Journal of the American Medical Directors Association最新文献

Objectives: Magnesium deficiency is common in older adults and has been associated with reduced muscle functionality and several age-related diseases. Evidence of its relationship with frailty is scarce. We aimed to explore the association of magnesium intake with incident frailty in the Seniors-ENRICA-1 cohort.

Design: Prospective longitudinal cohort study.

Setting and participants: The ENRICA study is a population-based study (N = 13,105) that includes a representative sample of the noninstitutionalized Spanish population aged 18 years and older. For the present analyses, we used data from the community-dwelling participants aged 60 years and older at baseline (n = 2519). After exclusions, we included data from 1900 participants of the Seniors-ENRICA-1 cohort (mean age 68.7 ± 6.4 years; 51.7% women).

Methods: Food consumption was assessed at baseline with a validated, computer-based, face-to-face dietary history (DH-ENRICA), from which magnesium intake was estimated. Frailty was defined as having 3 or more of Fried criteria: exhaustion, low physical activity, slow gait speed, weakness, and weight loss. Analyses were performed with logistic regression adjusted for potential confounders.

Results: During a mean follow-up of 3.5 years, 136 new cases (7.2%) of frailty occurred. Compared with the lowest sex-specific quartile of magnesium intake, the fully adjusted odds ratio (95% CI) for incident frailty across increasing quartiles of intake was 0.62 (0.36, 1.07), 0.53 (0.28, 0.98), and 0.43 (0.21, 0.86), respectively (P-trend = .016). Corresponding results for slow gait speed were 0.68 (0.47, 1.01), 0.58 (0.37, 0.89), and 0.52 (0.32-0.84), respectively (P-trend = .008). Other Fried criteria showed a similar tendency to reduced frailty incidence with increasing magnesium intake, without achieving statistical significance in the fully adjusted model.

Conclusions and implications: Higher magnesium intake was inversely and independently associated with lower frailty risk, especially of slow gait speed, in community-dwelling older adults, suggesting that adequate intake of this vital ion could help prevent unhealthy aging.

Objective: To explore a comprehensive overview of digital technologies used for fall detection in older adults, categorizing the types, functions, and usability of these systems.

Design: A scoping review was conducted to search across 5 databases (Embase, Medline [OVID], CINAHL, Coherence and IEEE Explore) from January 2013 to September 2023.

Setting and participants: Studies in older adults living in nursing homes, care homes, residential homes, respite care homes, and all skilled and ambulatory care facilities (without context restrictions).

Methods: This review followed the 6 methodological stages: (1) identification of research question; (2) identification of relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and an optional stage, (6) consulting with stakeholders regarding findings to explore pivotal concepts in emerging technology usage in long-term care for falls detection among older people. Data were extracted and categorized based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results: A total of 73 studies met the inclusion criteria. Four main categories of fall detection technologies were identified: motion and sensor technologies, imaging and visual systems, environmental sensors, and robotic and autonomous systems. Commonly used devices: wearable accelerometers, gyroscopes, infrared array sensors, and smart carpet pressure sensors. Data storage methods were wearable devices, cameras, and floor-mounted sensors. Communication technologies included Bluetooth, Wi-Fi, and GPS, and notification methods ranged from alarms and SMS to cloud communications. Various health care response teams, including caregivers, health care providers, and emergency services, were integral to the fall detection systems.

Conclusions and implications: Most studies primarily focus on fall detection; however, we recommend further clinical research to emphasize both fall detection and, more importantly, fall prevention (both primary and secondary). Investigating the effectiveness of fall prevention technologies in real-world settings will be crucial for enhancing the safety and quality of life of the aging population.

Objectives: Given the particularity of Asian cultures and dietary habits, there is a need to establish a neuroprotective dietary pattern specially for the Asian stroke high-risk population, to prevent cognitive impairment.

Design: A systematic review and cross-sectional study.

Setting and participants: Chinese stroke high-risk population from the CIRCLE (NCT03542734) study.

Methods: The Oriental Intervention for Enhanced Neurocognitive healTh (ORIENT) diet was developed by replacing the western foods in the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diet with appropriate Asian alternatives, and refining the recommended intake frequency based on a systematic review, which examined Asian studies in the cognition-diet field. Cognitive impairment was defined as a global cognitive score ≥1 SD below the sample mean, based on the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network vascular cognitive impairment battery.

Results: A total of 568 participants were finally included, with 325 men (57.2%) and a mean age of 60.5 ± 7.3 years. Participants in the highest tertile of ORIENT score had 60.5% lower odds of cognitive impairment than those in the lowest tertile (odds ratio = 0.395, 95% CI = 0.165-0.944, P = .044) when adjusted for demographic variables, lifestyle factors, and health status. Multiple linear regression analysis showed that each 1-point increase in ORIENT score was associated with 0.048 higher global cognitive score, 0.281 higher Mini-Mental State Examination score, and 0.344 higher Montreal Cognitive Assessment score.

Conclusions and implications: High adherence to ORIENT diet was associated with lower odds of cognitive impairment, providing a potential neuroprotective dietary pattern for Chinese stroke high-risk population.

Objectives: To examine the associations of smoking cessation with the subsequent frailty status trajectory using data from a nationally representative sample of community-dwelling older adults living in England.

Design: A prospective panel study.

Setting and participants: A total of 2600 community-dwelling older adults aged 60 or older in England who used to smoke.

Methods: The past smokers were divided into 5 groups based on years since smoking cessation: 0-10, 11-20, 21-30, 31-40, and 41+ years. The Frailty Index (FI) was constructed using 60 deficits and repeatedly calculated every 2 years over 16 years. Trajectories of FI according to years since smoking cessation were estimated by a mixed-effects model.

Results: A mixed-effects model adjusted for age, sex, education, wealth, and alcohol use showed that FI increased over time in all groups and that longer duration since smoking cessation was significantly associated with lower FI. Those who quit 41 years earlier or more had the lowest frailty trajectory, however, there was still a gap between them and never smokers.

Conclusions and implications: The current study showed that past smokers with a longer duration of quitting smoking had a significantly lower degree of frailty at baseline and over time. These findings highlight beneficial effects of smoking cessation on frailty even in middle or old age and could be used in public health education to promote the importance of quitting smoking.

Objectives: Well-designed, health-promoting physical work environments have the potential to reduce burnout and attrition for employees who work in long-term care (LTC) facilities. Unfortunately, there is limited existing guidance for LTC facility owners and operators related to specific health-promoting design strategies for LTC work environments. This narrative review aims to fill this knowledge gap.

Methods: Information was synthesized from healthy-building certification standards for health care and non-health care buildings, LTC design guidelines, academic studies, and expert commentaries. The review was conducted in 3 phases to (1) identify specific space types and design characteristics generally considered to be health-supportive, (2) gather existing research on the identified strategies to critically analyze their supportive value, and (3) communicate the findings to a broad audience of stakeholders.

Results: Five specific space types and 21 design characteristics were identified as both supportive of employee health and well-being, and relevant to LTC physical work environments.

Conclusions: When health care organizations construct new facilities or renovate existing facilities, using these health-promoting design strategies should be considered. Benefits of health-promoting physical work environments include better employee mental and physical health, less burnout, and less turnover. Reducing burnout and increasing employee retention is essential to mitigate the ongoing staffing crisis in the LTC industry.

The inappropriate use of antipsychotic medications in older adults can reduce the quality of life and increase the risk of adverse drug interactions. To address this concern, a quality improvement study was implemented across 34 long-term care (LTC) homes in Ontario, Canada. The study aimed to reduce inappropriate antipsychotic use by implementing evidence-based deprescribing practices. The study resulted in a 40.6% reduction in inappropriate antipsychotic use. The results of this study can inform quality improvement approaches for reducing the inappropriate use of antipsychotics in LTC and beyond.

Objectives: Persons living with dementia (PLwD) often feel lonely and bored. This study examined the impact of group activities on the well-being of this population when these activities were facilitated by enhanced group activity kits (EGAKs) and compared the impact of this intervention with (1) group activities not facilitated by EGAKs and (2) the absence of group activities.

Design: The study was conducted as a stepped-wedge clustered trial.

Setting and participants: The study included 123 PLwD from 6 nursing care units and 4 senior day units for PLwD in the Tel Aviv and Jerusalem metropolitan areas of Israel.

Methods: The participants took part in group activities while their well-being was assessed using the Group Observational Measurement of Engagement (GOME) assessment tool, from which a Wellbeing Index was derived. Participants attended baseline group activities, during which a facility staff activity leader conducted activities without using EGAKs. Thereafter, the same activity leader and participants engaged in activities that used EGAKs. During the course of the study, 1 activity leader resigned, and her participants, no longer offered group activities, were assessed at the times during which their previous activities would have occurred.

Results: Significant improvement in well-being (P < .001) was found during group activities facilitated using EGAKs compared with group activities conducted by the same activity leader not using EGAKs. Compared with baseline group activity sessions (without EGAKs), a no-activity state yielded a highly significant decrease in well-being (P < .001).

Conclusions and implications: The results demonstrate the potential utility of EGAKs to improve the well-being of people living with dementia. This relatively inexpensive innovation can be made available on a large scale to nursing homes, assisted living facilities, and senior day centers. Future research should expand the range of content of EGAKs in order to serve PLwD of diverse cultural backgrounds.

Objectives: To examine the effect of social support on the risk of caregiver's functional disability due to spouse's functional disability.

Design: Longitudinal study.

Setting and participants: In this cohort study using the Ohsaki Cohort 2006 Study data, the baseline survey was conducted from December 1, 2006, to December 15, 2006, and included 7598 older adults, including 3799 couples, ≥65 years of age.

Methods: The incidence of spouse's functional disability was defined as certification for the Long-term Care Insurance, which uses a nationally uniform standard of functional disability. The primary outcome was the incidence of the caregiver's functional disability, and the follow-up period was between December 16, 2006, and November 30, 2019. Five social support questionnaires were used to assess the degree of emotional and instrumental social support available to each participant. The Cox proportional hazards model was used to evaluate the incidence of functional disability among caregivers after the occurrence of spouses' functional disability. Subgroup analyses were also conducted according to the status of emotional and instrumental social support.

Results: The caregiver's functional disability increased significantly among those whose spouses had functional disability compared with those whose spouses had no disability (multivariate hazard ratio [HR], 1.86). Emotional and instrumental social support showed significant positive interactions on this association (emotional and instrumental support: P for interaction < .01 and < .01, respectively), and the risk of caregiver's disability was higher among those without social support than among those with social support (with emotional support: HR, 1.84; without emotional support: HR, 2.51; with instrumental support: HR, 1.85; without instrumental support: HR, 2.31).

Conclusions and implications: Social support may help to alleviate the increased risk for caregiver's functional disability due to the spouse's functional disability.

Objectives: Comprehensive multidisciplinary rehabilitation has been proven to benefit patients recovering from hip fracture surgery, enhancing postoperative outcomes. However, challenges persist in delivering such rehabilitation due to health care system limitations and inadequate policies. This study aimed to evaluate the clinical effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) in comparison to a conventional rehabilitation after hip fracture surgery.

Design: A parallel-group, single-blind, multicenter randomized clinical trial.

Setting and participants: Three in-hospital rehabilitation settings; 203 hip fracture surgery patients aged 65 years and older were randomized and followed up for 1 year.

Methods: The main outcome assessed ambulatory function, using the Koval and Functional Ambulation Category (FAC) scales. Functional outcomes were evaluated upon rehabilitation admission, discharge, and during follow-up at 3, 6, and 12 months post-surgery. The prevalence of independent ambulation and recovery to prefracture ambulatory status at each follow-up time point were analyzed.

Results: The FIRM group demonstrated superior improvements in Koval and FAC scores, along with most secondary outcomes during the 1-year follow-up. Significant changes from baseline to 12 months were observed in Koval scores (mean difference, -4.13 [95% CI, -4.56 to -3.70] vs -3.22 [95% CI, -3.86 to -2.61], P = .016) and FAC scores (mean difference, 3.37 [95% CI, 3.01 to 3.72] vs 2.56 [95% CI, 2.10 to 3.02], P = .006). At the 12-month follow-up point, this group also showed higher rates of independent ambulation (53 [76.8%] vs 28 [56.0%], P = .016) and recovery to prefracture ambulatory status (56 [81.2%] vs 31 [62.0%], P = .020) than the conventional group.

Conclusions and implications: The FIRM demonstrated superior effectiveness compared with conventional rehabilitation in improving ambulation and other functional outcomes in older adults with hip fracture. This finding provides valuable insights for managing comprehensive multidisciplinary postoperative care for hip fractures in South Korea and beyond.

Objectives: To synthesize evidence on the implementation and effectiveness of age-friendly interventions in intensive care units (ICUs) to optimize care for older adults.

Design: Systematic review of studies published up to February 2024, focusing on interventions tailored to meet the needs of older adults in ICU settings.

Setting and participants: Comparative studies conducted in ICUs worldwide, involving older adults receiving critical care, were reviewed.

Methods: A systematic search of databases including Embase, MEDLINE, and Cochrane was performed. The quality of studies was assessed using the ROSVIS-II tool, and findings were synthesized narratively and thematically.

Results: Out of 1200 articles initially identified, 45 studies met inclusion criteria. Age-friendly interventions (eg, geriatric assessment teams, multimodal care bundles) demonstrated significant benefits, including a 19% reduction in major in-hospital complications and shorter hospital stays by an average of 3 days.

Conclusions and implications: The review supports the effectiveness of age-friendly interventions in improving clinical outcomes for older ICU patients. However, consistent reporting of effect sizes was lacking, and more high-quality comparative effectiveness research is needed. Implications for practice include integrating these interventions into standard ICU protocols to enhance older adult care. Policy implications involve advocating for health care policies that support the dissemination and implementation of effective age-friendly practices. Further research should focus on establishing a robust evidence base to guide implementation and policy decisions.