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A Pragmatic Approach to Identifying Goal-Concordant Care for Nursing Home Residents With Alzheimer's Disease or Related Dementias 为患有阿尔茨海默氏症或相关痴呆症的疗养院住院患者确定目标一致护理的实用方法》(A Pragmatic Approach to Identifying Goal-Concordant Care for Nursing Home Residents with Alzheimer's Disease or Related Dementias.
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.jamda.2024.105266
Natalie C. Ernecoff PhD, MPH, Hyunkyung (Yulia) Yun MS, MSW, Ellen McCreedy PhD, MPH, Laura C. Hanson MD, MPH, Susan L. Mitchell MD, MPH
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引用次数: 0
Oropharyngeal Dysphagia in Hospitalized Older Adults with Dementia: A Prospective Cohort Study 住院老年痴呆症患者的口咽吞咽困难:前瞻性队列研究
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.jamda.2024.105267
Alexander Makhnevich MD , Alexandra Perrin BA , Kristen Porreca MD , Ji Yoon Lee MS , Cristina Sison PhD , Valeria Gromova BS , Kaitlyn Accardi MPH , Isaac David MPH , LaTaviah Burch RN , Vincent Chua BS , Stefani D'Angelo MS , Rebecca Affoo PhD , Michael S. Pulia MD, PhD , Nicole Rogus-Pulia PhD, CCC-SLP , Liron Sinvani MD

Objective

Oropharyngeal dysphagia (dysphagia) is highly prevalent (up to 86%) in hospitalized patients with Alzheimer disease and related dementias (ADRD). This study aims to describe the management and clinical course of dysphagia in hospitalized patients with ADRD.

Design

Prospective observational cohort study.

Setting and Participants

The study was conducted across 10 hospitals within a large health system in New York. Participants were older adults with ADRD admitted to the medicine service and diagnosed with dysphagia to liquids on speech-language pathologist (SLP) assessment and were recruited between January and June 2023.

Methods

Baseline characteristics [eg, dementia Functional Assessment Staging Tool (FAST)], dysphagia management (eg, prescribed diet), and clinical course (eg, dysphagia improvement, respiratory complications) were collected.

Results

Of patients with ADRD and dysphagia (n = 62), the average age was 86.5 and 66.1% were FAST Stage 7. On admission, 48.4% had pneumonia, 79.0% had delirium, and 69.4% were made nil per os (NPO) for aspiration risk. Of those who received SLP reassessment after diet initiation (n = 25), 76% demonstrated dysphagia improvement; 75% of patients with FAST stage 7 demonstrated improvement. Respiratory complications occurred in 21.0% of patients on the following diets: NPO, nasogastric tube feeding, dysphagia diets, and comfort feeds. In univariate analyses, hospital-acquired dehydration, no dysphagia improvement, and delirium were associated with respiratory complications.

Conclusions and Implications

The potential for dysphagia improvement in hospitalized patients with ADRD (even those with advanced dementia) highlights the critical need for standardizing reassessment. Further studies are needed to evaluate factors associated with respiratory complications in this population.
目的:口咽吞咽困难(吞咽困难)在阿尔茨海默病及相关痴呆症(ADRD)住院患者中发病率很高(高达86%)。本研究旨在描述 ADRD 住院患者吞咽困难的处理方法和临床过程:前瞻性观察队列研究:研究在纽约一家大型医疗系统内的 10 家医院进行。参与者为在内科住院并经语言病理学家(SLP)评估确诊为液体吞咽困难的患有 ADRD 的老年人,招募时间为 2023 年 1 月至 6 月:收集基线特征(如痴呆功能评估分期工具[FAST])、吞咽困难管理(如处方饮食)和临床过程(如吞咽困难改善、呼吸系统并发症):在患有 ADRD 和吞咽困难的患者(n = 62)中,平均年龄为 86.5 岁,66.1% 属于 FAST 第 7 阶段。入院时,48.4%的患者患有肺炎,79.0%的患者出现谵妄,69.4%的患者因有吸入风险而被定为无吸入(NPO)。在饮食开始后接受SLP重新评估的患者中(n = 25),76%的患者吞咽困难有所改善;75%的FAST 7期患者吞咽困难有所改善。在使用以下饮食的患者中,21.0% 出现了呼吸系统并发症:NPO、鼻胃管喂食、吞咽困难饮食和舒适喂食。在单变量分析中,医院获得性脱水、吞咽困难无改善和谵妄与呼吸系统并发症有关:ADRD 住院患者(甚至是晚期痴呆患者)的吞咽困难有可能得到改善,这凸显了标准化重新评估的迫切需要。还需要进一步研究,以评估与该人群呼吸系统并发症相关的因素。
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引用次数: 0
Tailored Strategies to Support Implementation of the Information System in Acute Care Setting for Older Adults Postdischarge Self-Management: A Modified Delphi Study 支持在急症护理环境中实施老年人出院后自我管理信息系统的定制策略:改良德尔菲研究》。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.jamda.2024.105262
Dorothy Yingxuan Wang MPA, Eliza Lai-Yi Wong PhD, Annie Wai-Ling Cheung MPhil, Zoe Pui-Yee Tam BSs, Eng-Kiong Yeoh MBBS, Kam-Shing Tang MD
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引用次数: 0
Navigating the Global Landscape of Exercise Interventions for Knee Osteoarthritis: Exploring Evolving Trends and Emerging Frontiers From a Bibliometric and Visualization Analysis Perspective (2011–2022) 运动干预膝骨关节炎的全球导航:从文献计量学和可视化分析角度探索不断变化的趋势和新兴前沿领域(2011-2022 年)》。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.jamda.2024.105269
Qianhong Chen ME , Keren Cai BS , Shuyao Li BS , Xinlin Du BS , Fuqiang Wang BS , Yu Yang ME , Ming Cai PhD

Objectives

This study utilizes visual analysis methods to retrospectively examine the evolution and trends in exercise interventions for knee osteoarthritis (KOA) research from 2011 to 2022.

Design

Bibliometric and visualization analysis review.

Setting and Participants

Using the Web of Science database, the literature search range is from January 1, 2011, to December 31, 2022, with the language specified as English and document type set to Article.

Methods

Visual analysis was used to analyze literature in the field of exercise interventions for KOA, with KOA and exercise interventions as the key search terms. Visualization maps for countries/regions were created using Tableau and Scimago Graphica software. Institutional, author, and keyword visualization maps were drawn using CiteSpace and VOSviewer software.

Results

In total, 3137 articles were included in the visual analysis. The United States emerged as the leading country in terms of publication volume and contribution. Moreover, developed countries such as the United States, Australia, United Kingdom, and Canada have established close and stable cooperative relationships. The University of Melbourne stood out as the institution with both the highest publication volume and centrality. At the forefront of research output in this field was Bennell K.L. from the University of Melbourne. The journal with the highest co-citation frequency was Osteoarthritis and Cartilage. The keyword clustering map highlighted an evolution in the field of exercise interventions for KOA, emphasizing 8 key research themes spanning knee osteoarthritis, serum cartilage, osteoarthritis initiative, patellofemoral pain, total knee arthroplasty, exercise-induced hypoalgesia, isometric exercise, and anterior cruciate ligament reconstruction. Burst analysis revealed that older adult was the earliest and most prominent keyword, with contemporary topics such as patellofemoral pain, safety, musculoskeletal disorder, and neuromuscular exercise considered as research hotspots and future directions in this field.

Conclusions and Implications

The global attention on exercise interventions for KOA research is expanding, emphasizing the importance of strengthened connections among developing countries and collaborative author groups. Recent trends have shifted toward topics such as neuromuscular training, treatment safety, and musculoskeletal disorders, whereas research interest in patellofemoral pain remains unabated. Neuromuscular training for KOA represents the current frontier in this field. Future research should delve into the effects of diverse types of exercise interventions for KOA on neuromuscular injury and recovery, exploring feasibility and safety to formulate personalized exercise plans for patients with KOA.
目的:本研究利用视觉分析方法,回顾性地考察了 2011 年至 2022 年膝关节骨性关节炎(KOA)研究中运动干预的演变和趋势:本研究利用可视化分析方法,回顾性地考察了2011年至2022年膝关节骨关节炎(KOA)运动干预研究的演变和趋势:设计:文献计量学和可视化分析回顾:使用 Web of Science 数据库,文献搜索范围为 2011 年 1 月 1 日至 2022 年 12 月 31 日,语言指定为英语,文献类型设置为文章:方法:以KOA和运动干预为关键检索词,采用可视化分析方法对KOA运动干预领域的文献进行分析。使用 Tableau 和 Scimago Graphica 软件创建了国家/地区的可视化地图。使用 CiteSpace 和 VOSviewer 软件绘制了机构、作者和关键词可视化地图:共有 3137 篇文章被纳入可视化分析。从发表量和贡献率来看,美国居首位。此外,美国、澳大利亚、英国和加拿大等发达国家也建立了密切而稳定的合作关系。墨尔本大学是出版量和中心地位最高的机构。墨尔本大学的 Bennell K.L. 在这一领域的研究成果处于领先地位。共同引用频率最高的期刊是《骨关节炎与软骨》。关键词聚类图突显了运动干预 KOA 领域的演变,强调了 8 个关键研究主题,涵盖膝关节骨关节炎、血清软骨、骨关节炎倡议、髌股关节疼痛、全膝关节置换术、运动引起的低痛感、等长运动和前十字韧带重建。突发分析表明,老年人是最早出现和最突出的关键词,髌骨股骨痛、安全性、肌肉骨骼疾病和神经肌肉运动等当代主题被视为该领域的研究热点和未来方向:全球对针对 KOA 的运动干预研究的关注正在不断扩大,这强调了加强发展中国家和合作作者群之间联系的重要性。最近的趋势已转向神经肌肉训练、治疗安全性和肌肉骨骼疾病等主题,而对髌骨股骨痛的研究兴趣却有增无减。针对 KOA 的神经肌肉训练是该领域的前沿课题。未来的研究应深入探讨不同类型的 KOA 运动干预对神经肌肉损伤和恢复的影响,探索为 KOA 患者制定个性化运动计划的可行性和安全性。
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引用次数: 0
Reliability and Validity of the New Urgency Classification Model for Acute Medical Care in Dutch Nursing Home Setting 荷兰养老院急症医疗护理新急症分类模型的可靠性和有效性。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.jamda.2024.105268
Romy B.M. Dockx MD , Yvonne M.J. Goërtz PhD , Daisy J.A. Janssen MD, PhD , Nancy S.N. Lenaerts MD

Objective

To validate an Urgency Classification Model developed for telephone triage in Dutch nursing homes.

Design

Retrospective observational study.

Setting and Participants

Retrospective analysis of triage data of nursing home residents in a medical service organization, active in 40 nursing homes across the Netherlands.

Methods

An Urgency Classification Model for nursing home care was developed through a collaborative cocreation session by modifying existing acute medical care delivery models. All inquiries to central triage personnel during regular working hours between April 1 and April 30, 2022, were retrospectively categorized according to the new Urgency Classification Model (“urgency,” consisting of 6 levels from U0 to U5; and “goals of care and treatment limitations,” consisting of 4 options) by 2 independent physicians to evaluate the reliability using Cohen's kappa. To ascertain validity, the categorized data were juxtaposed with the executed treatment plan as documented in the patient records.

Results

Of 387 inquiries, consensus between assessors using the Urgency Classification Model was reached upon initial independent classification of urgency in 77.0% (n = 298, Cohen's kappa 0.654) of cases and in 77.3% (n = 299, Cohen's kappa 0.649) of goals of care and treatment limitations classification, representing substantial interrater reliability. A strong positive correlation was found between the urgency identified through the Urgency Classification Model and the observed urgency in the executed treatment, rs = 0.662, P < .001; the same urgency was given in 71.5% (n = 276) of all inquiries. Overtriage (meaning the model classified the inquiry as more urgent than the executed treatment plan) occurred in 9.8% (n = 38) and undertriage in 18.7% (n = 72).

Conclusion and Implications

The new Urgency Classification Model is a valid and reliable classification tool for implementation within its intended target population. Universal and comprehensive implementation is expected to lead to more appropriate care delivery, while realizing integration with the acute medical care frameworks already in place.
目的: 验证为荷兰养老院电话分诊开发的紧急状况分类模型:验证为荷兰养老院电话分流开发的紧急状况分类模型:设计:回顾性观察研究:对一家医疗服务机构的养老院居民分流数据进行回顾性分析:方法:通过修改现有的急诊医疗服务模式,在一次合作共创会议上开发出了养老院护理急诊分类模式。在 2022 年 4 月 1 日至 4 月 30 日的正常工作时间内,由两名独立医生根据新的急诊分级模型("急诊 "包括从 U0 到 U5 的 6 个级别;"护理目标和治疗限制 "包括 4 个选项)对所有向中央分诊人员提出的询问进行了回顾性分类,并使用科恩卡帕评估其可靠性。为确定有效性,将分类数据与患者病历中记录的已执行治疗计划并列:在 387 例问诊中,77.0% 的病例(n = 298,Cohen's kappa 0.654)和 77.3%的病例(n = 299,Cohen's kappa 0.649)的护理目标和治疗限制分类中,评估者之间在使用急诊分类模型进行初步独立急诊分类后达成了共识,这表明评估者之间的可靠性很高。通过急迫性分类模型确定的急迫性与执行治疗中观察到的急迫性之间存在很强的正相关性,rs = 0.662,P < .001;71.5%(n = 276)的问询具有相同的急迫性。9.8%(n = 38)的问询发生了 "过分类"(即模型将问询分类为比已执行的治疗计划更紧急),18.7%(n = 72)的问询发生了 "欠分类":新的紧急程度分类模型是一种有效、可靠的分类工具,可在其目标人群中实施。普遍而全面的实施有望带来更适当的护理服务,同时实现与现有急症医疗护理框架的整合。
{"title":"Reliability and Validity of the New Urgency Classification Model for Acute Medical Care in Dutch Nursing Home Setting","authors":"Romy B.M. Dockx MD ,&nbsp;Yvonne M.J. Goërtz PhD ,&nbsp;Daisy J.A. Janssen MD, PhD ,&nbsp;Nancy S.N. Lenaerts MD","doi":"10.1016/j.jamda.2024.105268","DOIUrl":"10.1016/j.jamda.2024.105268","url":null,"abstract":"<div><h3>Objective</h3><div>To validate an Urgency Classification Model developed for telephone triage in Dutch nursing homes.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting and Participants</h3><div>Retrospective analysis of triage data of nursing home residents in a medical service organization, active in 40 nursing homes across the Netherlands.</div></div><div><h3>Methods</h3><div>An Urgency Classification Model for nursing home care was developed through a collaborative cocreation session by modifying existing acute medical care delivery models. All inquiries to central triage personnel during regular working hours between April 1 and April 30, 2022, were retrospectively categorized according to the new Urgency Classification Model (“urgency,” consisting of 6 levels from U0 to U5; and “goals of care and treatment limitations,” consisting of 4 options) by 2 independent physicians to evaluate the reliability using Cohen's kappa. To ascertain validity, the categorized data were juxtaposed with the executed treatment plan as documented in the patient records.</div></div><div><h3>Results</h3><div>Of 387 inquiries, consensus between assessors using the Urgency Classification Model was reached upon initial independent classification of urgency in 77.0% (n = 298, Cohen's kappa 0.654) of cases and in 77.3% (n = 299, Cohen's kappa 0.649) of goals of care and treatment limitations classification, representing substantial interrater reliability. A strong positive correlation was found between the urgency identified through the Urgency Classification Model and the observed urgency in the executed treatment, r<sub>s</sub> = 0.662, <em>P</em> &lt; .001; the same urgency was given in 71.5% (n = 276) of all inquiries. Overtriage (meaning the model classified the inquiry as more urgent than the executed treatment plan) occurred in 9.8% (n = 38) and undertriage in 18.7% (n = 72).</div></div><div><h3>Conclusion and Implications</h3><div>The new Urgency Classification Model is a valid and reliable classification tool for implementation within its intended target population. Universal and comprehensive implementation is expected to lead to more appropriate care delivery, while realizing integration with the acute medical care frameworks already in place.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105268"},"PeriodicalIF":4.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289809","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}
引用次数: 0
Perspectives of Nursing Home Staff in Advance Care Planning Conversations: Experiences from the APPROACHES Project 养老院工作人员在预先护理计划对话中的观点:APPROACHES 项目的经验。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.jamda.2024.105265
Kathleen T. Unroe MD, MHA, MS , Hillary D. Lum MD, PhD , Susan E. Hickman PhD

Objectives

Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences – a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP.

Design

Qualitative interviews regarding ACP specialists’ experiences and perceived intervention impact.

Setting and Participants

Staff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation.

Methods

Fourteen staff were interviewed. Interviews were transcribed and coded by the research team.

Results

There were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process.

Conclusions and Implications

Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.
目标:预先护理计划(ACP)被认为是疗养院环境中的最佳实践;然而,疗养院员工的培训和结构化 ACP 计划的实施缺乏一致性。为了了解参与 APPROACHES(一项旨在改善 ACP 的嵌入式实用临床试验)的员工的经验,我们对养老院的 ACP 专家进行了一项定性研究访谈:设计:就 ACP 专家的经验和感知的干预影响进行定性访谈:在 APPROACHES 项目实施过程中与住院患者进行了至少 10 次 ACP 交谈:对 14 名员工进行了访谈。研究小组对访谈内容进行了转录和编码:共确定了 21 个编码,然后将其提炼为以下 5 个主题:(1) ACP 专家计划的经验,(2) 参与 ACP 对话,(3) 与痴呆症相关的注意事项,(4) ACP 的益处和挑战,以及 (5) ACP 过程中的多方参与。参与者的回答表明,ACP 专家计划的经验各不相同,并强调了与家属和居民(尤其是痴呆症患者)进行对话的许多相关方面。ACP 的益处(包括建立关系和提高对健康状况变化的准备程度)与敏感的谈话主题和安排 ACP 讨论的后勤困难相关的挑战是平衡的。ACP 专家讨论了其他人在 ACP 过程中扮演的多重角色:分析结果为在养老院环境中全面实施 APPROACHES 和其他 ACP 计划提供了启示。疗养院员工根据其环境调整项目的经验反映了 ACP 专家项目的实用性。
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引用次数: 0
Conception of a Recognized Accreditation for a Senior-Friendly Hospital: The Accreditation “Hospital Attentive to the Elder” 老年友好医院认证的构想:"关爱老年人医院 "认证。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.jamda.2024.105264
Frédéric Bloch MD, PhD , Maya Roucout MD , Sylvie Beaucamp , Pauline Detant , Joel Koch , Martial Roucout , Anne-Cécile Gilquin

Objectives

Consideration of the need to strengthen the commitment of professionals to the good care of the older population in hospitals has been emerging over the last several years. The steering committee of the geriatric sector of the hospitals of our Hospital Consortium (HC) has structured an accreditation project to promote the commitment of professionals to the good care of older adult patients in hospitals: the “Hospital Attentive to the Elder” (HAE) accreditation. This global approach aims to better adapt care to the needs of this population in the hospital and promote positive values (eg, kindness, attentive support).

Design

The creation of the HAE accreditation required the creation of an accreditation board, a referential framework, and an accreditation procedure.

Setting and Participants

The whole process was coordinated by the accreditation board, a multidisciplinary entity, representative of the hospitals of our HC.

Methods

The 5-step approach of the accreditation procedure includes a commitment to the HAE, with the support of the institutional board, and an internal self-assessment phase to guide the creation of action plans, followed by an accreditation cross-evaluation visit. The HAE accreditation is awarded to departments that meet the described criteria. This accreditation process was initially initiated by our HC.

Results

In June 2021, 6 of 10 hospitals of our HC and 11 departments, which mobilized 28 medical, paramedical, and quality referents, initiated the process. All 11 departments fulfilled the criteria for the accreditation, and a ceremony to hand out the certificates was organized in December 2023.

Conclusions and Implications

We envisage that this accreditation process could be offered at the regional and national level to any hospital or group of hospitals with departments that receive patients aged >75 years, regardless of their specialty.
目标:在过去的几年里,人们一直在考虑加强专业人员对医院老年病人的良好护理的承诺。我们医院联盟(HC)医院老年医学部门的指导委员会制定了一个认证项目,以促进医院专业人员致力于为老年患者提供良好的护理服务:"关爱老年人医院"(HAE)认证。这一全球性方法旨在使医院的护理更好地适应老年人群的需求,并推广积极的价值观(如仁慈、细心的支持):设计:创建 HAE 认证需要建立一个认证委员会、一个参考框架和一个认证程序:整个过程由评审委员会协调,该委员会是一个多学科实体,代表了我们 HC 的医院:评审程序的五个步骤包括:在机构董事会的支持下,对医管局的承诺;内部自我评估阶段,以指导行动计划的制定;随后是评审交叉评估访问。HAE 认证授予符合所述标准的部门。这一认证过程最初由我们的 HC.Results 发起:2021 年 6 月,我们的医疗保健中心的 10 家医院中的 6 家医院和 11 个科室启动了这一过程,动员了 28 名医疗、辅助医疗和质量推荐人。所有 11 个科室都达到了认证标准,并于 2023 年 12 月举行了证书颁发仪式:我们认为,在地区和国家层面上,任何一家医院或医院集团,只要其科室接收的患者年龄超过 75 岁,无论其属于哪个专业,都可以开展这项认证工作。
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引用次数: 0
Ten-Year Incidence of Sarcopenia in a Population-Based Cohort: Results from the Research on Osteoarthritis/Osteoporosis Against Disability Study 以人口为基础的队列中的肌肉疏松症十年发病率:ROAD 研究的结果。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.jamda.2024.105263
Toshiko Iidaka MD, PhD , Chiaki Horii MD, PhD , Gaku Tanegashima MD , Shigeyuki Muraki MD, PhD , Hiroyuki Oka MD, PhD , Hiroshi Kawaguchi MD, PhD , Kozo Nakamura MD, PhD , Toru Akune MD, PhD , Sakae Tanaka MD, PhD , Noriko Yoshimura MD, PhD

Objectives

To investigate the prevalence and incidence rates of sarcopenia in Japanese community-dwelling people according to the criteria of the Asian Working Group for Sarcopenia 2019 recommendations, using a large-scale population-based cohort over a 10-year follow-up period.

Design

Prospective cohort study.

Setting and Participants

This study was conducted using data from the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. In total, 1551 participants (521 men and 1030 women; mean age, 65.8 years) from the second ROAD survey (2008–2-10) were included in this study.

Methods

The participants from the second survey were followed-up at 4, 7, and 10 years. Skeletal muscle mass, handgrip strength, and walking speed were assessed. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The incidence of sarcopenia was calculated using the person-year method. Cox proportional hazard model was used to assess risk factors for incident sarcopenia.

Results

The prevalence of sarcopenia was 8.1% (8.8% in men and 7.7% in women), and the prevalence of severe sarcopenia was 2.9% (2.7% in men and 3.1% in women). The incidence rates of sarcopenia were 17.8 per 1000 and 14.5 per 1000 person-years in men and women, respectively. Additionally, the incidence rates of severe sarcopenia were 6.4 per 1000 and 4.2 per 1000 person-years in men and women, respectively. The significant risk factors for the incidence of sarcopenia were age [+1 year; hazard ratio (HR), 1.10; 95% CI, 1.08-1.12] and body mass index (−1 kg/m2; HR, 1.27; 95% CI, 1.20-1.35). The significant risk factors for the incidence of severe sarcopenia were age (+1 year; HR, 1.18; 95% CI, 1.14-1.22) and body mass index (−1 kg/m2; HR, 1.21; 95% CI, 1.10-1.33).

Conclusions and Implications

The prevalence and incidence rates of sarcopenia in Japan were clarified in this study.
目的根据 "亚洲肌少症工作组 "2019年建议的标准,通过一项为期10年的大规模人群队列随访,调查日本社区居民的肌少症患病率和发病率:前瞻性队列研究:本研究使用了骨关节炎/骨质疏松症致残研究(ROAD)的数据。本研究共纳入了 ROAD 第二次调查(2008-2-10)中的 1551 名参与者(男性 521 人,女性 1030 人;平均年龄 65.8 岁):方法:对第二次调查的参与者进行了 4 年、7 年和 10 年的随访。对骨骼肌质量、手握力和步行速度进行了评估。根据 "亚洲肌少症工作组 2019 年标准 "对 "肌少症 "进行定义。肌少症的发病率采用人年法计算。采用Cox比例危险模型评估肌肉疏松症发病的风险因素:结果:肌肉疏松症的发病率为8.1%(男性为8.8%,女性为7.7%),严重肌肉疏松症的发病率为2.9%(男性为2.7%,女性为3.1%)。男性和女性的肌肉疏松症发病率分别为每 1000 人年 17.8 例和 14.5 例。此外,严重肌肉疏松症的发病率在男性和女性中分别为每千人年 6.4 例和 4.2 例。肌少症发病率的重要风险因素是年龄(+1 岁;危险比 [HR],1.10;95% CI,1.08-1.12)和体重指数(-1 kg/m2;HR,1.27;95% CI,1.20-1.35)。严重肌肉疏松症发病率的重要风险因素是年龄(+1 岁;HR,1.18;95% CI,1.14-1.22)和体重指数(-1 kg/m2;HR,1.21;95% CI,1.10-1.33):本研究明确了日本肌肉疏松症的流行率和发病率。
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引用次数: 0
Differentiating Between Home Care Types to Identify Older Adults at Risk of Adverse Health Outcomes in the Community 区分家庭护理类型,识别社区中面临不良健康后果风险的老年人。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-11 DOI: 10.1016/j.jamda.2024.105257
Oscar S. Smeekes MD , Tim R. de Boer MSc , Robert D. van der Mei MSc, PhD , Bianca M. Buurman Msc, PhD , Hanna C. Willems MD, PhD

Objectives

Acute hospitalization, recurrent admissions, institutionalization, and death are important adverse health outcomes. Older adults receiving home care are especially at risk of these outcomes, yet it remains unclear if this risk differs between older adults receiving different types of home care and older adults not receiving home care.

Design

Retrospective cohort study using national claims data from 2019.

Setting and Participants

Community-dwelling Dutch individuals aged ≥ 65 years (N = 3,174,953).

Methods

Participants were categorized: no home care, household help, personal care, household help combined with personal care, or nursing home care at home. The primary outcomes were the number of people experiencing acute hospitalization, recurrent admissions, institutionalization, or death. Logistic regression models were applied.

Results

In total, 2,758,093 adults were included in the no home care group, 131,260 in the household help group, 154,462 in the personal care group, 96,526 in the household help combined with personal care group, and 34,612 in the nursing home care at home group. The risk of adverse outcomes differed between home care groups, with all showing higher odds compared with the no home care group. Individuals receiving household help combined with personal care had the highest odds for acute hospitalization [odds ratio (OR), 2.60; 95% CI, 2.55–2.64] and recurrent admissions (OR, 2.60; 95% CI, 2.55–2.65), while those receiving nursing home care at home had the highest odds for death (OR, 7.59; 95% CI, 7.35–7.85) and institutionalization (OR, 63.22; 95% CI, 60.94–65.58).

Conclusions and Implications

Differentiating between the type of home care older adults receive identifies subpopulations with different risks for adverse health outcomes compared with older adults not receiving home care. Older adults receiving personal care (nurse based) are at high risk for these outcomes and represent a substantial population with prevention potential. Future research should focus on developing effective interventions for this group.
目的:急性住院、反复住院、入住养老院和死亡是重要的不良健康后果。接受家庭护理的老年人尤其容易出现这些结果,但目前还不清楚接受不同类型家庭护理的老年人与不接受家庭护理的老年人之间的风险是否存在差异:回顾性队列研究,使用 2019 年的全国报销数据:社区居住的年龄≥65岁的荷兰人(N = 3,174,953):参与者被分为:无家庭护理、家庭帮助、个人护理、家庭帮助与个人护理相结合或在家接受养老院护理。主要结果是急性住院、反复住院、入住养老院或死亡的人数。研究采用了逻辑回归模型:共有 2,758,093 名成人被纳入无家庭护理组,131,260 名成人被纳入家庭帮助组,154,462 名成人被纳入个人护理组,96,526 名成人被纳入家庭帮助与个人护理相结合组,34,612 名成人被纳入居家护理组。不同家庭护理组出现不良后果的风险不同,与无家庭护理组相比,所有家庭护理组出现不良后果的几率都较高。接受家庭帮助和个人护理的患者发生急性住院(几率比 [OR],2.60;95% CI,2.55-2.64)和反复住院(OR,2.60;95% CI,2.55-2.65)的几率最高,而在家接受养老院护理的患者发生死亡(OR,7.59;95% CI,7.35-7.85)和入住养老院(OR,63.22;95% CI,60.94-65.58)的几率最高:与不接受家庭护理的老年人相比,根据老年人所接受的家庭护理类型的不同,可以识别出具有不同不良健康后果风险的亚人群。接受个人护理(以护士为基础)的老年人出现这些结果的风险很高,是具有预防潜力的重要人群。未来的研究应侧重于为这一群体制定有效的干预措施。
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引用次数: 0
A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care 抗精神病药物对长期护理院居民行为的纵向治疗效果分析》(A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care)。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-11 DOI: 10.1016/j.jamda.2024.105255
Daniel E.C. Leme PhD , Krista Mathias PhD , Amanda Mofina PhD , Rosa Liperoti MD , Gustavo S. Betini PhD , John P. Hirdes PhD

Objective

The proportion of long-term care (LTC) residents being treated with antipsychotic medication is high, and these medications may exacerbate behavioral symptoms. We used propensity scores to investigate the effect of antipsychotic use on the worsening of behavioral symptoms among residents in LTC facilities.

Design

A retrospective study.

Setting and participants

Residents in LTC in 8 provinces and 1 territory in Canada, without severe aggressive behavior at baseline and reassessed at follow-up, between March 2000 and March 2022.

Methods

We used propensity score matching and weighting to balance baseline covariates and logistic regression to estimate the effect of antipsychotics on the worsening of behavioral symptoms in the original, matched, and weighted cohorts. The treatment variable was use of antipsychotic medication at baseline and the outcome was worsening of behavior at follow-up.

Results

A total of 494,215 participants were included [318,234 women and 175,981 men; mean age 82.8 years (SD 10.1; range 18–112)].130 558 (26.4%) used antipsychotics at baseline and 88,632 (17.9%) had worsening behavior in follow-up. In the matched cohort, there were 249,698 participants, and 124,849 were matched (1:1) in each treatment group. There was a significant association between antipsychotic use at baseline and worsening in behavior at follow-up in the adjusted regression models [OR 1.27 (95% CI 1.25–1.29), <0.0001] as well as in matched [OR 1.20 (95% CI 1.17–1.21), <0.0001] and weighted [OR 1.26 (95% CI 1.24–1.28), <0.0001] cohorts.

Conclusions and implications

This study further evidence to support the cautious use of antipsychotics in LTC facilities. Future research in LTC facilities could include a more granular analyses of behavior change, including bidirectional analyses between different symptom severity classifications.
目的:接受抗精神病药物治疗的长期护理(LTC)患者比例很高,而这些药物可能会加重行为症状。我们采用倾向评分法研究了抗精神病药物的使用对长期护理机构居民行为症状恶化的影响:设计:一项回顾性研究:2000年3月至2022年3月期间,加拿大8个省和1个地区的长期护理机构居民,基线时无严重攻击性行为,随访时重新评估:我们使用倾向得分匹配和加权来平衡基线协变量,并使用逻辑回归来估计抗精神病药物对原始队列、匹配队列和加权队列中行为症状恶化的影响。治疗变量为基线时抗精神病药物的使用情况,结果为随访时的行为恶化情况:共有 494,215 名参与者(318,234 名女性和 175,981 名男性;平均年龄 82.8 岁 [SD 10.1;范围 18-112])被纳入其中。130,558 人(26.4%)在基线时使用过抗精神病药物,88,632 人(17.9%)在随访中出现行为恶化。在配对队列中,共有 249,698 名参与者,每个治疗组中有 124,849 人配对成功(1:1)。在调整后的回归模型中,基线使用抗精神病药物与随访时行为恶化之间存在明显关联(OR 1.27 [95% CI 1.25-1.29],结论与启示:本研究进一步证明了在 LTC 机构中谨慎使用抗精神病药物的必要性。未来在长者照护机构中开展的研究可以对行为变化进行更细致的分析,包括不同症状严重程度分类之间的双向分析。
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引用次数: 0
期刊
Journal of the American Medical Directors Association
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