Journal of the American Medical Directors Association最新文献

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

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

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

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

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

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

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

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

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

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

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

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

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

Design: Cross-sectional study with no intervention.

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

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

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

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

Objectives: Approximately one-third of older Americans experience a nursing home (NH) stay within 3 months of death, but it is unclear how NH characteristics influence end-of-life care. We investigated associations between NH characteristics and hospice use.

Design: Retrospective cohort study analyzing Medicaid and Traditional Medicare claims, Minimum Data Set, Centers for Medicare and Medicaid Services (CMS) Care Compare ratings, and other NH characteristics.

Setting and participants: Connecticut Medicaid-insured individuals with a serious illness and an NH stay within 6 months of death, deceased January 1, 2017-September 30, 2024.

Methods: Multivariable logistic regression analyzing associations between NH characteristics and (1) hospice use within 6 months of death and (2) short hospice use (≤7 days). Covariates included sociodemographics and clinical characteristics.

Results: Of 25,302 individuals, 51% were ≥85 years, 64.8% were women, and 79.3% were non-Hispanic White. Overall, 12,453 (49.2%) received hospice care, 4768 of 12,453 (38.3%) with short hospice use (≤7 days). Short-term (vs long-term) NH stays were associated with increased odds of hospice use and short hospice use. Many NH characteristics were associated with hospice use. Individuals with long-term stays had lower odds of hospice use with stays at NHs with the highest (vs lowest) CMS ratings for quality measures and staffing (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.44-0.68, OR, 0.78; 95% CI, 0.66-0.93, respectively). Those with short-term stays had lower odds of hospice use with stays at NHs with the highest CMS Health Inspection ratings. People with long-term stays at NHs that were part of a chain, had Alzheimer's care units, or had more beds had increased odds of hospice care.

Conclusions and implications: Among Connecticut Medicaid-insured decedents with NH stays, people with long-term stays and stays in NHs with better CMS ratings had lower odds of hospice use. The inverse relationship between hospice care and NH quality warrants further research and consideration of incorporating end-of-life quality measurement into CMS quality ratings.

Objectives: This study aimed to explore how self-efficacy and technophobia mediate the relationship between social participation and digital health literacy among older adults living in the community.

Design: We conducted a cross-sectional survey.

Setting and participants: We recruited 665 older adults in Qingdao, China, from September 2024 to February 2025.

Methods: Data were collected on sociodemographic characteristics, social participation, self-efficacy, technophobia, and digital health literacy. The SPSS PROCESS macro was used to investigate the mediating role of self-efficacy and technophobia between social participation and digital health literacy.

Results: There were positive correlations among social participation, self-efficacy, and digital health literacy (r = 0.429-0.646, P<.001), whereas technophobia was significantly and negatively correlated with these variables (r = -0.525 to -0.273, P<.001). In the mediation model, social participation was positively associated with digital health literacy (β = 0.284, P<.001). This association was accounted for by both the independent mediating roles of self-efficacy and technophobia, as well as their sequential roles as serial mediators.

Conclusions and implications: Social participation is associated with digital health literacy through the pathways of self-efficacy and technophobia. By fostering engagement opportunities, supportive environments, and positive role models, communities and families may help create conditions that are conducive to higher self-efficacy and lower technophobia among older adults, both of which are associated with higher levels of digital health literacy and a greater ability to benefit from opportunities in the digital age.

Objectives: To investigate associations between objective and subjective hearing assessments, cognitive function, and brain atrophy in older adults, which are currently insufficiently understood.

Design: Cross-sectional observational cohort study.

Setting and participants: 709 community-dwelling older adults in Japan aged ≥65 years who underwent a functional health examination between August 2021 and March 2023.

Methods: Hearing impairment was assessed objectively (via audiometric testing) and subjectively (via self-reported questionnaires). Associations between objective and subjective hearing assessments and brain atrophy were examined using binary logistic regression analysis. Hippocampal atrophy was the primary outcome measure.

Results: Among 709 participants [median age: 73 years (IQR 69-78 years); 428 women (60.8%)], 51.5% had neither objective nor subjective hearing impairment, 5.1% reported subjective impairment without objective impairment, 27.2% had objective impairment without subjective impairment, and 16.2% exhibited objective and subjective impairments. Objective hearing impairment was significantly associated with hippocampal atrophy (β = -0.088, P = .019, adjusted R² = 0.23). Participants with objective and subjective hearing impairment had significantly higher odds of hippocampal atrophy than those without impairments (adjusted odds ratio 1.91, 95% CI 1.01-3.61).

Conclusions and implications: These findings emphasize the importance of objective and subjective hearing assessments in older adults to identify hearing deficits and individuals at risk of neurodegeneration and cognitive decline. Incorporating hearing assessments into routine geriatric health evaluations may facilitate early interventions to mitigate brain atrophy and promote cognitive health.