Stephanie W. Chow

Background: Frail older adults undergoing surgery are at increased risk for postoperative complications, functional decline, and prolonged hospitalization. Although comprehensive geriatric assessment (CGA) is increasingly recognized as valuable in surgical care, feasible approaches for ambulatory preoperative assessment remain limited. Methods: We conducted a prospective cohort study of patients aged 65 years and older referred to an ambulatory preoperative geriatrics program at a large academic medical center between January 2022 and May 2024. Patients underwent CGA guided by the 7Ms framework, which extends the American Geriatrics Society 5Ms framework by incorporating Maintaining Care and Meals. Outcomes included the prevalence and patterns of geriatric syndromes, the types and frequency of preoperative recommendations, and process measures assessing program feasibility. Results: Sixty‐three older surgical patients were enrolled (mean age 81.7 years). Geriatric syndromes were common, including use of assistive walking devices in 60.3%, mild to terminal illness on the Clinical Frailty Scale in 22.2%, polypharmacy in approximately 90%, and mild cognitive impairment or dementia in 54.1%. Nutritional assessment identified 42.6% of patients at risk for malnutrition and 9.8% as malnourished. CGA guided by the 7Ms framework generated a mean of 11.2 individualized recommendations per patient, most commonly related to coordination with primary care clinicians (73.0%), physical therapy (54.0%), medication deprescribing or dose adjustment (50.8%), and delirium prevention (49.2%). Among enrolled patients, 40 patients (63.5%) ultimately proceeded with surgery, with a median of 11.5 days from initial visit to surgery. Conclusions: A structured comprehensive geriatric assessment guided by the 7Ms framework is feasible and clinically useful in the ambulatory preoperative setting. By explicitly incorporating care coordination and nutritional assessment, the 7Ms framework offers a pragmatic approach to identifying geriatric vulnerabilities and supporting preoperative optimization in older surgical patients.

Background: Academic medicine programs face compounded challenges from public health crises, health inequities, and evolving federal policies pertaining to Diversity, Equity, and Inclusion (DEI). Older adults and individuals living with serious illness—particularly those from marginalized communities—experienced greater morbidity and mortality during the COVID‐19 pandemic and may continue to see disproportionately negative outcomes amid 2025 federal regulatory changes. Methods: Within a Department of Geriatrics and Palliative Medicine, a DEI initiative evolved into the MOSAIC Council (Mission Oriented Strategies Advancing Inclusive Communities)—reframing its scope, governance, and program activities to preserve psychological safety, engagement, and institutional relevance. MOSAIC and departmental leadership defined the program's mission to: (1) foster a supportive and inclusive learning and work environment, (2) develop responsive approaches to discrimination and bias, and (3) provide accessible resources to support all department members. Activities consisted of lectures, facilitated forums, workshops, and community‐building experiences, with ongoing feedback used to guide program refinement. Results: From 2021 to 2025, MOSAIC demonstrated sustained engagement, delivering more than 140 sessions, consistent attendance, and positive participant feedback. Structural and resilient adaptations included expansion of the champion team, iterative feedback and needs assessments, and prioritization of flexible, community‐informed programming. Focus on internal community building and psychological safety supported program growth and resilience and facilitated integration of MOSAIC principles into departmental culture and practices. Conclusions: MOSAIC demonstrates that internal DEI development in a geriatric and palliative department can be sustained through intentional resilience and adaptive design, despite restrictive policy environments. This model offers a pragmatic framework for academic health programs seeking to improve workforce environment and advance equitable care for older adults and seriously ill populations while navigating evolving regulatory landscapes. Future directions include extending this framework to patient and caregiver communities.

Background: As the population ages, kidney transplantation ( KT ) is increasingly considered for older adults with advanced chronic kidney disease ( CKD ). However, frailty, cognitive impairment, and malnutrition complicate transplant decision‐making. A Comprehensive Geriatric Assessment ( CGA ) offers a multidimensional approach, but the relative contribution of individual CGA domains to transplant eligibility and receipt remains unclear. Methods: We conducted a retrospective observational study of 164 older adults with advanced CKD seeking KT and underwent CGA by a geriatrician at an urban academic center from September 2021 to July 2024. Associations between CGA domains and KT listing and receipt were evaluated using logistic regression analyses, adjusting for age and other clinical covariates. Results: Of the 164 participants, 139 (84.8%) were listed, and 24 (17.3%) received KT among them. While higher levels of functional status, as measured by activities of daily living ( ADL ), were associated with KT listing, instrumental ADL and gait speed were significantly associated with transplantation. Even after adjusting for age, better cognitive function, as assessed through clinical evaluation and Montreal Cognitive Assessment ( MoCA ), was also positively associated with both outcomes. Age‐adjusted nutritional status was independently associated with transplant listing eligibility. Conclusions: Individual domains of CGA , particularly physical function, cognition, and nutrition, are independently associated with KT decision‐making among older adults. Incorporating focused geriatric assessments into kidney transplant evaluation may improve risk stratification and reduce disparities in transplant access.