Geriatrics

Proactive care coordination before hospitalization did not reduce ED visits or hospitalizations

Randomized trial in 400 adults ≥65 with CVD risk and highly fragmented outpatient care compared proactive outreach versus usual post‑hospital coordination. No difference in ED visits or hospitalizations (0.25 vs 0.21 events per 100 person‑days; P=0.29). Uptake was low: 26.5% of eligible intervention patients accepted proactive coordination versus 100% in usual care. Conclusion: offering coordination earlier did not improve utilization and many patients declined help, suggesting targeted allocation may be preferable. 1

Older veterans face structural, usability, and age‑bias barriers to video telehealth

Formative ethnography observed 20 veterans ≥65 during pharmacist video visits, documenting previsit and in‑visit barriers. Common problems included broadband/device access and audio‑video setup difficulties requiring technical support. Investigators identified 'digital ageism'—internalized age expectations and surprised pride after success—distinct from access issues. Implication: design telepharmacy trials to address access, usability, and age‑related expectations to improve recruitment and engagement. 2

Swiss EHR model modestly discriminates but poorly calibrates for 30‑day readmission

Retrospective cohort of 9,429 discharges age ≥65 developed a logistic model predicting unplanned 30‑day readmission (19.6% event rate). Predictors included polypharmacy (OR 1.83), home care (OR 1.61), male sex (OR 1.42), comorbidity count (OR 1.12/diagnosis), shorter stay, and younger age. AUC was 0.716 but calibration was poor and sensitivity at a 10% threshold was 7.5%, limiting clinical utility. Recommendation: do not deploy this model for automated interventions until externally validated and recalibrated. 3