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Parkinson's disease (PD) is a neurological disorder with increasing prevalence and use of medical services. Both ageing and geographic locality have been shown to be associated with the prevalence of PD. Therefore, the purpose of this research was to determine the influence of ageing and locality on medical service use in PD. A retrospective data linkage analysis. Data were acquired from the Sax Institute's 45 and Up Study baseline and linked with the Social, Economic and Environmental Factors (SEEF) and Medicare Benefits Schedule (MBS) databases. Statistical analyses were performed on participant age and locality and persons who self-reported with PD living in New South Wales, Australia. A total of 1676 persons self-reported with PD from the 45 and Up Study baseline and were linked to the SEEF and MBS databases. Linear regression analysis showed increased likelihood for use of medical specialist services (46.9% for Neurology and 25.9% for Pathology) in major cities, however, there was a 44.9% increased use of General Practitioner (GP) services in rural, regional, remote (RRR) locality (p&#xa0;<&#xa0;0.01). Moreover, a reduced Neurology and Pathology service use beyond the statistical age threshold was shown in PD (p&#xa0;<&#xa0;0.05). Specialist medical and support services are influential in the early stages of diagnosis and in maintaining health-related quality of life in persons with PD. Disparities in the use of medical services were identified between geographic locality and ageing in persons with PD. The increased use of GP services may be associated with reduced accessibility to medical specialist services in RRR localities.

One in four persons with a uterus is unable to afford menstrual products, with even higher prevalence among low-income populations, an unmet need that contributes to preventable infections, missed school and work, and persistent health inequities. Despite the essential role of menstrual products in basic health and hygiene, many public health coverage programs across the United States, including Medicaid and other assistance programs, continue to exclude items such as pads and tampons. This gap disproportionately harms individuals who already face significant economic and health disparities. Although Flexible Spending Accounts and Health Savings Accounts now permit the use of funds for menstrual products, these mechanisms primarily benefit individuals with stable employment and disposable income, leaving the most vulnerable populations unprotected. Continued exclusion by insurance and assistance programs imposes an unnecessary financial and health burden and undermines dignity and well-being. Federal and state policymakers, including Congress, the Centers for Medicare & Medicaid Services, and state Medicaid agencies, have clear authority to address this inequity by expanding definitions of "durable medical equipment" and "hygiene supplies" to explicitly include menstrual products and by removing administrative barriers to coverage. The American Medical Women's Association calls for federal action to classify menstrual products as essential health services under Medicaid and other public assistance programs.

Disparities in interfacility transfer of patients with acute ischemic stroke have been identified at the regional level, but a national analysis has not been conducted. This study aims to evaluate patient-level trends and disparities in transfer rates based on sex, race, ethnicity, and insurance status using the Get With The Guidelines-Stroke registry. The Get With The Guidelines-Stroke registry was used to identify patients admitted with acute ischemic stroke between January 2016 and December 2021. We examined patient transfer rate by race/ethnicity groups and by patient insurance status. Odds of transferring out among each demographic group were calculated using a multivariable generalized linear mixed-effect model accounting for patient- and hospital-level confounders. Models were stratified by sex to test for any potential interaction between sex and race/ethnicity or insurance status. Among 776&#x2009;556 patients transferred out of 1333 sites, Hispanic and Black patients had lower odds of being transferred compared with non-Hispanic Whites among both males and females after adjustment for stroke severity and hospital characteristics (odds ratio [OR], 0.79 [95% CI, 0.74-0.84] for Hispanic females; OR, 0.88 [95% CI, 0.83-0.93] for Hispanic males; OR, 0.80 [95% CI, 0.76-0.83] for Black females; and OR, 0.84 [95% CI, 0.81-0.88] for Black males). Differences in transfer frequency were also noted based on insurance status. In the unadjusted model and model adjusted for stroke severity, patients of all non-Medicare payment groups had higher odds of being transferred out compared with Medicare patients. However, after also adjusting for hospital characteristics, patients with Medicaid had a lower frequency of transfer compared with patients with Medicare among males and females (OR, 0.75 [95% CI, 0.71-0.78] for females with Medicaid; OR, 0.78 [95% CI, 0.75-0.82] for males with Medicaid). In this large, nationwide cohort of patients with acute ischemic stroke, Black and Hispanic patients were less likely to be transferred than non-Hispanic White patients, and patients with Medicaid were less likely to be transferred than patients with Medicare. Further work is needed to understand the contributors to this disparity and the impact on access to high-quality stroke care.

Race and ethnicity measures in administrative data can vary geographically. The extent of this challenge in US nursing homes is not well described. To describe geographic variation in missing race and ethnicity data in the Minimum Data Set (MDS) 3.0 and Medicare claims, and to compare discrepancies across data sources. Cross-sectional study. Medicare beneficiaries with MDS 3.0 records between 2014 and 2018. The Medicare Beneficiary Summary File provided demographic information. Missingness of MDS race and ethnicity data by state, and misclassification of Medicare race and ethnicity enrollment database (EDB) and Research Triangle Institute (RTI) variables compared with MDS. We calculate the sensitivity, specificity, and positive predictive value of the EDB and RTI variables relative to the MDS. Among 18.1 million nursing home residents pooled across 2014-2018, geographic variation in missing race and ethnicity in the MDS 3.0 ranged from 1.2% to 14.7%. Compared with MDS, misclassification of residents classified as Hispanic in MDS ranged from 48.1% to 89.2% for EDB and 0.5% to 44.8% for RTI. Misclassification of residents classified as Asian American/Pacific Islander in MDS ranged from 29.4% to 77.2% for EDB and 12.7% to 65.4% for RTI. Misclassification of residents classified as Black ranged from 0% to 14.2% for EDB and 0% to 16.2% for RTI. Overall, the RTI variables provided better sensitivity and specificity of race and ethnicity than the EDB. Missing race and ethnicity data in the MDS varies geographically, as do discrepancies between MDS and EDB and RTI variables. Thoughtful consideration of these issues is recommended when handling missing MDS race and ethnicity data.

A disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS4) has been implicated in arthritis and lung fibroblast activation; however, its role in liver homeostasis and fibrogenesis remains largely unexplored. Here, we investigated the functional significance of ADAMTS4 in liver fibrosis. We found that hepatic ADAMTS4 mRNA expression was significantly elevated in patients with fibrotic steatohepatitis. In mouse models of liver fibrosis, genetic deletion of ADAMTS4 protected against liver fibrogenesis, accompanied by a marked reduction in the recruitment of myeloid-derived infiltrating macrophages. Mechanistically, ADAMTS4-mediated cleavage of versican generated versikine, which promoted macrophage migration and differentiation toward a pro-inflammatory phenotype in vitro. In addition, tumor necrosis factor (TNF)&#x3b1; significantly increased both the mRNA expression and protein secretion of ADAMTS4. Furthermore, ADAMTS4 directly induced collagen accumulation through activation of signal transducer and activator of transcription 3 (STAT3) in LX2 cells. To explore the potential genetic regulation of ADAMTS4 expression, we performed response-eQTL analysis in patients with metabolic dysfunction-associated steatotic liver disease and identified a single-nucleotide polymorphism associated with increased ADAMTS4 expression in a subset of patients carrying a specific genotype. Collectively, our findings identify ADAMTS4 as a critical regulatory factor that promotes the recruitment of myeloid-derived infiltrating macrophages and collagen accumulation during liver fibrogenesis, suggesting that targeting ADAMTS4 may represent a potential therapeutic strategy for liver fibrosis.

Mobility is a critical determinant of healthy aging. Agility, gait, balance, and fall risk, when left unassessed and unaddressed, may diminish older adults' ability to age in place, often leading to more restrictive, supervised care environments. This study examined racial and ethnic disparities in a composite mobility/functional measure in Hawai'i and the associations of selected social determinants of health (SDOH) with limitation status. We analyzed data from the Hawai'i Behavioral Risk Factor Surveillance System collected from 2019 through 2021. The study population included community-dwelling adults aged 55 years or older from the 4 largest racial and ethnic groups in Hawai'i: White, Filipino, Japanese, and Native Hawaiian (unweighted n = 10,039; weighted population estimate = 350,922). We used weighted logistic regression to assess associations between mobility limitations and SDOH. Mobility limitations were reported by 28% of Native Hawaiian people aged 55 years or older, compared with 17% to 19% among other groups. Native Hawaiian adults aged 55 to 64 years also had substantially higher prevalence of mobility limitations than adults of the same age in other racial and ethnic groups. Higher income was protective against mobility limitations for both Native Hawaiian and White adults. In contrast, the associations of education and health insurance with mobility limitations varied across groups, with weaker protective associations of education among Native Hawaiian adults. Findings suggest the importance of considering mobility-focused prevention and assessment for Native Hawaiian adults before the Medicare eligibility age of 65 years. To be effective, these interventions must be culturally grounded and tailored to the unique needs and lived experiences of Native Hawaiian communities.

Federal policy mandates adequate nursing home (NH) staffing, yet staffing adequacy remains difficult to define and measure. In 2022, the Centers for Medicare & Medicaid Services (CMS) incorporated annual turnover into Five-Star Ratings but adopted a definition excluding staff below a 120-hour-in-90-days threshold, potentially underestimating turnover and weakening validity. Using Payroll-Based Journal and CareCompare data (2020Q2-2024Q1), we replicated CMS-reported turnover and constructed an inclusive measure counting new hires. We assessed divergence between definitions, associations with ten standardized CMS quality indicators, and changes in facility rankings. By 2022-2023, 45% of nursing hires were excluded under CMS's definition. As short-term staffing increased, CMS-specification and inclusive turnover diverged (correlation 0.91-0.82). Associations with quality outcomes were modest and similar across definitions. However, facility rankings differed substantially: only 30% of facilities remained in the same turnover decile, with reclassification concentrated among NHs with high short-term attrition, greater contract use, and distinct ownership and payer mix. CMS turnover metrics miss nearly half of turnover, understating instability and reshaping facility comparisons without improving associations with quality outcomes. As short-term staffing expands, the CMS measure risks becoming less informative about workforce instability, underscoring how metric definitions shape oversight and reporting.

In response to the COVID-19 pandemic, federal policymakers temporarily lifted long-standing restrictions on telemedicine, resulting in an unprecedented and rapid expansion of virtual care across video, audio, and asynchronous modalities. When integrated into longitudinal care relationships, telemedicine can increase access, reduce patient burden, and support continuity for people facing geographic, mobility, or socioeconomic barriers. However, telemedicine also introduces new clinical, regulatory, equity, and safety challenges that require deliberate policy design. Beyond its clinical considerations, telehealth offers environmental and logistical benefits, including reduced travel time and cost, decreased fuel consumption, lower transportation expenses, and lower greenhouse gas emissions. In this position paper, the American College of Physicians updates its previous policy paper on telemedicine to reflect changes in payment policy, licensure, prescribing authority, and utilization patterns that have occurred over the past decade and accelerated during the COVID-19 public health emergency. This paper focuses on access, payment policy, licensure, prescribing practices, equity, and patient safety across federal and state programs and private payers and emphasizes the conditions under which telemedicine should be integrated into clinical practice. Key developments addressed include the expansion and partial lapse of Medicare telemedicine waivers, evolving U.S. Drug Enforcement Administration rules governing prescribing, increased reliance on interstate practice, and normalization of telemedicine by private payers.

Gender-based reimbursement disparities in orthopedic surgery remain poorly understood, particularly when accounting for practice composition and setting. The purpose of this study was to compare and evaluate gender-based differences in Medicare reimbursement and practice patterns among female and male orthopedic surgeons. A cross sectional analysis of public Medicare data from 2013 to 2021 was performed. Outcomes included annual Medicare payments, submitted charges, total services, service categories, and beneficiaries treated by orthopedic surgeons who bill Medicare. Univariate and multivariable analyses quantified differences in payment, practice volume and composition, geographic adjustment, and Current Procedural Terminology (CPT)-matched reimbursements. A total of 29,357 orthopedic surgeons (27,442 men and 1,919 women) billed Medicare fee-for-service during the study period. Female surgeons, on average, submitted 48.3% fewer total charges and received 44.1% lower annual Medicare payments per surgeon compared with male surgeons. These differences persisted after multivariable regression adjusted for practice metrics and excluded top and bottom earners. Female surgeons also billed fewer services, treated fewer beneficiaries, and submitted fewer unique CPT codes. However, payment disparities persisted even after matching surgeons by volume of services, beneficiaries, and years in practice. Male surgeons performed higher volumes of all 10 highest-paying orthopedic CPT codes. In CPT matched analyses, female surgeons received lower reimbursement per service than male surgeons performing identical procedures. These findings suggest that the observed gender-based disparities in orthopedic surgery Medicare reimbursement cannot be explained by differences in volume, procedural mix, or geographic practice cost. Instead, they likely reflect a combination of structural and behavioral mechanisms described in prior literature that may influence how access to clinical opportunities, referrals, and reimbursement practices unfold in surgical practices. Variations in coding practices may represent an important focus for future investigation and targeted educational initiatives. Level III, Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.

To examine national trends in Medicare office-based procedures for chronic rhinitis and nasal obstruction, emphasizing minimally invasive interventions such as posterior nasal nerve (PNN) ablation and nasal valve repair with radiofrequency ablation. Retrospective longitudinal analysis of Medicare physician and provider utilization data from 2017 to 2023. Office-based procedural care across the United States. Current Procedural Terminology (CPT) codes 30117 (destruction of intranasal lesion), 30140 (inferior turbinate submucous resection), 31295 (maxillary balloon dilation), and 30802 (radiofrequency inferior turbinate reduction) were analyzed, focusing on office-based procedures. CPT 30117 served as a surrogate for PNN ablation and nasal valve repair using radiofrequency ablation. Annual service counts, beneficiaries, Medicare payments, total spending, provider-level adoption, geographic distribution, and early adopter patterns were analyzed. Linear regression evaluated trends over time (P&#x2009;<&#x2009;.05). From 2017 to 2023, CPT 30117 services rose from 1009 to 11,409 (compound annual growth rate [CAGR] 49.8%), 30140 increased from 3218 to 5792 (CAGR 10.3%), 31295 slightly declined (10,3120&#x2009;&#x2192;&#x2009;9180; CAGR -1.9%), and 30802 declined from 1353 to 863 (CAGR -7.2%). Spending grew sharply for 30117 ($0.41M &#x2192; $5.08M; +1139%) and 31295 ($12.36M &#x2192; $15.4M; +25%), modestly for 30140 ($0.89M &#x2192; $1.05M; +18%), and declined for 30802 ($0.19M &#x2192; $0.10M; -47%). Texas, Florida, and Arizona had concentrated utilization. In-office use of CPT 30117 has grown rapidly, outpacing other nasal procedures, reflecting the adoption of new PNN ablation and nasal airway remodeling devices. These trends underscore the need for ongoing evidence development, with further clarification anticipated following new device and procedure-specific coding.

Leading oncology societies recommend assessing pre-treatment frailty to guide care for older adults with cancer. However, frailty may change post-diagnosis. This study characterized post-diagnosis frailty and its association with overall survival among older women with ovarian cancer. We included 24,725 women aged 65+ diagnosed with ovarian cancer between 2000 and 2019 from Surveillance, Epidemiology, and End Results (SEER)-Medicare. Frailty was quantified at diagnosis and 1-3&#xa0;years post-diagnosis using a validated claims-based index. We compared patients' frailty at the beginning and end of each year. At 1, 2, and 3&#xa0;years post-diagnosis, we fit a Cox proportional hazards model including frailty at diagnosis and current frailty to assess associations with survival. Frailty distribution at diagnosis was: 7.1% non-frail, 71% pre-frail, 18% mildly frail, 3.4% moderately frail, and 0.9% severely frail. During year 1, 38% of women maintained frailty status, 4% improved, 26% worsened, and 32% died. In years 2-3, some women remained stable while others improved or worsened. There were 21,309 deaths during a median follow-up of 25&#xa0;months (interquartile range 7-58). Frailty at diagnosis was not associated with survival after adjusting for current frailty (hazard ratios [HRs] for severely frail versus non-frail =0.98, 1.00, 0.76 at 1, 2, 3&#xa0;years, respectively, all p-values>0.20). Current frailty was strongly associated with survival, and the association increased over time (HRs =2.26, 2.77, 3.70, respectively; all p-values<0.001). Post-diagnosis frailty is dynamic. Current frailty has a stronger association with overall survival compared to frailty at diagnosis. Repeated frailty assessments should be incorporated into clinical practice.

In 2024, 6.9 million Americans lived with Alzheimer's disease and related dementias (ADRD), with nursing homes serving as a major site of care. Antidepressants are the most prescribed psychotropic medications among nursing home residents with ADRD, yet detailed information on prescribing patterns, potential indications, and associated resident and facility characteristics remain limited. Using 2018 minimum data set 3.0 assessments linked to Medicare claims, we conducted a cross-sectional study of long-stay nursing home residents aged &#x2265;&#x2009;65&#x2009;years with ADRD who were continuously enrolled in Medicare fee-for-service for 120&#x2009;days before their annual assessment. We described usage by drug class and type and compared characteristics of users versus non-users overall and by potential indications: depression, anxiety, pain, and insomnia. Among 232,543 residents with ADRD, 51.6% used antidepressants. Fewer than 5% had moderate or severe depressive symptoms (PHQ-9&#x2009;&#x2265;&#x2009;10). Use was highest among residents with depression or anxiety (69.5%), pain (61.9%), and insomnia (60.0%). Among those without these conditions, 14.1% were prescribed antidepressants. SSRIs were the most prescribed class (60.7%) overall. Citalopram, mirtazapine, sertraline, and trazodone were the most common medications. Residents with any current level of depression severity were more likely to use antidepressants compared to those without symptoms, whereas all levels of cognitive impairment were associated with lower use compared with cognitively intact residents with ADRD. Polypharmacy was strongly associated with increased use, while diabetes, heart failure, and stroke were associated with reduced use. Antidepressants were frequently prescribed to residents with ADRD despite limited documentation of active depressive symptoms. Limitations in accurately capturing depressive symptoms in nursing home records, including underreporting by residents due to cognitive impairment and reliance on staff observation rather than self-report, may contribute to apparent discordance between symptoms and prescribing. Further research should evaluate treatment appropriateness, deprescribing opportunities, and risk-benefit balance of chronic treatment in this population.

To develop a random survival forest (RSF) machine learning (ML) model for predicting venous thromboembolism (VTE) risk in rheumatoid arthritis (RA) patients initiating biological (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) and compare its model performance with a regularized Cox regression (RegCox) model. This retrospective cohort study using the 5% Medicare data (2012-2020) identified older RA patients (&#x2265; 65&#x2009;years) initiating b/tsDMARDs (index date), including tumor necrosis factor inhibitors (TNFi) bDMARDs, non-TNFi bDMARDs, and tsDMARDs between January 1, 2013, through December 31, 2019. Study cohort was followed until an incident composite VTE event or censoring. Data were divided into training (75%) and testing (25%) sets. The RSF model was trained to predict VTE events during the follow-up period in the training set, with the RegCox model as the reference model. The performance of these models was evaluated in the testing data using the C-index. Variable importance of the predictors was assessed. Of 3,648 RA patients, 360 (9.87%) experienced any VTE event. The RSF model had better performance (C-index [95% CI]&#x2009;=&#x2009;0.609[0.602-0.617]) than the RegCox model (C-index [95% CI]&#x2009;=&#x2009;0.599[0.597-0.602], p&#x2009;=&#x2009;0.0021). Variables commonly identified as the top influential variables were varicose veins, inpatient visits, Elixhauser score, emergency room visits, and outpatient visits. The RSF model performed slightly better in identifying VTE in RA patients after b/tsDMARDs initiation than RegCox. Incorporating additional clinical and contextual information beyond claims data may further enhance predictive accuracy in future studies. Biological (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) are newer medications that can treat rheumatoid arthritis (RA). However, recent randomized controlled clinical trials found the tsDMARDs may increase the risk of venous thromboembolism (VTE) among patients with RA. In this study, we developed a novel random survival forest (RSF) machine learning model to predict the VTE risk involving 3,648 older adults (&#x2265;65) with RA who were newly prescribed b/tsDMARD. Our results suggested that the RSF model achieved modest improved performance compared to the RegCox model in predicting the risk of VTE among these older adults with RA. Our findings from the RSF model may help rheumatologists better understand the high-risk RA patient profile who may be at risk of VTE. Incorporating additional variables from other datasets may improve the RSF&#x2019;s model performance.

Coronary artery calcification (CAC) and mitral annular calcification (MAC) reflect cardiovascular aging and systemic atherosclerosis and have each been associated with the risk of atrial fibrillation (AF). To examine the joint associations of CAC and MAC with incident AF in the Multi-Ethnic Study of Atherosclerosis (MESA). CAC and MAC were assessed using cardiac computed tomography and quantified by Agatston scoring. Participants were categorized into four groups: no CAC and no MAC (reference), CAC present without MAC, MAC present without CAC, both CAC and MAC present. Incident AF was identified through hospitalization records and Medicare claims. Multivariable-adjusted Cox proportional hazards models examined the association between CAC/MAC categories and incident AF. Improvement in AF risk prediction with the addition of CAC and MAC to Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE-AF) risk score was assessed using Harrell's C-statistic. Among 6588 participants (mean age 62 &#x200b;&#xb1; &#x200b;10 years; 53% female) free of baseline AF, 1306 incident AF events occurred over a median follow-up of 16.5 years. Participants with both CAC and MAC present had the highest risk of AF. Compared with the reference group, CAC present without MAC, MAC present without CAC, and both CAC and MAC present were associated with 39%, 74%, and 96% higher risks of incident AF, respectively. Addition of CAC and MAC improved discrimination of the CHARGE-AF model (C-statistic 0.746 to 0.754; p &#x200b;< &#x200b;0.01). CAC and MAC were jointly associated with incident AF, and their inclusion in a risk score improved AF risk prediction.

Advanced practice providers (APPs) are increasingly involved in surgical care delivery. This study analyzed Medicare data for total joint arthroplasty services delivered by APPs and explored their geographic distribution and practice characteristics. A retrospective analysis was conducted using Medicare data from 2014 to 2023. Providers submitting claims for arthroplasty-related services were identified and classified by provider type. Demographic characteristics, practice locations, billing trends, and payment ratios were analyzed over the study period. Monetary values were adjusted for inflation to 2023 dollars. There were 187,481 unique providers providing arthroplasty-related services over the study period. Most were orthopaedic surgeons (n = 121,087, 65%), and fewer were APPs (n = 66,394, 35%). The number of APPs increased 87% over the study period compared with a 17% increase observed among surgeons. The APPs were more likely to practice in rural areas (11 versus 7%), be newer in practice (11 versus 23 years), and have fewer office visits (32 versus 43) (all P < 0.001). The mean payment ratios were lower for APPs than surgeons (0.14 versus 0.22; P < 0.001) and decreased for both provider groups over the study period. Projections to 2030 demonstrated 15,782 orthopaedic surgeons (56%), 9,752 physician assistants (34%), and 2,884 nurse practitioners (10%) providing arthroplasty-related services. The proportion of APPs providing arthroplasty-related services increased significantly from 2014 to 2023. Further work is needed to delineate APP responsibilities in total joint arthroplasty, including the development of standardized training pathways and evidence-based guidelines to support multidisciplinary care delivery.

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Falls are a leading cause of preventable injury and disability among older adults. Although fall risk screening is routine in the Medicare Annual Wellness Visit (AWV), timely follow-up after a positive screen is often lacking. We implemented a primary care-based quality improvement initiative to increase the rate of fall risk prevention interventions provided to older adults at elevated fall risk. We conducted a retrospective study of patients aged &#x2265;&#x2009;65&#x2009;years who completed an AWV between September 2024 and October 2025 and screened positive for fall risk using a three-item screener and confirmed with an abnormal Timed Up and Go (TUG) test. On January 1, 2025, we implemented a package of two quality improvement strategies to improve the uptake of evidence-based fall prevention interventions. First, we implemented a SmartSet in the Electronic Health Record which guides clinicians to select a clinically appropriate follow-up after a positive fall risk screen, and second, the geriatrics clinic proactively reached out to eligible patients to schedule comprehensive fall and bone health assessments. We evaluated follow-up rates over time. Outcomes measured 120&#x2009;days post-screening during the AWV included: (1) the proportion of patients &#x2265;&#x2009;65 with any documented follow-up action post-screening (physical therapy referral, case management visit, geriatrics referral, or geriatrics clinic visit), (2) any geriatrics referral, (3) any geriatrics visit, (4) any physical therapy referral, and (5) any case management referral. Three hundred thirty-five patients aged &#x2265;&#x2009;65&#x2009;years completed an AWV, screened as positive for fall risk, and had an abnormal TUG. Any follow-up increased from 53.8% to 67.8%. Follow-up geriatrics clinic visits increased from 7.5% to 40.4%. Primary care referral rates to geriatrics, physical therapy referrals and case management referrals remained stable. A proactive package of implementation strategies embedded in primary care significantly improved follow-up rates after positive fall risk screening.

This study identifies the long-term and short-term users of home-delivered meals, i.e., Meals on Wheels (MOW) services, and how they differ across socioeconomic and health status. The analysis relies on a nationally representative sample of 65+ Medicare beneficiaries from the 2013-2021 National Health and Aging Trends Study. A fixed effect multinomial logit model, with lagged indicators and complex survey design, predicts the probabilities of being a short-term (1&#xa0;year or less) or long-term (2+ years) MOW client. Beneficiaries' characteristics predictive of long-term MOW use include identifying as Black, being on Medicaid, pre-frail, and having 2+ IADL limitations. Medicaid enrollment is one of the few statistically significant predictors for short-term MOW use. These results reveal that long-term MOW users are more heterogeneous and vulnerable than short-term users. Understanding the reasons various individuals rely on MOW services for multiple years may inform policy on the social and care needs of older adults.

Public health emergency waivers enacted during the COVID-19 pandemic dramatically expanded telemedicine use. Expiration of these waivers would limit access to this convenient care option for older adults, but it is unknown how expiration would affect patients' burden of care, quantified as health care contact days (days receiving in-person care). To measure the extent to which telemedicine days experienced by older adults enrolled in traditional Medicare may supplement in-person health care contact days and to estimate how telemedicine waiver expiration could increase the number of health care contact days. This is a cross-sectional study of the 2022 Medicare Current Beneficiary Survey examining a nationally representative sample of community-dwelling adults aged 65 years or older enrolled in traditional Medicare. Data analysis was performed from March 2025 to March 2026. The primary outcomes were total telemedicine days (days with any telemedicine service) and additional health care contact days if telemedicine waivers expired (telemedicine days converted to in-person contact days, assuming 100% substitution). Multivariable logistic and Poisson regressions evaluated associations between patient characteristics and the probability and rate of additional health care contact days. Among 5151 community-dwelling older adults (weighted number, 27&#x202f;321&#x202f;585 individuals; mean [SD] age, 74.6 [7.0] years; 2496 female individuals [52.4%]), 1294 (weighted 22.7%) used telemedicine. Telemedicine use varied widely (median [IQR], 1 [1-3] telemedicine day; maximum, 91 days), with 10.5% of telemedicine users (135 respondents) accounting for 50% of all telemedicine days. If telemedicine waivers expired and all affected telemedicine services were substituted with in-person services, 74.1% of older adults (951 respondents) using telemedicine would experience at least 1 additional health care contact day, totaling 8&#x202f;772&#x202f;118 additional contact days. Having more chronic conditions (adjusted odds ratio for >10 conditions, 8.42; 95% CI, 5.44-13.00) and difficulty getting places (adjusted odds ratio, 1.29; 95% CI, 1.10-1.53) were associated with higher odds of additional contact days. This cross-sectional study of older adults enrolled in traditional Medicare found that most older adults using telemedicine would experience additional health care contact days if telemedicine waivers expired and all affected telemedicine services were substituted with in-person services. The resulting burden would fall disproportionately on adults with multiple chronic conditions and difficulty getting places, potentially exacerbating access barriers for patients most in need of care.