Journal of the American Medical Directors Association最新文献

Objectives: This study compares what matters to residents and how they experience personalized care across nursing facilities, assisted living facilities, residential care facilities, and adult foster homes in Oregon.

Design: Secondary data analysis of qualitative comments collected through validation of the Resident Voicing Importance, Experience, and Well-Being (ResidentVIEW) instrument.

Setting and participants: Residents were from 32 nursing facilities (n = 245), 31 assisted living facilities/residential care facilities (n = 212), and 119 adult foster homes (n = 188) in Oregon (December 2017-September 2019).

Methods: Practical thematic analysis to develop codes consisting of complete phrases, and biweekly meetings to refine themes.

Results: Three key themes emerged from the data. The first, loss, disregard, or limitation of personhood, described how residents across all care settings experienced a restriction in their decision-making. The second, "sometimes" nature of independence and choice, highlighted the inconsistency of autonomy, where choices were overridden by rigid institutional schedules. The third, respecting and including the person behind the "resident," emphasized the importance of staff recognizing residents as individuals, along with residents' value of social inclusion, meaningful engagement, and being part of the community rather than simply existing within it.

Conclusions and implications: Findings reveal the nuanced ways in which person-centered care is experienced and how it can be either fostered or limited by the care setting. Residents' experiences of autonomy and dignity are fluid and shaped by the context of their care setting. Staff training must be supported by consistent staffing practices that actively uphold and reinforce personhood across all types of care environments. There is a clear call from residents to be heard, valued, and seen as integral members in the environment they are living in.

Objectives: Frailty is a common geriatric syndrome associated with adverse health outcomes. Although gait speed is widely recognized as a predictor of frailty, the contribution of other gait parameters remains unclear, particularly among initially robust older adults. This study aimed to examine the associations between multiple gait variables and incident frailty in community-dwelling older adults who were nonfrail at baseline.

Design: A prospective observational study.

Setting and participants: A total of 1898 community-dwelling older adults (mean age: 73.0 ± 4.9 years, age range: 65-92 years, 50.9% women) who were determined to be nonfrail by the Kihon Checklist in the baseline survey were included.

Methods: Gait variables, including gait speed, were measured using the Walkway system. Frailty status was reassessed after 3 years via a mailed Kihon Checklist survey. Participants classified as either pre-frail or frail at follow-up were considered to have incident frailty, in order to capture early functional decline. Logistic regression analyses were conducted to evaluate the associations between gait variables and incident frailty.

Results: In this study, 611 participants (32.2%) were classified into the incident frailty during follow-up (524 pre-frailty and 87 frailty). Logistic regression analysis showed that gait speed [odds ratio (OR), 0.273; 95% confidence interval (CI), 0.152-0.491], step length (OR, 0.947; 95% CI, 0.924-0.970), and cadence (OR, 0.987; 95% CI, 0.976-0.998) were significantly associated with the onset of frailty. Furthermore, step length was independently associated with the onset of frailty, even in models adjusted for gait speed and covariates (OR, 0.945; 95% CI, 0.909-0.982).

Conclusions and implications: Step length was identified as a significant indicator of incident frailty in healthy older adults. For early frailty screening, a comprehensive assessment that includes step length, rather than gait speed alone, may be more informative.

Objectives: To examine whether unionized nursing homes in New York State show different levels of resident voice-measured through formal complaints-and how ownership relates to these patterns.

Design: Cross-sectional analysis of 2022 facility-level data.

Setting and participants: A total of 511 New York State nursing homes categorized by union status and ownership type.

Methods: Resident voice was defined as complaints per 100 residents submitted to the New York State Department of Health Complaint Hotline. Key predictors were union status and ownership, with covariates including facility size, payer mix, occupancy, hospital admissions, and quality rating.

Results: Of the 511 facilities, 361 (70.6%) were unionized. Unionized homes had fewer complaints on average (57.9 vs 64.4 per 100 residents; P = .04). Among unionized facilities, higher Medicaid (β = 0.885; P < .001) and Medicare shares (β = 0.567; P = .003) were positively associated with complaints and higher overall quality ratings were inversely associated (β = -6.77; P < .001).

Conclusions and implications: Nursing homes with unionized workforces display distinct patterns of resident voice. These findings suggest that workforce organization may influence the institutional environment in ways that either facilitate or constrain residents' ability to advocate for improved care. Understanding how labor structures intersect with ownership and quality conditions can inform future policy efforts aimed at strengthening resident-centered care and guide research on mechanisms linking workforce organization to resident advocacy behaviors.

Objective: To examine the association between individual characteristics and type of initial long-term services and supports (LTSS) among older adults receiving Medicaid home- and community-based services (HCBS) or nursing home (NH) care.

Design: Cohort study of traditional Medicare beneficiaries surveyed between 2002 and 2009 linked with Medicare and Medicaid administrative files through 2018.

Setting and participants: The study population includes 581 dual-eligible individuals aged ≥65 at the time of initial LTSS use. Study population was predominantly Black (67.1%), female (69.0%), and with a household income below $15,000/year (78.3%).

Methods: Initial HCBS and long-term NH use were identified using Medicaid data and Minimum Data Set (MDS) nursing home assessments. Sociodemographic factors were identified using the Southern Community Cohort Study (SCCS) survey dataset. Chronic conditions and prior health care use were identified using traditional Medicare claims. A multivariate logistic model predicted whether individuals initiated LTSS with HCBS use, adjusting for individual-level covariates and state and year fixed effects.

Results: Half of the sample (N = 291) initiated LTSS with HCBS and the other half (N = 290) initiated with NH use between 2008 and 2018. Factors associated with a higher likelihood of initiating LTSS with HCBS included Black race (marginal effect [ME], 0.13; 95% CI, 0.05-0.21) and female sex (ME, 0.19; 95% CI, 0.12-0.26). Factors associated with higher likelihood of initiating LTSS with NH instead of HCBS included older age, Alzheimer's disease and related dementias (ADRD) diagnosis, recent hospitalization, and higher education levels. Among individuals with ADRD, several factors-Black race, living with others, and prior emergency room use-were associated with higher likelihood of initiating LTSS with HCBS and prior hospitalization was associated with initial NH use.

Conclusion and implications: Among dual-eligible older adults initiating LTSS, factors related to more complex medical needs were associated with a higher likelihood of NH use rather than HCBS use as their initial LTSS option.

Objectives: To compare the prevalence of vaccination programs between nursing homes (NHs) and assisted living communities (ALs) and examine how these programs relate to perceived hospitalization risk and temporary admission suspensions due to outbreaks.

Design: Descriptive analysis of facility-level survey data from the 2023 Ohio Biennial Survey of Long-Term Care Facilities, which has a >90% response rate.

Setting and participants: All licensed NHs and ALs in Ohio were surveyed and answered questions related to vaccination programs (n = 736; n = 623).

Methods: Three measures were analyzed: presence of a vaccination program for 7 vaccine-preventable illnesses [influenza; COVID-19; respiratory syncytial virus (RSV); pneumococcal; hepatitis B; shingles; and tetanus, diphtheria, and pertussis (Tdap)], perceived risk of transferring residents to the hospital for these illnesses, and temporary suspension of admissions due to outbreaks. All measures were binary and sample averages were calculated separately for NHs and ALs. Facility characteristics associated with COVID-19-related admission suspensions were compared.

Results: NHs had a higher prevalence of vaccination programs for all 7 vaccine-preventable illnesses compared with ALs. The largest differences were observed for RSV, pneumococcal, hepatitis B, shingles, and Tdap. ALs reported higher perceived risk of transferring residents to the hospital for all illnesses, whereas NHs reported the highest perceived risk for respiratory illnesses. Temporary admission suspensions due to outbreaks were uncommon; when reported, they were primarily associated with COVID-19. Facilities with COVID-19-related suspensions were more likely to be smaller and not-for-profit/government owned. NHs with outbreaks were more often located in rural areas, and ALs with outbreaks were more often located in urban areas.

Conclusions and implications: Significant disparities exist in vaccination program implementation between NHs and ALs. Expanding vaccination programs in ALs may reduce hospitalization risk and strengthen outbreak prevention. Targeted policy efforts, improved education, and resource allocation are needed to ensure equitable access to comprehensive vaccination programs across long-term care settings.

Objectives: To examine which pain-related characteristics are most strongly associated with impairments in physical performance among community-dwelling older adults.

Design: Cross-sectional study with no intervention.

Setting and participants: A total of 694 adults aged 60 years or older, of both sexes, registered in Primary Health Care Units in Parnamirim, Brazil.

Methods: Chronic pain (lasting more than 3 months) was self-reported. Physical performance was assessed using the Short Physical Performance Battery (SPPB). Bivariate analyses were conducted using Student's t-tests and χ² tests. Multiple linear regression was applied to evaluate the association between pain-related variables and total SPPB scores, adjusting for covariates.

Results: Chronic pain prevalence was 56%. Pain exacerbation during walking was reported by 32%, and mean pain intensity was 5.7. The mean SPPB score was 9 (±2), and 31% of participants had low physical performance. Pain intensity and pain while walking were associated with worse physical performance; however, only pain intensity remained an independent predictor in adjusted models. Additional factors associated with lower performance included female sex, polypharmacy, lower engagement in walking activity, and lower Leganés Cognitive Test (LCT) scores.

Conclusions and implications: Chronic pain, especially its intensity, is independently associated with reduced physical performance in older adults. These findings reinforce the need for primary care services to prioritize the identification and management of chronic pain to help preserve mobility and functional capacity in aging populations.