{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:46:42Z","timestamp":1791254802371,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,1,22]],"date-time":"2020-01-22T00:00:00Z","timestamp":1579651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2020,4]]},"abstract":"\n BACKGROUND<\/jats:title>\n Anticoagulation (AC) for stroke prevention in long\u2010term care (LTC) residents with atrial fibrillation (AF) involves a challenging risk\u2010benefit evaluation. We measured the association of geriatric conditions with discontinuation of AC.<\/jats:p>\n <\/jats:sec>\n \n DESIGN<\/jats:title>\n Retrospective cohort analysis.<\/jats:p>\n <\/jats:sec>\n \n SETTING<\/jats:title>\n LTC facilities across the United States.<\/jats:p>\n <\/jats:sec>\n \n PARTICIPANTS<\/jats:title>\n A total of 48 545 individuals residing in LTC facilities in 2015 with AF and sufficient information to establish their status as someone who stopped AC vs someone who continued AC.<\/jats:p>\n <\/jats:sec>\n \n MEASUREMENTS<\/jats:title>\n \n We measured the association of six geriatric conditions\u2014recent fall, severe activity of daily living (ADL) dependency (21\u201028 on a 28\u2010point scale), mobility impairment, cognitive impairment, body mass index (BMI) less than\u200918.5 kg\/m\n 2<\/jats:sup>\n , and weight loss (\u22655% in 1 month or\u2009\u226510% in 6 months)\u2014with discontinuation of AC. To identify cases of discontinuation, we required a pattern of being on AC over two consecutive recordings of the Minimum Data Set, the nursing home quality control data set recorded every 90\u2009days, followed by two assessments being off AC\u2014pattern of \u201con\u2010on\u2010off\u2010off.\u201d By contrast, we required a pattern of \u201con\u2010on\u2010on\u2010on\u201d for continuers. We then constructed six logistic regression models to measure the independent association between each geriatric condition and discontinuation of AC, adjusted for CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc stroke risk score, recent bleeding hospitalization, and other confounders.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n There were 4172 discontinuers and 44 373 continuers. Recent fall predicted a 1.9\u2010fold increase in the odds of discontinuation (odds ratio = 1.91; 95% confidence interval = 1.66\u20102.20), whereas mobility and cognitive impairment only increased the odds by 14% to 17%. Severe ADL dependency, BMI\u2009less than\u200918.5 kg\/m\n 2<\/jats:sup>\n , and weight loss of 10% each increased odds of discontinuation by 55% to 68%. CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc score did not predict discontinuation.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n \n Several geriatric conditions predicted discontinuation of AC, whereas CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc score did not. Future research should examine the association of geriatric conditions and discontinuation of warfarin discrete from newer anticoagulants and association of geriatric conditions with development of stroke and bleeding.\n J Am Geriatr Soc 68:717\u2013724, 2020<\/jats:bold>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.16335","type":"journal-article","created":{"date-parts":[[2020,1,22]],"date-time":"2020-01-22T05:24:40Z","timestamp":1579670680000},"page":"717-724","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Geriatric Conditions Predict Discontinuation of Anticoagulation in Long\u2010Term Care Residents With Atrial Fibrillation"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1300-7124","authenticated-orcid":false,"given":"Alok","family":"Kapoor","sequence":"first","affiliation":[{"name":"Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School Reliant Medical Group, and Fallon Health Worcester Massachusetts"},{"name":"University of Massachusetts Medical School Worcester Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gray","family":"Foley","sequence":"additional","affiliation":[{"name":"Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School Reliant Medical Group, and Fallon Health Worcester Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Zhang","sequence":"additional","affiliation":[{"name":"Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School Reliant Medical Group, and Fallon Health Worcester Massachusetts"},{"name":"Department of Health Policy and Promotion, School of Public Health and Health Sciences University of Massachusetts Amherst Amherst Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhua","family":"Zhou","sequence":"additional","affiliation":[{"name":"Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School Reliant Medical Group, and Fallon Health Worcester Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybil","family":"Crawford","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical School Worcester Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"McManus","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical School Worcester Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Gurwitz","sequence":"additional","affiliation":[{"name":"Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School Reliant Medical Group, and Fallon Health Worcester Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.05.063"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2005.01.006"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.516344"},{"issue":"4","key":"e_1_2_7_5_1","first-page":"600","article-title":"STOPPFrail (screening tool of older persons prescriptions in frail adults with limited life expectancy): consensus validation","volume":"46","author":"Lavan AH","year":"2017","journal-title":"Age Ageing"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfami.4.12.1017"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1997.00440300080006"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52117.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.20.2458"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw210"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.03.022"},{"key":"e_1_2_7_12_1","unstructured":"Long\u2010Term Care Facility Resident Assessment Instrument 3.0 User's Manual. (2015).https:\/\/www.cms.gov\/Medicare\/Quality\u2010Initiatives\u2010Patient\u2010Assessment\u2010Instruments\/NursingHomeQualityInits\/Downloads\/MDS\u201030\u2010RAI\u2010Manual\u2010V113.pdf. Accessed January 10 2020."},{"key":"e_1_2_7_13_1","unstructured":"Minimum Data Set (MDS)\u2010 Version 3.0. Nursing Home Comprehensive (NC) Item Set. (2011).https:\/\/www.cms.gov\/Medicare\/Quality\u2010Initiatives\u2010Patient\u2010Assessment\u2010Instruments\/NursingHomeQualityInits\/Downloads\/Archive\u2010Draft\u2010of\u2010the\u2010MDS\u201030\u2010Nursing\u2010Home\u2010Comprehensive\u2010NC\u2010Version\u20101140.pdf. Accessed January 10 2020."},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/gly265"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2318-9"},{"key":"e_1_2_7_16_1","unstructured":"World Health Organization. Mean Body Mass Index (BMI).2017.https:\/\/www.who.int\/gho\/ncd\/risk_factors\/bmi_text\/en\/. Accessed January 10 2020."},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1584"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31824e319f"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000575"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2008.616"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1062860608316109"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(96)00025-X"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2004.06.002"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-12-14"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.6.1385"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.18.2031"},{"issue":"20","key":"e_1_2_7_27_1","first-page":"2419","article-title":"Knowledge gaps in cardiovascular care of the older adult population: a scientific statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society","volume":"67","author":"Rich MW","year":"2016","journal-title":"J Am Geriatr Soc"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.16335","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.16335","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.16335","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.16335","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T16:49:14Z","timestamp":1762188554000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.16335"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,22]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1111\/jgs.16335"],"URL":"https:\/\/doi.org\/10.1111\/jgs.16335","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,22]]},"assertion":[{"value":"2019-11-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-12-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}