In 2025, the Centers for Medicare and Medicaid Services (CMS) began requiring hospitals participating in the Hospital Inpatient Quality Reporting (IQR) program to report on a new "Age-Friendly Hospital Measure." The hope is that, by attesting to this measure, hospitals will develop evidence-based processes to improve care for older adults in hospital settings.

On this week's podcast, we explore this new measure with Sheri Ling, CMS's Deputy Chief Medical Officer serving in the Center for Clinical Standards and Quality (CCSQ). We've also invited some returning guests from our past Age Friendly Health Systems podcast, Julia Adler-Milstein and Stephanie Rogers, to discuss how they are thinking about this new measure and how we should operationalize it.

We go over everything you will want to know about the new measure, including:

• How does this CMS measure differ from both Age-Friendly Health Systems and the 4Ms movement we've been hearing about for years (and that we did the podcast on in 2020 here)

• Why is CMS finally making "Age-Friendly" a formal, structural requirement for hospitals now?

• What is an attestation measure vs outcome measure, and why is this one an attestation measure?

• A deeper dive into the 5 domains to the measure (Eliciting Patient Goals, Medication Management, Frailty Screening, Social Determinants of Health, and Leadership/Governance.

Lastly, here are some great resources if you want to help get this started at your hospital:

• A report by JAHF, Julia and others on how to think about different dimensions of measure performance

• Health Affairs Scholar paper on related the 4Ms to the 5 domains

• Two CMS resources with detailed information on how to meet and report on the five domains of this measure:

• • Age-Friendly Hospital Specifications (July 2025)

  • Age-Friendly Hospital Measure Attestation Guide

A few weeks ago, I was skimming this NEJM paper for UCSF's Division of Geriatrics Journal club on de-prescribing anti-hypertensive medications for older adults in nursing homes. Seemed to make a world of sense. The study found no difference between the deprescribing arm and the usual care arm in mortality, the primary study outcome. I thought, great! So we can deprescribe anti-hypertensives without changing mortality, that must be what the authors concluded.

I was shocked, therefore, to read in the first paragraph of the discussion that the deprescribing arm did not achieve the hypothesized 25% reduction in mortality. What?!? Why would deprescribing be associated with reduced mortality? That's not the main reason or even the first reason I think of for deprescribing. Reducing side effects that impair quality of life, sure. Less pill burden, of course. But prolonged life? Seemed a stretch.

Today we hear from the first author of this study, Athanase Benetos, an esteemed geriatrician-researcher from France. For context, we also interviewed Mike Steinman, co-chair of the Beers criteria and co-lead of the US Deprescribing Research Network.

We learned about:

• Why the hypothesis of reduced mortality in deprescribing was justified, based on natural decreases in blood pressure with aging, and the Partridge study, an observational study that found higher risks of mortality associated with using multiple anti-hypertensive and low blood pressure.

• Why mortality was chosen as the primary outcome.

• Is a negative superiority study the same as what they might have found in a non-inferiority study? (stay with us)

• Variation in outcome by frailty status

• How to place this study in context with other research, such as the Danton study mentioned on a recent podcast about deprescribing near the end of life. Dantos was a study of deprescribing for nursing home residents with dementia that was stopped early due to safety concerns. Other studies for context include Sprint, Optimize, and an observational study by Bocheng Jing (UCSF statistician in our group).

At the end, we ask our guests to put it together. With all that we know at this point, what's a clinician to do? To deprescribe or not to deprescribe?

And, zoot alors! I get to sing Hymne A L'amour in French! Athanase recounts the moving story of how Edith Piaf sang this song the night she learned the man she loved, Marcel Cerdan, died in a plane crash.

-Alex Smith

It's an era of breakthroughs in Alzheimer's research, yet for many clinicians, it's also a time of profound uncertainty. We are currently navigating competing definitions of the disease, multiple new biomarkers coming on market seemingly every week, and the clinical rollout of new amyloid antibodies.

How do we translate this rapid-fire science into daily practice? On this week's GeriPal podcast, we sit down with dementia experts Halima Amjad, Barak Gaster, and Heather Whitson. We dive deep into:

• The evolving definitions of Alzheimer's disease. Does someone have Alzheimer's disease if you have only an abnormal biomarker as defined by the Alzheimer's Association, or is amyloid pathology necessary but not sufficient to define Alzheimer's as per the International Working Group (IWG) recommendations?

• Where do blood-based biomarkers for Alzheimer's fit into the diagnostic workup, and should they be used at all in primary care? FYI - here is my take on that question in a recent JAMA IM article titled "The Limited Role of Alzheimer's Disease Blood-Based Biomarkers in Primary Care."

• What's the role of amyloid antibodies in the care of individuals with Alzheimer's disease, including who to use them on?

We covered a lot and discussed some of these resources that you can do a deeper dive on:

• Blood-based biomarker resources

• • JAMA article on Blood-Based Biomarkers for Alzheimer's Disease: Preventing Unintended Consequences

  • Alzheimer's Dementia article on Blood-based biomarkers for detecting Alzheimer's disease pathology in cognitively impaired individuals within specialized care settings: A systematic review and meta-analysis

  • JAMA IM article on The Limited Role of Alzheimer Disease Blood-Based Biomarkers in Primary Care

• Appropriate use recommendations for amyloid antibodies

• • Donanemab: Appropriate use recommendations

  • Lecanemab: Appropriate Use Recommendations

• Primary Care Resources

• • Cognition in Primary Care program

  • A JAGS article on "Large Health System Quality Improvement Intervention Providing Training and Tools to Improve Detection of Cognitive Impairment in Primary Care"

• Other resources

• • AGS's new online curriculum for Alzheimer's Disease

By Eric Widera