients were more medically complex than both the geriatrics clinic overall and the reference group (average HCC score 2.4). Same-day labs were ordered in 34% of ACC visits and same-day imaging was ordered in 15% of ACC visits. Compared to the reference group, the geriatrics clinic showed a potentially greater reduction in calls escalated due to lack of same-day access (−3.1%; p = 0.08) and a larger increase in same-day scheduling (+2.8%; p = 0.13), though neither reached statistical significance.
Conclusions
An ACC model was successfully implemented within a geriatric primary care clinic and there was a trend toward improvement in same-day clinic access for these medically complex older adults. Further review of patient triage processes, financial impact, and patient satisfaction is needed for program evaluation, refinement, and expansion.
April 28, 2026: 74(6):1729-1737
Background
Home-based medical care (HBMC) is an important care model for older adults with complex health conditions and functional limitations that can potentially prevent institutionalization. Historically, HBMC has comprised small, independent provider organizations. It is unknown whether consolidation observed in other health care sectors has similarly affected HBMC.
Methods
We used the American Academy of Home Care Medicine's national provider directory to identify a cohort of practices billing traditional, fee-for-service Medicare for HMBC in 2022. Using Pitchbook Inc., we identified whether an acquisition occurred for each of these practices and categorized acquisition types as private equity (PE) firm buyouts, health system acquisitions, and other corporate acquisitions. We described most recent acquisition timing from 2012 to 2024 for this cohort of practices and compared 2022 practice characteristics by most recent acquisition status and type as of 2022, using this as a proxy to describe current practice ownership.
Results
The majority of HBMC practices in our cohort with any acquisition were acquired in 2022, with the greatest number of recent private equity firm buyouts in 2021. Among 2308 HBMC practices serving 476,088 Medicare fee-for-service patients in 2022, 12.6% of patients received care from PE-acquired practices, 2.4% from health system-acquired practices, and 5.0% from other corporate-acquired practices. Acquired practices were generally larger and cared for patients with slightly higher hierarchical condition category (HCC) scores who were less often high-needs qualified. Performance measures did not differ meaningfully between acquired and non-acquired practices.
Conclusions
A significant share of HBMC patients is cared for by practices that have been acquired, with further investigation warranted to understand potential effects on patient selection and care quality.
Journal of the American Geriatrics Society. June 15, 2026: 74(6):C1-C1
Journal of the American Geriatrics Society. June 15, 2026: 74(6):1525-1526
Journal of the American Geriatrics Society. June 15, 2026: 74(6):1849-1849