Journal of the American Medical Directors Association最新文献

{"title":"What Matters to Residential Long-Term Care Residents: Contextualizing Perceptions of Person-Centered Care","authors":"Luis J. Cordero BS, MPH(c) ,&nbsp;Sarah Dys PhD, MPA ,&nbsp;Diana White PhD","doi":"10.1016/j.jamda.2025.106104","DOIUrl":"10.1016/j.jamda.2025.106104","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Design</h3><div>Secondary data analysis of qualitative comments collected through validation of the Resident Voicing Importance, Experience, and Well-Being (ResidentVIEW) instrument.</div></div><div><h3>Setting and Participants</h3><div>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).</div></div><div><h3>Methods</h3><div>Practical thematic analysis to develop codes consisting of complete phrases, and biweekly meetings to refine themes.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions and Implications</h3><div>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.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106104"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146064308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Certified Nursing Assistants’ Perceived Needs and Technology Access in Mental Health Self-Care Training: Findings From a Cross-Sectional Survey","authors":"E-Shien Chang PhD ,&nbsp;Joanna Bryan Ringel MPH ,&nbsp;Sanjay Pinto PhD ,&nbsp;Chenjuan Ma PhD, MSN ,&nbsp;Faith Wiggins BS ,&nbsp;Ronica Peramsetty BS ,&nbsp;Tony Rosen MD, MPH ,&nbsp;Madeline R. Sterling MD, MPH, MS","doi":"10.1016/j.jamda.2025.106035","DOIUrl":"10.1016/j.jamda.2025.106035","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the interest of certified nursing assistants (CNAs) in self-care mental health (MH) training, the characteristics associated with this interest, and their level of technology access to participate in online training.</div></div><div><h3>Design</h3><div>We conducted a secondary analysis of a cross-sectional telephone survey of CNAs fielded in 2020.</div></div><div><h3>Setting and Participants</h3><div>A total of 195 CNAs aged 18 and older employed across 98 licensed skilled nursing facilities in New York.</div></div><div><h3>Methods</h3><div>Our team developed survey instruments and first piloted them with direct care workers and community partners. Novel measures included CNAs' self-reported interests, perceived needs, and preferences regarding MH training and access to technology. We performed bivariate analyses to examine the association between CNAs’ MH interests and their sociodemographic characteristics, health, caregiving roles and duties, and emotional well-being.</div></div><div><h3>Results</h3><div>More than three-quarters of CNAs (75.4%) in our sample expressed interest in MH training. Compared with those with no interest, CNAs interested in MH training were significantly more likely to be double- or triple-duty caregivers (ie, those caring for dependent children and/or older family members) (<em>P</em> &lt; .001). There was also a wide range of technology access across different devices among CNAs interested in MH training. Although most have access to devices that could enable them to receive potential MH training, 16.3% reported lacking the necessary technology in their homes to participate. CNAs who reported a lack of technology access were significantly older (<em>P</em> = .034), had less education (<em>P</em> = .031), and had more years of experience in the health care field (<em>P</em> = .034).</div></div><div><h3>Conclusion and Implications</h3><div>Most CNAs welcome MH training, although access to technology to obtain such virtual training varies. Addressing CNA MH through increased training could play a critical role in supporting their well-being and enhancing their ability to provide quality care both at work and at home. Strategies to address uptake and dissemination are urgently needed.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106035"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Falls as a Predictor of Future Dementia in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis","authors":"Juncai Li MS,&nbsp;Zhe Meng MS,&nbsp;Shuangxin Zhang PhD,&nbsp;Longjie Wei MS,&nbsp;Qirui Zhang MS,&nbsp;Yijia Lin MS,&nbsp;Bonolo William MS,&nbsp;Xiuling Zhou MBBS","doi":"10.1016/j.jamda.2025.106089","DOIUrl":"10.1016/j.jamda.2025.106089","url":null,"abstract":"<div><h3>Objectives</h3><div>To systematically review and quantitatively synthesize evidence on the predictive role of falls for future dementia in middle-aged and older adults.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>Middle-aged and older adults without dementia (aged ≥40 years).</div></div><div><h3>Methods</h3><div>Systematically retrieved literature from 4 English-language databases—PubMed, Embase, Web of Science, and the Cochrane Library—from inception to July 1, 2025. Prospective and retrospective cohort studies investigating the association between falls and future development of dementia were included. Study quality was assessed using the Newcastle-Ottawa Scale. A random-effects model was applied using Stata 17.0 software to conduct a pooled analysis of the incidence of dementia in middle-aged and older adults (≥40 years) with a history of falls, as well as the strength of the association between falls and future dementia [adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs)].</div></div><div><h3>Results</h3><div>A total of 7 studies were included, of which 5 were included in the meta-analysis, comprising a total of 2,922,624 participants. Results indicate that among 1,246,410 middle-aged and older adults with a history of falls, the pooled incidence of future dementia was 11.6% (95% CI, 4.2%–19.0%; <em>I</em>^<em>2</em> = 99.8%). Among older adults (≥60 years), the pooled incidence was 12.3% (95% CI, 4.7%–20.0%; <em>I</em>^<em>2</em> = 99.8%). Both single falls (aHR, 1.20; 95% CI, 1.07–1.36) and multiple falls (aHR, 1.74; 95% CI, 1.53–1.98) increased the risk of future all-cause dementia, and multiple falls were a more robust predictor of future dementia. Collectively, the results indicate that the frequency of falls exhibits a dose-response relationship with dementia risk.</div></div><div><h3>Conclusions and Implications</h3><div>This study demonstrates that multiple falls are a significant predictor of future dementia and highlights the importance of fall frequency. Recurrent falls may serve as a potential clinical marker for identifying individuals at higher risk. Clinicians should maintain heightened vigilance for cognitive decline in middle-aged and older adults with a history of recurrent falls to facilitate early detection of dementia. Given the limited evidence base and high heterogeneity, further high-quality research is warranted to clarify this association and support preventive strategies in aging populations.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106089"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics Associated With Home Health Care Referral After Discharge From Hospital","authors":"Natalie R. Turner LMSW ,&nbsp;Tracy M. Mroz PhD, OTR/L ,&nbsp;Amber Sabbatini MD, MPH","doi":"10.1016/j.jamda.2025.106087","DOIUrl":"10.1016/j.jamda.2025.106087","url":null,"abstract":"<div><h3>Objectives</h3><div>Most older adults prefer to recover at home, making home health care (HHC) an important alternative to institutional post-acute care (eg, skilled nursing, inpatient rehabilitation). Understanding factors associated with HHC referral at hospital discharge—relative to other options—can align care with patient preferences and support aging in place. This study examined individual, hospital, and community characteristics associated with HHC referral vs institutional post-acute care among Medicare beneficiaries.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Settings and Participants</h3><div>Participants included beneficiaries referred to HHC, skilled nursing, or inpatient rehabilitation at hospital discharge in 100% Medicare fee-for-service claims, 2017-2019. Hospital characteristics came from Centers for Medicare &amp; Medicaid Services Hospital Cost Reports, and community-level variables came from the 2017 Agency for Healthcare Research and Quality Social Determinants of Health database.</div></div><div><h3>Methods</h3><div>Our outcome was discharge to HHC vs institutional post-acute care (eg, skilled nursing, inpatient rehabilitation). Mixed-effects linear probability models estimated associations between individual-, hospital-, and community-level characteristics with HHC referral among Medicare beneficiaries at hospital discharge.</div></div><div><h3>Results</h3><div>The study population included 11,139,222 hospital discharges among 6,287,660 Medicare beneficiaries. Older age, longer length of stay, urban dwelling, and dual-eligibility were associated with lower rates of HHC referral. Beneficiaries of color had higher rates of HHC referral than non-Hispanic White beneficiaries. Large (&gt;400 beds), nonteaching, and safety net hospitals were associated with higher rates of HHC referral. Communities with higher percentages of racially and ethnically minoritized residents and older adults had higher rates of HHC referral. However, models explained only 13% of the variation in post-acute care referral, underscoring the limited ability of administrative claims data to capture all relevant determinants.</div></div><div><h3>Conclusions and Implications</h3><div>Referral decisions for post-acute care are influenced by individual-, hospital-, and community-level factors. As the use of HHC continues to grow, greater attention is needed to how these decisions are made to ensure equitable access to preferred and appropriate care for older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106087"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146064000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Step Length for Predicting the Onset of Frailty in Community-Dwelling Healthy Older Adults: A Prospective Cohort Study","authors":"Daiki Yamagiwa PhD ,&nbsp;Osamu Katayama PhD ,&nbsp;Ryo Yamaguchi PhD ,&nbsp;Takahiro Shimoda PhD ,&nbsp;Chika Nakajima MSc ,&nbsp;Ayuka Kawakami PhD ,&nbsp;Shoma Akaida PhD ,&nbsp;Keitaro Makino PhD ,&nbsp;Hiroyuki Shimada PhD","doi":"10.1016/j.jamda.2025.106090","DOIUrl":"10.1016/j.jamda.2025.106090","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Design</h3><div>A prospective observational study.</div></div><div><h3>Setting and Participants</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions and Implications</h3><div>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.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106090"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Analysis of an Advance Care Planning Implementation Quality Assessment Tool (ACP-QAT) for Nursing Homes","authors":"Peiyuan Zhang PhD ,&nbsp;Joan Davitt PhD ,&nbsp;Nancy Kusmaul PhD ,&nbsp;Paul Sacco PhD ,&nbsp;Kathleen T. Unroe MD ,&nbsp;John G. Cagle PhD","doi":"10.1016/j.jamda.2025.106105","DOIUrl":"10.1016/j.jamda.2025.106105","url":null,"abstract":"<div><h3>Objective</h3><div>A reliable and valid assessment of advance care planning (ACP) implementation in nursing homes (NHs) remains a gap, which can be a hindrance for policymakers and researchers to holistically understand the current quality of ACP implementation and identify aspects for improvement. This paper therefore conducted a psychometric analysis of the Advance Care Planning Implementation Quality Assessment Tool (ACP-QAT) to examine its internal consistency reliability, interrater reliability, and construct validity, including convergent validity and known-group validity.</div></div><div><h3>Design</h3><div>Cross-sectional survey.</div></div><div><h3>Setting and Participants</h3><div>An interdisciplinary sample of 31 health care providers (eg, physicians, nurses, and social workers) working in NHs were recruited.</div></div><div><h3>Method</h3><div>Participants rated the quality of 3 vignettes that represented different ACP implementation quality (high, medium, and low). The primary measure of ACP implementation quality was the tool consisting of 19 binary questions (Yes = 1/No = 0) under 2 dimensions: nursing home structural support, and standardized implementation procedures. A proxy measure was a researcher-constructed 5-point Likert-type item capturing respondents’ global impressions of implementation quality assessment.</div></div><div><h3>Results</h3><div>The tool demonstrated excellent internal consistency reliability for the Structural Support Subscale and Implementation Process Subscale and full scale with Kuder-Richardson Formula 20 coefficients over 0.90. Interrater reliability at the total score level assessed using a 2-way random-effects model intraclass correlation coefficient (ICC) (absolute agreement) was almost perfect (ICC = 0.80). In addition to good indications of reliability, the tool also demonstrated acceptable convergent validity through the strong and positive association between the composite score assessed by the tool and the 1-item global assessment across all vignettes (<em>r</em> = 0.81, <em>P</em> &lt; .001), and known-group validity (<span><math><mrow><mi>χ</mi></mrow></math></span>²(2) = 62.7, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>These findings suggest that ACP-QAT is a reliable and valid instrument for assessing key components of ACP implementation, including both nursing home structural support and standardized procedures.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106105"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can I Stay, or Must I Go Now? A Cohort Study of Discharge Appeals in a Post-Acute Skilled Nursing Facility","authors":"W. James Deardorff MD ,&nbsp;Grant Tominaga BS ,&nbsp;James D. Harrison MPH, PhD ,&nbsp;Himali Weerahandi MD, MPH ,&nbsp;Matthew J. Miller PT, DPT, PhD ,&nbsp;Michi Yukawa MD, MPH ,&nbsp;Kenneth Lam MD, MAS","doi":"10.1016/j.jamda.2025.106108","DOIUrl":"10.1016/j.jamda.2025.106108","url":null,"abstract":"<div><h3>Objectives</h3><div>Patients admitted to a skilled nursing facility (SNF) for short-term rehabilitation after hospitalization often feel unprepared to return home and may appeal discharge dates set by SNFs and/or insurers. There are additional concerns that Medicare Advantage (MA) insurers may be more aggressive about discharging patients earlier compared with traditional Medicare. Yet, little has been published on the characteristics of patients who appeal and their outcomes.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Participants included patients admitted to a single SNF after hospitalization from March 1, 2024, to March 31, 2025, who filed discharge appeals.</div></div><div><h3>Methods</h3><div>We collected information via chart reviews on patient demographics (eg, age, insurance coverage), comorbidities, function scores, and documented reasons for appeal. We also identified outcomes following appeal (eg, 30-day rehospitalization, death).</div></div><div><h3>Results</h3><div>Of 453 eligible SNF admissions, 47 (10.4%) patients filed 58 appeals [mean age 79.3 (SD = 10.6), 25 (53.2%) female, 9 (19.1%) Asian, 7 (14.9%) Black, 20 (42.6%) in traditional Medicare, 27 (57.4%) in MA]. Median (IQR) time from SNF admission to first appeal was 19.0 (15.0–30.5) days. Eleven patients (23.4%) won their appeals. The median (IQR) time from first appeal to discharge was 8 (7–13) and 4 (3–8) days among patients who won their appeals vs those who lost their final appeal, respectively. The 30-day rehospitalization and 30-day mortality rates among those who won their appeals were 0% (n = 0 of 11) and 18.2% (n = 2 of 11), respectively. Among those who lost their final appeal, rates were 27.8% (n = 10 of 36) and 0% (n = 0 of 36), respectively. The most common reason for appealing was patient and/or family/caregiver concern about discharge readiness (n = 28, 59.6%).</div></div><div><h3>Conclusions and Implications</h3><div>In this single-SNF study, 10% of post-acute patients appealed their discharge, commonly citing concerns about discharge readiness, with most ultimately losing their final appeal. This study lays the groundwork for future research examining appeals processes and outcomes on a broader scale.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106108"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioethics Peer Review: A Structured Evaluation Framework for Long-Term Care Environments","authors":"Diana C. Anderson MD, MArch, FACHA ,&nbsp;David A. Deemer MD, MA ,&nbsp;William J. Hercules MArch, FAIA, FACHA, FACHE ,&nbsp;Stowe Locke Teti MA, HEC-C","doi":"10.1016/j.jamda.2025.106088","DOIUrl":"10.1016/j.jamda.2025.106088","url":null,"abstract":"<div><div>Health care environments—particularly the built environment—can function like health care interventions, achieving medicine-like effects that shape the lived experience of persons in long-term care (LTC). Despite a growing body of evidence-based design research illustrating the clinical and behavioral influence of environmental conditions, these findings are not consistently incorporated into new LTC construction and renovation. This reflects divergent trajectories of knowledge development across medicine, architecture, and LTC operations. Because shortcomings in environmental design fall outside medical oversight, research protections, and enforceable architectural standards, opportunities to support safety, well-being, and autonomy often remain unrecognized. To address this gap, we developed the Bioethics Peer Review for Long-Term Care Design, a multidisciplinary evaluative process grounded in clinical ethics consultation and aligned with the 5M geriatric framework. We describe the model, its rationale, and lessons learned from pilot applications in 2 LTC facilities.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106088"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Updated Mortality and Community Discharge Prognostic Model for Older Adults Admitted to Skilled Nursing Facilities for Post-Acute Care","authors":"W. James Deardorff MD ,&nbsp;Siqi Gan MPH ,&nbsp;Bocheng Jing MS ,&nbsp;Kenneth Lam MD, MAS ,&nbsp;W. John Boscardin PhD ,&nbsp;Alexander K. Smith MD, MS, MPH ,&nbsp;Sei J. Lee MD, MAS","doi":"10.1016/j.jamda.2025.106103","DOIUrl":"10.1016/j.jamda.2025.106103","url":null,"abstract":"<div><h3>Objectives</h3><div>We previously developed a multi-outcome prognostic model for older adults admitted to skilled nursing facilities (SNFs) for short-term rehab using Medicare data. However, incorporating predictors from the Minimum Data Set (MDS), a mandated comprehensive assessment, may improve model performance. This study sought to develop an updated model with MDS elements for use on day 7 of SNF admission when clinical trajectories are more established.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Twenty percent national sample of community-dwelling Medicare Fee-for-Service beneficiaries aged ≥66 admitted to an SNF for at least 7 days following a hospitalization between 2017 and 2019.</div></div><div><h3>Methods</h3><div>We predicted 2 outcomes: 6-month mortality and successful community discharge (community discharge without rehospitalization or death in the subsequent 30 days). For model development, we started with predictors from our published Medicare-based model (age, sex, Medicaid status, discharge diagnosis, hospital length of stay, admission type, comorbidities, prior hospitalizations), used Least Absolute Shrinkage and Selection Operator (LASSO) on MDS elements for variable selection, and performed logistic regression to determine predictor coefficients. Model performance was assessed by concordance statistics (c-statistics), calibration plots, and decision curve analysis.</div></div><div><h3>Results</h3><div>The cohort included 426,680 individuals [mean age 81.3 years (SD = 8.3), 62.7% female, 7.9% Black]. Overall, 19.9% died within 6 months, and 57.6% experienced a successful community discharge. The updated MDS model, which included Medicare predictors and 6 MDS items (activities of daily living score, cognitive status, urinary incontinence, bowel incontinence, oxygen use, walking balance), showed improvements over the Medicare model in discrimination [bootstrapped optimism-corrected c-statistic of 0.789 (95% CI, 0.787–0.790) vs 0.747 (95% CI, 0.745–0.749) for 6-month mortality and 0.730 (95% CI, 0.728–0.731) vs 0.685 (95% CI, 0.683–0.687) for successful community discharge, respectively], net benefit, and fraction of new information. Models showed good calibration.</div></div><div><h3>Conclusions and Implications</h3><div>Incorporating MDS data from the first 7 days of SNF admission improved the accuracy of predictions of 6-month mortality and successful community discharge.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 4","pages":"Article 106103"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Dual-Task Assessment Be Used to Discriminate Recurrent Fallers in Older Populations? A Systematic Review.","authors":"Nora L Curtin, Alexa Lauinger, Frederic Montz, Tanner Murphy, Libak Abou, Joseph Peters","doi":"10.1016/j.jamda.2026.106174","DOIUrl":"https://doi.org/10.1016/j.jamda.2026.106174","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether dual-task assessment (DTA) can discriminate single/nonfallers from recurrent fallers in older adults, and to identify specific DTA protocols and outcome measures most predictive of recurrent falls.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Setting and participants: </strong>This systematic review followed Cochrane and PRISMA reporting guidelines. A search was conducted in August 2025 using PubMed, Embase, Scopus, Web of Science, CINHAL, SPORTDiscuss, and PsycINFO. Keywords associated with dual task, older populations, and recurrent falls were included in the search strategy. Prospective and retrospective cohort studies were included if they assessed adults ≥60 years old with DTA and recorded ≥2 falls over at least 3 months. Studies with neurologically impaired individuals with motor deficits were excluded. A total of 2472 community-dwelling adults across 9 studies were included in this review.</p><p><strong>Methods: </strong>Two independent reviewers screened studies, assessed quality using Standard Quality Assessment, and extracted data on demographics, methodology, and outcomes. DTA protocol heterogeneity precluded meta-analysis.</p><p><strong>Results: </strong>Six studies (66.7%), which is equivalent to 56.3% of the study participants, found that DTA could discriminate recurrent fallers from single/nonfallers. Gait variability as measured by swing time variability and longer completion time for DTA were most predictive for identifying older individuals at risk for recurrent falls.</p><p><strong>Conclusions and implications: </strong>Decline in DTA performance, particularly the time to complete the DTA, may be associated with recurrent falling in older adults. Time to complete the DTA is a feasible screening tool for outpatient use. Currently, protocol variations limit generalizability, warranting standardization of methods and further validation for clinical adoption.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"106174"},"PeriodicalIF":3.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}