{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:02:34Z","timestamp":1789794154460,"version":"4.0.1"},"reference-count":50,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["3RF1AG069782\u201001S1"],"award-info":[{"award-number":["3RF1AG069782\u201001S1"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extreme temperatures and elevated fine particulate matter (PM2.5; particles 2.5\u2009\u03bcm or less) pose serious health risks for older adults. Nursing facility residents may be especially susceptible because they have complex health needs and limited ability to self\u2010protect, and because nursing facility construction and HVAC capacity can be insufficient to buffer indoor environments from outdoor extremes. Yet, nursing facility regulations address only indoor temperature with no comparable standards for indoor air quality, including PM2.5. We assessed whether outdoor extreme heat, extreme cold, and elevated PM2.5 were associated with emergency department (ED) visits and hospitalizations among nursing facility residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using 2017\u20132020 Medicare and Medicaid claims linked to daily weather data, we conducted longitudinal analyses with nursing facility fixed effects to estimate associations between extreme heat, extreme cold, and elevated PM2.5 (PM2.5\u2009&gt;\u20099\u2009\u03bcg\/m\n                      <jats:sup>3<\/jats:sup>\n                      ) and all\u2010cause ED visits and hospitalizations among dual\u2010eligible nursing facility residents aged 65\u2009years and older.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The sample included 24,784,081 nursing facility\u2010days from 24,760 facilities across 47 states and Washington, DC. Extreme temperature and elevated PM2.5 were associated with increased acute care utilization. On extreme heat days, ED visits and hospitalizations increased by 0.022 (95% CI, 0.003\u20130.041) and 0.025 (95% CI, 0.011\u20130.039) per 1000 resident\u2010days, respectively. On elevated PM2.5\u2009days, corresponding increases were 0.020 (95% CI, 0.013\u20130.027) and 0.017 (95% CI, 0.012\u20130.022) per 1000 resident\u2010days. Extreme cold was also associated with an increase in hospitalizations of 0.014 per 1000 resident\u2010days (95% CI, 0.001\u20130.027).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among nursing facility residents, acute care events increased on extreme temperature days despite the existing indoor temperature regulations. Acute care events also increased on elevated PM2.5\u2009days. These findings suggest that environmental exposures contributed to acute care utilization among nursing facility residents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70720","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T04:35:33Z","timestamp":1789792533000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Extreme Temperatures, Elevated\n                    <scp>PM2.5<\/scp>\n                    , and Acute Care Events Among Dual\u2010Eligible Nursing Facility Residents"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3177-7184","authenticated-orcid":false,"given":"Hyunjee","family":"Kim","sequence":"first","affiliation":[{"name":"Center for Health Systems Effectiveness Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clint","family":"Sergi","sequence":"additional","affiliation":[{"name":"Center for Health Systems Effectiveness Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Senders","sequence":"additional","affiliation":[{"name":"Center for Health Systems Effectiveness Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Courchaine","sequence":"additional","affiliation":[{"name":"Center for Health Systems Effectiveness Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Montrose","sequence":"additional","affiliation":[{"name":"Environmental and Radiological Health Sciences Colorado State University  Fort Collins Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan S.","family":"Walker","sequence":"additional","affiliation":[{"name":"School of Public and Community Health Sciences University of Montana  Missoula Montana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15715"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2023.121041"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.045751"},{"key":"e_1_2_8_5_1","unstructured":"American Heart Association \u201cHeart Disease & Stroke Statistics Update Fact Sheet Older Adults & Cardiovascular Diseases in the United States \u201d2026 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