Pub Date : 2025-02-26DOI: 10.1016/j.jamda.2025.105494
Catherine D. Laird BPharm, Kylie A. Williams BPharm, PhD, Helen Benson BPharm, PhD
Objectives
The primary outcome of this study is to test the feasibility of pharmacists completing Fracture Risk Scale (FRS) assessments using resident data routinely held by long-term care (LTC) facilities. Secondary outcomes are to ascertain the proportion of residents assessed as high fracture risk who currently receive osteoporosis medicines and explore whether under- or overuse of osteoporosis medicines is occurring based on residents' fracture risk.
Design
Feasibility study.
Setting and Participants
Four LTC facilities from southeast Queensland, Australia, with a total of 281 residents participated in the study during April and May 2024.
Methods
A pharmacist reviewed individual resident files for all residents of participating facilities. Necessary data were extracted from resident files to determine their fracture risk using the FRS manual calculation tool. Residents' use of osteoporosis medicines and nutritional supplements (vitamin D and calcium) was analyzed based on their calculated fracture risk.
Results
FRS assessments were completed for 275 residents (97.9%). There were 149 residents (54.2%) assessed as having a high fracture risk, of which 43 (28.9%) were prescribed an osteoporosis medicine. Conversely, 28 residents (22.2%) with a low fracture risk received an osteoporosis medicine. Underuse of vitamin D and calcium supplements was found for all residents, irrespective of fracture risk.
Conclusions and Implications
The feasibility of pharmacists completing FRS assessments was demonstrated. Incorporating the FRS into routine clinical practice provides a promising means to support pharmacists advising on osteoporosis prescribing decisions for LTC residents. Widespread underuse of vitamin D and calcium for all LTC residents and the underuse of osteoporosis medicines by residents with a high fracture risk were found. Future research is necessary to establish if incorporating the FRS into clinical practice can address this undertreatment and reduce fracture rates in LTC.
{"title":"Pharmacists Improving Osteoporosis Management in Long-Term Care Using Fracture Risk Assessments: A Feasibility Study","authors":"Catherine D. Laird BPharm, Kylie A. Williams BPharm, PhD, Helen Benson BPharm, PhD","doi":"10.1016/j.jamda.2025.105494","DOIUrl":"10.1016/j.jamda.2025.105494","url":null,"abstract":"<div><h3>Objectives</h3><div>The primary outcome of this study is to test the feasibility of pharmacists completing Fracture Risk Scale (FRS) assessments using resident data routinely held by long-term care (LTC) facilities. Secondary outcomes are to ascertain the proportion of residents assessed as high fracture risk who currently receive osteoporosis medicines and explore whether under- or overuse of osteoporosis medicines is occurring based on residents' fracture risk.</div></div><div><h3>Design</h3><div>Feasibility study.</div></div><div><h3>Setting and Participants</h3><div>Four LTC facilities from southeast Queensland, Australia, with a total of 281 residents participated in the study during April and May 2024.</div></div><div><h3>Methods</h3><div>A pharmacist reviewed individual resident files for all residents of participating facilities. Necessary data were extracted from resident files to determine their fracture risk using the FRS manual calculation tool. Residents' use of osteoporosis medicines and nutritional supplements (vitamin D and calcium) was analyzed based on their calculated fracture risk.</div></div><div><h3>Results</h3><div>FRS assessments were completed for 275 residents (97.9%). There were 149 residents (54.2%) assessed as having a high fracture risk, of which 43 (28.9%) were prescribed an osteoporosis medicine. Conversely, 28 residents (22.2%) with a low fracture risk received an osteoporosis medicine. Underuse of vitamin D and calcium supplements was found for all residents, irrespective of fracture risk.</div></div><div><h3>Conclusions and Implications</h3><div>The feasibility of pharmacists completing FRS assessments was demonstrated. Incorporating the FRS into routine clinical practice provides a promising means to support pharmacists advising on osteoporosis prescribing decisions for LTC residents. Widespread underuse of vitamin D and calcium for all LTC residents and the underuse of osteoporosis medicines by residents with a high fracture risk were found. Future research is necessary to establish if incorporating the FRS into clinical practice can address this undertreatment and reduce fracture rates in LTC.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105494"},"PeriodicalIF":4.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433370","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}
The increasing number of patients with dementia necessitates the development of rapid and convenient tools to assist with dementia diagnosis. We previously demonstrated the difference in the postural control characteristics during static standing among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and vascular dementia (VaD). In this study, we evaluated the classification accuracy of the postural sway test to assess its capacity to distinguish between types of dementia.
Design
A cross-sectional study.
Setting and Participants
Memory clinic outpatients aged 65-85 years who were clinically diagnosed with AD, DLB, VaD, and cognitively normal (CN) outpatients.
Methods
Static upright standing measurements were conducted under open- and closed-eye conditions to calculate 40 parameters. After variable selection based on statistical significance, 3 dementia classification models (AD vs DLB, AD vs VaD, and DLB vs VaD) based on postural control parameters were created. Bias-corrected accuracy measures using bootstraps were used for assessing the classification performances.
Results
The data of 1734 participants (1158 with AD, 105 with DLB, 46 with VaD, and 425 with CN) were analyzed. The area under the curves of receiver operating characteristic curves for AD vs DLB, AD vs VaD, and DLB vs VaD were 0.647 (0.646-0.649), 0.763 (0.761-0.765), and 0.659 (0.656-0.662), respectively.
Conclusions and Implications
Postural control characteristics differentiated between dementia types with reasonable to good accuracy, especially in the comparison between AD and VaD. Postural control testing may become a valuable assistive tool for dementia diagnosis in the future.
目的：随着痴呆症患者人数的不断增加，有必要开发快速、便捷的工具来帮助诊断痴呆症。我们曾证实，阿尔茨海默病（AD）、路易体痴呆（DLB）和血管性痴呆（VaD）患者在静态站立时的姿势控制特征存在差异。在本研究中，我们评估了姿势摇摆测试的分类准确性，以评估其区分痴呆类型的能力：设计：横断面研究：方法：静态直立站立测量在无遮挡的情况下进行：在睁眼和闭眼条件下进行静态直立测量，计算 40 个参数。根据统计学意义选择变量后，根据姿势控制参数创建了3种痴呆分类模型（AD vs DLB、AD vs VaD和DLB vs VaD）。使用自举法进行偏差校正准确度测量，以评估分类效果：对1734名参与者（1158名AD患者、105名DLB患者、46名VaD患者和425名CN患者）的数据进行了分析。AD与DLB、AD与VaD、DLB与VaD的接收者操作特征曲线下面积分别为0.647（0.646-0.649）、0.763（0.761-0.765）和0.659（0.656-0.662）：体位控制特征区分痴呆类型的准确性尚可，尤其是在AD和VaD的比较中。未来，姿势控制测试可能会成为诊断痴呆症的重要辅助工具。
{"title":"Postural Sway Characteristics Distinguish Types of Dementia","authors":"Kosuke Fujita PhD , Taiki Sugimoto PhD , Hisashi Noma PhD , Yujiro Kuroda PhD , Nanae Matsumoto PhD , Kazuaki Uchida PhD , Yoko Yokoyama MS , Yoshinobu Kishino MD , Takashi Sakurai MD, PhD","doi":"10.1016/j.jamda.2025.105497","DOIUrl":"10.1016/j.jamda.2025.105497","url":null,"abstract":"<div><h3>Objectives</h3><div>The increasing number of patients with dementia necessitates the development of rapid and convenient tools to assist with dementia diagnosis. We previously demonstrated the difference in the postural control characteristics during static standing among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and vascular dementia (VaD). In this study, we evaluated the classification accuracy of the postural sway test to assess its capacity to distinguish between types of dementia.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Memory clinic outpatients aged 65-85 years who were clinically diagnosed with AD, DLB, VaD, and cognitively normal (CN) outpatients.</div></div><div><h3>Methods</h3><div>Static upright standing measurements were conducted under open- and closed-eye conditions to calculate 40 parameters. After variable selection based on statistical significance, 3 dementia classification models (AD vs DLB, AD vs VaD, and DLB vs VaD) based on postural control parameters were created. Bias-corrected accuracy measures using bootstraps were used for assessing the classification performances.</div></div><div><h3>Results</h3><div>The data of 1734 participants (1158 with AD, 105 with DLB, 46 with VaD, and 425 with CN) were analyzed. The area under the curves of receiver operating characteristic curves for AD vs DLB, AD vs VaD, and DLB vs VaD were 0.647 (0.646-0.649), 0.763 (0.761-0.765), and 0.659 (0.656-0.662), respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Postural control characteristics differentiated between dementia types with reasonable to good accuracy, especially in the comparison between AD and VaD. Postural control testing may become a valuable assistive tool for dementia diagnosis in the future.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105497"},"PeriodicalIF":4.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-25DOI: 10.1016/j.jamda.2025.105521
Chantal Backman, Wenshan Li, Soha Shah, Steve Papp, Stephen G Fung, Asnake Yohannes Dumicho, Meltem Tuna, Franciely Daiana Engel, Colleen Webber, Luke Turcotte, Daniel I McIsaac, Paul E Beaulé, Véronique French-Merkley, Stéphane Poitras, Benoit Lafleur, Jennifer Watt, Corita Vincent, Sharon Straus, Alexandre Tran, Kristen Pitzul, Sara J T Guilcher, Arrani Senthinathan, Peter Tanuseputro
Objective: To describe and compare the factors that impact initial rehabilitation type after hip fracture surgery.
Setting and participants: People aged between 50 and 105 with a hip fracture who had a surgical repair in Ontario, Canada, between January 1, 2015, and December 31, 2021.
Methods: Descriptive statistics and a multinomial logistic regression model were used to identify factors associated with initial rehabilitation type.
Results: In this study, 63,401 individuals were included with a mean age of 80 years (standard deviation [SD] 10.9), mostly female (67.3%), with 86.3% living in urban areas at the time of hospitalization and most (72.6%) admitted from the community without home care. A total of 24.5% of individuals did not receive any form of rehabilitation. Rurality of residence decreased the odds of having an initial rehabilitation type in complex continuing care (odds ratio [OR], 0.23; 95% CI, 0.21-0.26), in inpatient rehabilitation (OR, 0.26; 95% CI, 0.24-0.28), or in community rehabilitation (OR, 0.54; 95% CI, 0.50-0.58) compared with no rehabilitation. Dementia decreased the odds of having an initial rehabilitation type in complex continuing care (OR, 0.75; 95% CI, 0.69-0.81), in inpatient rehabilitation (OR, 0.44; 95% CI, 0.41-0.47), or in community rehabilitation (OR, 0.88; 95% CI, 0.82-0.95) compared with receiving no rehabilitation. Previous history of fragility fracture decreased the odds of having an initial rehabilitation type in either complex continuing care (OR, 0.30; 95% CI, 0.27-0.34), in inpatient rehabilitation (OR, 0.27; 95% CI, 0.24-0.29), or in community rehabilitation (OR, 0.33; 95% CI, 0.30-0.37) compared with no rehabilitation.
Conclusions and implications: Rurality of residence, dementia, and previous history of fragility fractures reduced the odds of receiving specialized inpatient rehabilitation and increased the odds of receiving no rehabilitation. Future research should focus on achieving more equitable care for individuals living in rural settings, with dementia, or with previous fragility fractures to enhance the quality of care and achieve best outcomes for the overall hip fracture population.
{"title":"Factors Influencing Initial Rehabilitation Type After Hip Fracture Surgery: A Retrospective Cohort Study.","authors":"Chantal Backman, Wenshan Li, Soha Shah, Steve Papp, Stephen G Fung, Asnake Yohannes Dumicho, Meltem Tuna, Franciely Daiana Engel, Colleen Webber, Luke Turcotte, Daniel I McIsaac, Paul E Beaulé, Véronique French-Merkley, Stéphane Poitras, Benoit Lafleur, Jennifer Watt, Corita Vincent, Sharon Straus, Alexandre Tran, Kristen Pitzul, Sara J T Guilcher, Arrani Senthinathan, Peter Tanuseputro","doi":"10.1016/j.jamda.2025.105521","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105521","url":null,"abstract":"<p><strong>Objective: </strong>To describe and compare the factors that impact initial rehabilitation type after hip fracture surgery.</p><p><strong>Design: </strong>Retrospective population-based cohort study.</p><p><strong>Setting and participants: </strong>People aged between 50 and 105 with a hip fracture who had a surgical repair in Ontario, Canada, between January 1, 2015, and December 31, 2021.</p><p><strong>Methods: </strong>Descriptive statistics and a multinomial logistic regression model were used to identify factors associated with initial rehabilitation type.</p><p><strong>Results: </strong>In this study, 63,401 individuals were included with a mean age of 80 years (standard deviation [SD] 10.9), mostly female (67.3%), with 86.3% living in urban areas at the time of hospitalization and most (72.6%) admitted from the community without home care. A total of 24.5% of individuals did not receive any form of rehabilitation. Rurality of residence decreased the odds of having an initial rehabilitation type in complex continuing care (odds ratio [OR], 0.23; 95% CI, 0.21-0.26), in inpatient rehabilitation (OR, 0.26; 95% CI, 0.24-0.28), or in community rehabilitation (OR, 0.54; 95% CI, 0.50-0.58) compared with no rehabilitation. Dementia decreased the odds of having an initial rehabilitation type in complex continuing care (OR, 0.75; 95% CI, 0.69-0.81), in inpatient rehabilitation (OR, 0.44; 95% CI, 0.41-0.47), or in community rehabilitation (OR, 0.88; 95% CI, 0.82-0.95) compared with receiving no rehabilitation. Previous history of fragility fracture decreased the odds of having an initial rehabilitation type in either complex continuing care (OR, 0.30; 95% CI, 0.27-0.34), in inpatient rehabilitation (OR, 0.27; 95% CI, 0.24-0.29), or in community rehabilitation (OR, 0.33; 95% CI, 0.30-0.37) compared with no rehabilitation.</p><p><strong>Conclusions and implications: </strong>Rurality of residence, dementia, and previous history of fragility fractures reduced the odds of receiving specialized inpatient rehabilitation and increased the odds of receiving no rehabilitation. Future research should focus on achieving more equitable care for individuals living in rural settings, with dementia, or with previous fragility fractures to enhance the quality of care and achieve best outcomes for the overall hip fracture population.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105521"},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531309","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}
Pub Date : 2025-02-25DOI: 10.1016/j.jamda.2025.105491
Yule Hu MSc , Yan Li PhD , Jiaying Li MSc , Justina Yat Wa Liu PhD , Sylvia M. Gustin PhD , Mengqi Li PhD , Angela Yee Man Leung PhD
Objective
Telehealth is an encouraging solution for the remote delivery of cognitive interventions. This review aimed to identify the characteristics and effectiveness of telehealth interventions on cognitive functions and related quality of life in adults with neurological disorders.
Design
Systematic review and meta-analysis.
Settings and Participants
Community and residential, adults with neurological disorders.
Methods
Six English and 2 Chinese databases were searched from inception to August 2024. Randomized controlled trials that evaluated telehealth interventions for cognitive function in adults with neurological disorders were eligible. The meta-analysis was conducted using R (Version 4.1.3). The Revised Cochrane risk of bias tool for randomized trials (RoB 2) tool was used for risk of bias assessment.
Results
Sixteen studies with 952 participants were included, 14 of which were eligible for the meta-analysis. Asynchronous telehealth via apps/websites with regular online supervision was the most commonly used format. The pooled results suggested that telehealth interventions could significantly improve global cognitive function [standardized mean difference (SMD) = 0.95; 95% confidence interval (CI): 0.06∼1.83; P = .035], memory (SMD, 0.79; 95% CI: 0.36∼1.23; P = .0004), and quality of life (SMD, 0.57; 95% CI, 0.14∼1.00; P = .01) compared with controls. However, there was no statistically significant effect on attention (SMD, 0.12; 95% CI, −0.11∼0.35, P = .31), executive function (SMD, 0.06; 95% CI, −0.30∼0.42, P = .73), or language (SMD, 0.44; 95% CI, −0.01∼0.89, P = .054).
Conclusions and Implications
Telehealth interventions are safe, feasible and acceptable for adults with neurological disorders, and could potentially reduce health care cost. They have beneficial effects on global cognitive function, memory, and quality of life. More exercise-based telehealth interventions with adequate statistical power and rigorous designs are needed to evaluate the long-term benefits and financial impact.
{"title":"Effectiveness of Telehealth Interventions on Cognitive Function and Quality of Life in Adults With Neurological Disorders: A Systematic Review and Meta-Analysis","authors":"Yule Hu MSc , Yan Li PhD , Jiaying Li MSc , Justina Yat Wa Liu PhD , Sylvia M. Gustin PhD , Mengqi Li PhD , Angela Yee Man Leung PhD","doi":"10.1016/j.jamda.2025.105491","DOIUrl":"10.1016/j.jamda.2025.105491","url":null,"abstract":"<div><h3>Objective</h3><div>Telehealth is an encouraging solution for the remote delivery of cognitive interventions. This review aimed to identify the characteristics and effectiveness of telehealth interventions on cognitive functions and related quality of life in adults with neurological disorders.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Settings and Participants</h3><div>Community and residential, adults with neurological disorders.</div></div><div><h3>Methods</h3><div>Six English and 2 Chinese databases were searched from inception to August 2024. Randomized controlled trials that evaluated telehealth interventions for cognitive function in adults with neurological disorders were eligible. The meta-analysis was conducted using R (Version 4.1.3). The Revised Cochrane risk of bias tool for randomized trials (RoB 2) tool was used for risk of bias assessment.</div></div><div><h3>Results</h3><div>Sixteen studies with 952 participants were included, 14 of which were eligible for the meta-analysis. Asynchronous telehealth via apps/websites with regular online supervision was the most commonly used format. The pooled results suggested that telehealth interventions could significantly improve global cognitive function [standardized mean difference (SMD) = 0.95; 95% confidence interval (CI): 0.06∼1.83; <em>P</em> = .035], memory (SMD, 0.79; 95% CI: 0.36∼1.23; <em>P</em> = .0004), and quality of life (SMD, 0.57; 95% CI, 0.14∼1.00; <em>P</em> = .01) compared with controls. However, there was no statistically significant effect on attention (SMD, 0.12; 95% CI, −0.11∼0.35, <em>P</em> = .31), executive function (SMD, 0.06; 95% CI, −0.30∼0.42, <em>P</em> = .73), or language (SMD, 0.44; 95% CI, −0.01∼0.89, <em>P</em> = .054).</div></div><div><h3>Conclusions and Implications</h3><div>Telehealth interventions are safe, feasible and acceptable for adults with neurological disorders, and could potentially reduce health care cost. They have beneficial effects on global cognitive function, memory, and quality of life. More exercise-based telehealth interventions with adequate statistical power and rigorous designs are needed to evaluate the long-term benefits and financial impact.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105491"},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425610","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}
Pub Date : 2025-02-25DOI: 10.1016/j.jamda.2025.105502
Wenwei Zhu MD , Qianyun Liu MD , Zhimin Yan MD , Wenming Zhou MD , Pengfei Rong MD, PhD , Zhichao Feng MD, PhD
Objectives
Previous research has demonstrated notable differences in body composition and mortality risk following hip fracture between sexes. This study aimed to investigate the sex-specific associations between body composition profile and mortality in older patients undergoing hip fracture surgery.
Design
Dual-center cohort study.
Setting and Participants
We included 488 older patients (aged ≥60 years) with hip fracture treated with surgery.
Methods
The cross-sectional area and attenuation of skeletal muscle, subcutaneous adipose tissue, and intermuscular adipose tissue at the the upper thigh level on preoperative pelvic computed tomography (CT) were measured. The relationship between body composition and mortality was determined using Cox proportional hazards analysis stratified by sex.
Results
The mean age of the cohort was 76.2 ± 8.7 years, and 312 (63.9%) were women. Within 1 year after surgery, 89 (18.2%) patients died. Female patients had greater subcutaneous adipose tissue area [SATA; median (interquartile range), 196.5 (160.1∼228.5) vs 147.1 (111.3∼181.1) cm2; P < .001] and lower skeletal muscle area [SMA; 187.2 (167.3∼212.4) vs 255.5 (223.2∼286.1) cm2; P < .001] compared with male patients. In the sex-stratified multivariable analyses, SATA in females [hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.86∼0.97; P = .003] and SMA in men (HR, 0.93; 95% CI, 0.86∼1.00; P = .05) were significant predictors of 1-year mortality. Incorporation of SATA or SMA within the existing Nottingham Hip Fracture Score (NHFS) showed slightly improved performance in predicting 1-year mortality among women [area under the curve (AUC), 0.70 vs 0.64, P = .11] or men (AUC, 0.76 vs 0.71, P = .06), respectively.
Conclusions and Implications
Reduced subcutaneous adiposity is associated with mortality in older women undergoing hip fracture surgery, while reduced muscle mass predicts mortality in men. These findings highlight the importance of considering sexual dimorphism in the development of novel biomarkers and effective treatment strategies.
{"title":"Sex-Specific Body Composition Profile Determined by Pelvic Computed Tomography Associated with Mortality in Older Patients with Hip Fracture","authors":"Wenwei Zhu MD , Qianyun Liu MD , Zhimin Yan MD , Wenming Zhou MD , Pengfei Rong MD, PhD , Zhichao Feng MD, PhD","doi":"10.1016/j.jamda.2025.105502","DOIUrl":"10.1016/j.jamda.2025.105502","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous research has demonstrated notable differences in body composition and mortality risk following hip fracture between sexes. This study aimed to investigate the sex-specific associations between body composition profile and mortality in older patients undergoing hip fracture surgery.</div></div><div><h3>Design</h3><div>Dual-center cohort study.</div></div><div><h3>Setting and Participants</h3><div>We included 488 older patients (aged ≥60 years) with hip fracture treated with surgery.</div></div><div><h3>Methods</h3><div>The cross-sectional area and attenuation of skeletal muscle, subcutaneous adipose tissue, and intermuscular adipose tissue at the the upper thigh level on preoperative pelvic computed tomography (CT) were measured. The relationship between body composition and mortality was determined using Cox proportional hazards analysis stratified by sex.</div></div><div><h3>Results</h3><div>The mean age of the cohort was 76.2 ± 8.7 years, and 312 (63.9%) were women. Within 1 year after surgery, 89 (18.2%) patients died. Female patients had greater subcutaneous adipose tissue area [SATA; median (interquartile range), 196.5 (160.1∼228.5) vs 147.1 (111.3∼181.1) cm<sup>2</sup>; <em>P</em> < .001] and lower skeletal muscle area [SMA; 187.2 (167.3∼212.4) vs 255.5 (223.2∼286.1) cm<sup>2</sup>; <em>P</em> < .001] compared with male patients. In the sex-stratified multivariable analyses, SATA in females [hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.86∼0.97; <em>P</em> = .003] and SMA in men (HR, 0.93; 95% CI, 0.86∼1.00; <em>P</em> = .05) were significant predictors of 1-year mortality. Incorporation of SATA or SMA within the existing Nottingham Hip Fracture Score (NHFS) showed slightly improved performance in predicting 1-year mortality among women [area under the curve (AUC), 0.70 vs 0.64, <em>P</em> = .11] or men (AUC, 0.76 vs 0.71, <em>P</em> = .06), respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Reduced subcutaneous adiposity is associated with mortality in older women undergoing hip fracture surgery, while reduced muscle mass predicts mortality in men. These findings highlight the importance of considering sexual dimorphism in the development of novel biomarkers and effective treatment strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105502"},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-24DOI: 10.1016/j.jamda.2025.105522
Yu-Jung Jenny Wei, Almut G Winterstein, Siegfried Schmidt, Roger B Fillingim, Stephan Schmidt, Michael J Daniels, Steven T DeKosky, Henry Young, Ting-Yuan David Cheng
Objectives: Clinical decisions to continue or discontinue long-term opioid therapy (LTOT; ≥3 months) for older cancer survivors remain challenging due to limited evidence on the risks and benefits of this treatment practice. This study aims to examine the associations of discontinuing LTOT with clinical and opioid-related adverse event (ORAE) outcomes among older cancer survivors residing in long-term care (LTC) settings.
Designs: This retrospective cohort study analyzed data from the 100% Medicare nursing home sample from 2010 to 2021.
Setting and participants: LTC residents aged ≥65 years who were survivors of cancer for at least 1 year and received LTOT for chronic pain.
Methods: Discontinuation of LTOT was defined as no prescription opioid refills for at least 90 days. Clinical outcomes included worsening pain, physical function, and depression; ORAE outcomes included counts of pain-related hospitalizations, pain-related emergency department visits, opioid use disorder, and opioid overdose. We used modified Poisson models for clinical outcomes and Poisson models for ORAE outcomes, adjusting baseline covariates via inverse probability of treatment weighting.
Results: Of 21,861 episodes of cancer survivors with LTOT, 18,984 survivors (86.8%) continued LTOT, whereas 2877 survivors (13.2%) discontinued LTOT. The discontinuers vs continuers had lower adjusted risk of worsening pain (relative risk 0.65, 95% CI 0.59-0.74, P < .001) and lower adjusted rates of opioid use disorder (rate ratio 0.76, 95% CI 0.64-0.90, P < .001) and opioid overdose (rate ratio 0.33, 95% CI 0.21-0.52, P < .001) at the 1-year follow-up, with no difference in physical function and depressive symptoms or rates of pain-related hospitalizations and emergency department visits.
Conclusions and implications: Discontinuing vs continuing LTOT was associated with lower risk of worsening pain, opioid use disorder, and opioid overdose, with nondifferential risks of the other studied outcomes. Discontinuing vs continuing LTOT may confer benefits that outweigh risks among older LTC cancer survivors.
{"title":"Outcomes of Discontinuing Long-Term Opioid Therapy Among Older Cancer Survivors in Long-Term Care Settings.","authors":"Yu-Jung Jenny Wei, Almut G Winterstein, Siegfried Schmidt, Roger B Fillingim, Stephan Schmidt, Michael J Daniels, Steven T DeKosky, Henry Young, Ting-Yuan David Cheng","doi":"10.1016/j.jamda.2025.105522","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105522","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical decisions to continue or discontinue long-term opioid therapy (LTOT; ≥3 months) for older cancer survivors remain challenging due to limited evidence on the risks and benefits of this treatment practice. This study aims to examine the associations of discontinuing LTOT with clinical and opioid-related adverse event (ORAE) outcomes among older cancer survivors residing in long-term care (LTC) settings.</p><p><strong>Designs: </strong>This retrospective cohort study analyzed data from the 100% Medicare nursing home sample from 2010 to 2021.</p><p><strong>Setting and participants: </strong>LTC residents aged ≥65 years who were survivors of cancer for at least 1 year and received LTOT for chronic pain.</p><p><strong>Methods: </strong>Discontinuation of LTOT was defined as no prescription opioid refills for at least 90 days. Clinical outcomes included worsening pain, physical function, and depression; ORAE outcomes included counts of pain-related hospitalizations, pain-related emergency department visits, opioid use disorder, and opioid overdose. We used modified Poisson models for clinical outcomes and Poisson models for ORAE outcomes, adjusting baseline covariates via inverse probability of treatment weighting.</p><p><strong>Results: </strong>Of 21,861 episodes of cancer survivors with LTOT, 18,984 survivors (86.8%) continued LTOT, whereas 2877 survivors (13.2%) discontinued LTOT. The discontinuers vs continuers had lower adjusted risk of worsening pain (relative risk 0.65, 95% CI 0.59-0.74, P < .001) and lower adjusted rates of opioid use disorder (rate ratio 0.76, 95% CI 0.64-0.90, P < .001) and opioid overdose (rate ratio 0.33, 95% CI 0.21-0.52, P < .001) at the 1-year follow-up, with no difference in physical function and depressive symptoms or rates of pain-related hospitalizations and emergency department visits.</p><p><strong>Conclusions and implications: </strong>Discontinuing vs continuing LTOT was associated with lower risk of worsening pain, opioid use disorder, and opioid overdose, with nondifferential risks of the other studied outcomes. Discontinuing vs continuing LTOT may confer benefits that outweigh risks among older LTC cancer survivors.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105522"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523766","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}
Pub Date : 2025-02-24DOI: 10.1016/j.jamda.2025.105492
Natalia Drapała MPH , Ilona Barańska MSc, MPH, PhD , Lieve Van den Block MSc, PhD , Tinne Smets MSc, PhD , Nele Van Den Noortgate MD, PhD , Harriet Finne-Soveri MD, PhD , Giovanni Gambassi MD, PhD , Bregje D. Onwuteaka-Philipsen PhD , Katarzyna Szczerbińska MD, PhD
Objective
To determine the extent and factors associated with relatives' engagement in end-of-life care for residents of long-term care facilities (LTCFs) during the last week before the resident's death.
Design
A cross-sectional retrospective survey.
Setting and Participants
A total of 814 relatives of deceased LTCF residents in a representative sample of 229 LTCFs in Belgium, Finland, Italy, the Netherlands, and Poland.
Methods
LTCFs reported all residents’ deaths in the past 3 months. In each case, standardized questionnaires were sent to the LTCF manager, nurse, physician, and relative most involved in care. A multivariable logistic regression model was applied to assess which factors and characteristics of the relative and deceased resident were associated with more time spent with the resident in the last week of life.
Results
Compared with Poland, relatives from the Netherlands [odds ratio (OR), 14.22; 95% CI, 6.56–30.82], Belgium (OR, 10.24; 95% CI 4.87–24.52), and Finland (OR, 2.57; 95% CI, 1.18–5.58) had higher odds of spending more than 14 hours with residents in the last week of life. Female relatives, who were their partners or spouses, and who provided more than 11 hours of care weekly before the resident's admission to the LTCF (OR, 2.96; 95% CI 1.55–5.65) were more likely to visit the dying resident during the last week of life. Residents placed in the LTCF due to their behavioral problems or dependency in activities of daily living (ADL) were less frequently visited by their relatives in the last week of life (OR, 0.34; 95% CI, 0.16–0.71 and OR, 0.54; 95% CI, 0.36–0.82, respectively).
Conclusions and Implications
Resident's behavioral problems and dependency in ADLs at the time of admission to the LTCF were associated with their relative's lower engagement in end-of-life care. We also found substantial differences in relatives' engagement among countries. Further research is required to identify the causes of these discrepancies and to develop culture-specific support for relatives.
{"title":"Engagement of Relatives in End-of-life Care of Residents in Long-Term Care Facilities: A Cross-Sectional Study in 5 EU Countries","authors":"Natalia Drapała MPH , Ilona Barańska MSc, MPH, PhD , Lieve Van den Block MSc, PhD , Tinne Smets MSc, PhD , Nele Van Den Noortgate MD, PhD , Harriet Finne-Soveri MD, PhD , Giovanni Gambassi MD, PhD , Bregje D. Onwuteaka-Philipsen PhD , Katarzyna Szczerbińska MD, PhD","doi":"10.1016/j.jamda.2025.105492","DOIUrl":"10.1016/j.jamda.2025.105492","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the extent and factors associated with relatives' engagement in end-of-life care for residents of long-term care facilities (LTCFs) during the last week before the resident's death.</div></div><div><h3>Design</h3><div>A cross-sectional retrospective survey.</div></div><div><h3>Setting and Participants</h3><div>A total of 814 relatives of deceased LTCF residents in a representative sample of 229 LTCFs in Belgium, Finland, Italy, the Netherlands, and Poland.</div></div><div><h3>Methods</h3><div>LTCFs reported all residents’ deaths in the past 3 months. In each case, standardized questionnaires were sent to the LTCF manager, nurse, physician, and relative most involved in care. A multivariable logistic regression model was applied to assess which factors and characteristics of the relative and deceased resident were associated with more time spent with the resident in the last week of life.</div></div><div><h3>Results</h3><div>Compared with Poland, relatives from the Netherlands [odds ratio (OR), 14.22; 95% CI, 6.56–30.82], Belgium (OR, 10.24; 95% CI 4.87–24.52), and Finland (OR, 2.57; 95% CI, 1.18–5.58) had higher odds of spending more than 14 hours with residents in the last week of life. Female relatives, who were their partners or spouses, and who provided more than 11 hours of care weekly before the resident's admission to the LTCF (OR, 2.96; 95% CI 1.55–5.65) were more likely to visit the dying resident during the last week of life. Residents placed in the LTCF due to their behavioral problems or dependency in activities of daily living (ADL) were less frequently visited by their relatives in the last week of life (OR, 0.34; 95% CI, 0.16–0.71 and OR, 0.54; 95% CI, 0.36–0.82, respectively).</div></div><div><h3>Conclusions and Implications</h3><div>Resident's behavioral problems and dependency in ADLs at the time of admission to the LTCF were associated with their relative's lower engagement in end-of-life care. We also found substantial differences in relatives' engagement among countries. Further research is required to identify the causes of these discrepancies and to develop culture-specific support for relatives.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105492"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425612","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}
Pub Date : 2025-02-22DOI: 10.1016/j.jamda.2025.105493
Seo Yeong Bak, Young Choi PhD
Objective
This study investigated the relationship between frailty and quality of life in middle-aged and older adults, and determined how age influences the relationship between frailty and quality of life.
Design
A cross-sectional study from Korean Longitudinal Study of Ageing (2006–2020).
Setting and Participants
There were a total of 9301 participants aged ≥45 years at baseline (2006).
Methods
Frailty was assessed using the Korean Frailty Instrument, which categorized participants as non-frail, pre-frail, or frail. Quality of life (QoL) was measured using a visual analog, ranging from 0 (worst) to 100 (best) in 10-point intervals. We used multiple linear mixed models to examine the association between frailty and QoL among middle-aged and older adults and to test the interaction effect of frailty status and age on QoL.
Results
Of 9301 participants, 53.7% were non-frail, 30.3% were pre-frail, and 16.0% were frail. Average QoL scores were 68.7 in the non-frail group, 59.9 in the pre-frail group, and 48.2 in the frail group (P < .001). The linear mixed model analysis showed that pre-frail (β = −2.235, SE = 0.152, P < .001) and frail (β = −5.072, SE = 0.269, P < .001) individuals had lower QoL scores compared with non-frail individuals. Although QoL scores remained stable across age groups in non-frail individuals, those with frail status showed an increase in QoL with age.
Conclusions and Implications
Frailty is significantly associated with lower QoL in both middle-aged and older adults. In addition, the interaction of age and frailty showed that QoL improves with age in frail people. This suggests that the impact of frailty on QoL is greater in middle age.
{"title":"Association Between Frailty and Quality of Life in Middle-Aged and Older Adults","authors":"Seo Yeong Bak, Young Choi PhD","doi":"10.1016/j.jamda.2025.105493","DOIUrl":"10.1016/j.jamda.2025.105493","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigated the relationship between frailty and quality of life in middle-aged and older adults, and determined how age influences the relationship between frailty and quality of life.</div></div><div><h3>Design</h3><div>A cross-sectional study from Korean Longitudinal Study of Ageing (2006–2020).</div></div><div><h3>Setting and Participants</h3><div>There were a total of 9301 participants aged ≥45 years at baseline (2006).</div></div><div><h3>Methods</h3><div>Frailty was assessed using the Korean Frailty Instrument, which categorized participants as non-frail, pre-frail, or frail. Quality of life (QoL) was measured using a visual analog, ranging from 0 (worst) to 100 (best) in 10-point intervals. We used multiple linear mixed models to examine the association between frailty and QoL among middle-aged and older adults and to test the interaction effect of frailty status and age on QoL.</div></div><div><h3>Results</h3><div>Of 9301 participants, 53.7% were non-frail, 30.3% were pre-frail, and 16.0% were frail. Average QoL scores were 68.7 in the non-frail group, 59.9 in the pre-frail group, and 48.2 in the frail group (<em>P</em> < .001). The linear mixed model analysis showed that pre-frail (β = −2.235, SE = 0.152, <em>P</em> < .001) and frail (β = −5.072, SE = 0.269, <em>P</em> < .001) individuals had lower QoL scores compared with non-frail individuals. Although QoL scores remained stable across age groups in non-frail individuals, those with frail status showed an increase in QoL with age.</div></div><div><h3>Conclusions and Implications</h3><div>Frailty is significantly associated with lower QoL in both middle-aged and older adults. In addition, the interaction of age and frailty showed that QoL improves with age in frail people. This suggests that the impact of frailty on QoL is greater in middle age.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105493"},"PeriodicalIF":4.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425672","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}
Pub Date : 2025-02-22DOI: 10.1016/j.jamda.2025.105517
Lindsay J Peterson, Kelly M Smith
Objectives: To use quantitative and qualitative data to assess nursing home administrators' perceptions of a program using personal care attendants (PCAs) to ease staffing challenges, and to better understand factors concerning perceptions of success of lack thereof.
Design: Convergent mixed methods design, in which quantitative and qualitative data were collected concurrently and analyzed separately, with results combined for interpretation.
Setting and participants: Florida nursing home administrators (N = 74).
Methods: We developed a survey to collect data on administrators' use and perceptions of the PCA program. Data from closed-end questions assessing the value and use of PCAs and data on nursing home characteristics (eg, bed size, profit status) were analyzed using multiple logistic regression. Open-ended responses were analyzed using deductive thematic analysis. Quantitative and qualitative data were combined for further analysis.
Results: We found greater use of PCAs (more PCAs hired) was associated with 6% greater odds of finding the program beneficial (odds ratio, 1.06; 95% CI, 1.0-1.12; P = .049), controlling for facility characteristics. Qualitative analysis identified 3 themes: benefits of the PCA program, barriers to the success of the program, and steps taken to improve the program's usefulness. In further analysis, we identified an overarching theme of administrator proactivity in the implementation of the PCA program. Integration of quantitative and qualitative results found a relationship between assessing the PCA program as beneficial and taking proactive steps to facilitate use of PCAs.
Conclusions and implications: Success of the PCA program in easing staffing challenges may have depended on administrators being proactive, in contrast to those who negatively assessed the program and took a more passive approach. Results provide evidence of differing leadership styles in the use of the PCA program, suggesting leadership training could better equip nursing home leaders to implement staffing initiatives. More research is recommended on the relationship between administrative leadership, staffing, and quality.
{"title":"Assessing a Statewide Nursing Home Staffing Program Through Quantitative and Qualitative Survey Data.","authors":"Lindsay J Peterson, Kelly M Smith","doi":"10.1016/j.jamda.2025.105517","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105517","url":null,"abstract":"<p><strong>Objectives: </strong>To use quantitative and qualitative data to assess nursing home administrators' perceptions of a program using personal care attendants (PCAs) to ease staffing challenges, and to better understand factors concerning perceptions of success of lack thereof.</p><p><strong>Design: </strong>Convergent mixed methods design, in which quantitative and qualitative data were collected concurrently and analyzed separately, with results combined for interpretation.</p><p><strong>Setting and participants: </strong>Florida nursing home administrators (N = 74).</p><p><strong>Methods: </strong>We developed a survey to collect data on administrators' use and perceptions of the PCA program. Data from closed-end questions assessing the value and use of PCAs and data on nursing home characteristics (eg, bed size, profit status) were analyzed using multiple logistic regression. Open-ended responses were analyzed using deductive thematic analysis. Quantitative and qualitative data were combined for further analysis.</p><p><strong>Results: </strong>We found greater use of PCAs (more PCAs hired) was associated with 6% greater odds of finding the program beneficial (odds ratio, 1.06; 95% CI, 1.0-1.12; P = .049), controlling for facility characteristics. Qualitative analysis identified 3 themes: benefits of the PCA program, barriers to the success of the program, and steps taken to improve the program's usefulness. In further analysis, we identified an overarching theme of administrator proactivity in the implementation of the PCA program. Integration of quantitative and qualitative results found a relationship between assessing the PCA program as beneficial and taking proactive steps to facilitate use of PCAs.</p><p><strong>Conclusions and implications: </strong>Success of the PCA program in easing staffing challenges may have depended on administrators being proactive, in contrast to those who negatively assessed the program and took a more passive approach. Results provide evidence of differing leadership styles in the use of the PCA program, suggesting leadership training could better equip nursing home leaders to implement staffing initiatives. More research is recommended on the relationship between administrative leadership, staffing, and quality.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105517"},"PeriodicalIF":4.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502126","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}
Pub Date : 2025-02-22DOI: 10.1016/j.jamda.2025.105518
Xiao Wang, Emmanuelle Belanger, Derek Lake, Christopher Santostefano, Joan Teno, Susan L Mitchell, Pedro Gozalo
Objectives: Nursing home (NH) residents are high-cost, high-need Medicare beneficiaries. Accountable Care Organizations (ACOs) have the potential to improve quality of care and reduce potentially unnecessary health care utilization. This study aimed to assess the impact of Medicare Shared Savings Program (MSSP) ACOs on health care utilization among long-stay NH residents.
Design: "Intention-to-treat" and quasi-experimental design.
Setting and participants: A national cohort of 158,259 fee-for-service Medicare beneficiaries who were long-stay NH residents in 2011 or 2018. In each year, residents were included in the sample the first time their Minimum Data Set (MDS) assessments (ie, index MDS) met the following inclusion criteria: (1) age 66+; (2) dependence in 2 or more activities of daily living; (3) neither enrolled in hospice nor in coma; and (4) NH length of stay ≥90 days.
Methods: We followed residents' health care utilization and Medicare expenditures for 1 year after their index MDS date. Outcomes included any health care utilization in different care settings (ie, inpatient, outpatient emergency room visit/observational stay, skilled nursing facility, hospice) and corresponding Medicare expenditures. We used difference-in-differences models to estimate the association between ACO attribution and health care utilization in 2018, using 2011 as the pre-ACO baseline. To determine ACO attribution among the 2011 cohort, we developed an algorithm to replicate the ACO attribution in 2018 and used it to identify residents who would have been attributed to 2018 ACOs back in 2011. To address the endogeneity issue between ACO attribution and utilization outcomes, we used an "intention-to-treat" design to determine ACO attribution.
Results: Adjusted difference-in-differences results showed a lack of significant associations between ACO attribution and health care utilization or Medicare expenditures among long-stay NH residents.
Conclusions and implications: ACOs did not affect health care utilization of long-stay NH residents. Future payment reforms need to ensure that their benefits could reach these vulnerable older adults.
{"title":"Do Medicare Accountable Care Organizations Impact Health Care Utilization Among Long-Stay Nursing Home Residents?","authors":"Xiao Wang, Emmanuelle Belanger, Derek Lake, Christopher Santostefano, Joan Teno, Susan L Mitchell, Pedro Gozalo","doi":"10.1016/j.jamda.2025.105518","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105518","url":null,"abstract":"<p><strong>Objectives: </strong>Nursing home (NH) residents are high-cost, high-need Medicare beneficiaries. Accountable Care Organizations (ACOs) have the potential to improve quality of care and reduce potentially unnecessary health care utilization. This study aimed to assess the impact of Medicare Shared Savings Program (MSSP) ACOs on health care utilization among long-stay NH residents.</p><p><strong>Design: </strong>\"Intention-to-treat\" and quasi-experimental design.</p><p><strong>Setting and participants: </strong>A national cohort of 158,259 fee-for-service Medicare beneficiaries who were long-stay NH residents in 2011 or 2018. In each year, residents were included in the sample the first time their Minimum Data Set (MDS) assessments (ie, index MDS) met the following inclusion criteria: (1) age 66+; (2) dependence in 2 or more activities of daily living; (3) neither enrolled in hospice nor in coma; and (4) NH length of stay ≥90 days.</p><p><strong>Methods: </strong>We followed residents' health care utilization and Medicare expenditures for 1 year after their index MDS date. Outcomes included any health care utilization in different care settings (ie, inpatient, outpatient emergency room visit/observational stay, skilled nursing facility, hospice) and corresponding Medicare expenditures. We used difference-in-differences models to estimate the association between ACO attribution and health care utilization in 2018, using 2011 as the pre-ACO baseline. To determine ACO attribution among the 2011 cohort, we developed an algorithm to replicate the ACO attribution in 2018 and used it to identify residents who would have been attributed to 2018 ACOs back in 2011. To address the endogeneity issue between ACO attribution and utilization outcomes, we used an \"intention-to-treat\" design to determine ACO attribution.</p><p><strong>Results: </strong>Adjusted difference-in-differences results showed a lack of significant associations between ACO attribution and health care utilization or Medicare expenditures among long-stay NH residents.</p><p><strong>Conclusions and implications: </strong>ACOs did not affect health care utilization of long-stay NH residents. Future payment reforms need to ensure that their benefits could reach these vulnerable older adults.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105518"},"PeriodicalIF":4.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502127","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}
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