Journal of the American Medical Directors Association最新文献_第2页

Association Between Nursing Home Five-Star Ratings and Consumer Satisfaction 养老院五星评级与消费者满意度之间的关系。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-19 DOI: 10.1016/j.jamda.2024.105322

Objective

Consumers can currently access the Centers for Medicare and Medicaid Services Five-Star Quality Rating System when they choose a nursing home (NH). However, the system does not incorporate NH consumers’ opinions. Without having access to satisfaction or quality-of-life measures, consumers could make uninformed decisions. This study aims to investigate the association between five-star ratings and family/resident satisfaction scores.

Design

Secondary data analysis was used.

Setting and Participants

A unique, NH-level dataset of Ohio NHs that contains star ratings, satisfaction scores, and NH characteristics was constructed (N = 701). Data were drawn from the 2018 star rating data, 2018 Ohio Nursing Home Family Satisfaction Survey, 2017 Ohio Nursing Home Resident Satisfaction Survey, 2017 Ohio Biennial Survey of Long-Term Care Facilities, and the Certification and Survey Provider Enhanced Reports.

Methods

Chi-square and logistic regression analyses were conducted controlling other NH characteristics.

Results

Chi-square results showed consumer satisfaction and star ratings were correlated, but imperfectly related. Regression results found that NHs with higher family satisfaction score received significantly higher star ratings across all domains except the quality-measure star rating. For each 1% point increase in the family satisfaction score, the probability of being a 4 or 5 overall star NH increases by 1.1% point (P < .01), and being a 4 or 5 health inspection star NH increases by 1.2% points (P < .01). NHs with higher resident satisfaction score received significantly higher star ratings. For every 1% point increase in the resident satisfaction score, the probability of being a 4 or 5 star NH increases by 0.7% point (P < .05) across all star ratings.

Conclusions and Implications

Early studies found little relationship between five-star ratings and consumer satisfaction scores. This study found consumer satisfaction is associated, although imperfectly, with star ratings. This highlights the need to publicly report NH consumer perspectives to help them make informed care decisions.

目标：目前，消费者在选择养老院（NH）时，可以访问医疗保险和医疗补助服务中心的五星级质量评级系统。然而，该系统并不包含 NH 消费者的意见。由于无法获得满意度或生活质量的衡量标准，消费者可能会在不知情的情况下做出决定。本研究旨在调查五星评级与家庭/住户满意度得分之间的关联：设计：采用二级数据分析：构建了一个独特的俄亥俄州 NH 级数据集，其中包含星级评定、满意度评分和 NH 特征（N = 701）。数据来自 2018 年星级评定数据、2018 年俄亥俄州养老院家庭满意度调查、2017 年俄亥俄州养老院居民满意度调查、2017 年俄亥俄州两年一次的长期护理机构调查以及认证和调查提供方增强报告：方法：在控制其他 NH 特征的基础上进行卡方分析和逻辑回归分析：卡方分析结果显示，消费者满意度与星级评定存在相关性，但并非完全相关。回归结果发现，家庭满意度得分较高的 NH 在除质量测量星级评定外的所有领域获得的星级评定都明显较高。家庭满意度得分每增加 1%，成为 4 至 5 级综合星级 NH 的概率就会增加 1.1%（P < .01），成为 4 至 5 级健康检查星级 NH 的概率就会增加 1.2%（P < .01）。居民满意度较高的养老院获得的星级评分明显更高。在所有星级评定中，居民满意度得分每增加 1%，成为 4 至 5 星级 NH 的概率就会增加 0.7% 点（P < .05）：早期研究发现，五星评级与消费者满意度得分之间关系不大。本研究发现消费者满意度与星级评定之间存在关联，尽管这种关联并不完美。这凸显了公开报道NH消费者观点的必要性，以帮助他们做出明智的医疗决策。

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引用次数: 0

Point-of-Care Ultrasound in Post-acute and Long-Term Care: A Scoping Review. 护理点超声波在急性期后和长期护理中的应用：范围审查。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-19 DOI: 10.1016/j.jamda.2024.105320

Lior Abramson, Chelsea Perfect, Sarah Cantrell, Yuriy S Bronshteyn, Mamata Yanamadala, Gwendolen T Buhr

Objectives: Point-of-care ultrasound (POCUS) is an emerging application of ultrasonography that is being integrated into patient care in many medical specialties. The post-acute and long-term care (PALTC) setting has opportunities to adopt POCUS as a diagnostic aid to improve patient outcomes. We aim (1) to describe the current use of POCUS in PALTC and (2) to examine how the use of POCUS can advance in PALTC settings.

Design: Scoping review.

Setting and participants: PALTC facilities and residents.

Methods: The MEDLINE, Embase, CINAHL Complete, and Web of Science databases were searched by a medical librarian for studies on the use of POCUS in PALTC. All studies underwent dual, independent review during 2 phases of screening. We included all study designs where POCUS was obtained and interpreted by a provider at the bedside.

Results: Six studies met inclusion criteria. Most studies were conducted in the setting of COVID19 outbreaks in nursing homes and communities. The organ systems examined using POCUS were lung and vasculature. Lung ultrasound was shown to have variable diagnostic and prognostic utility in assessing lung injury secondary to COVID19. Ultrasound measurements of the vasculature were not useful for predicting hydration status.

Conclusion and implications: Implementation of POCUS in PALTC is feasible, but current literature is limited to use in only 2 organ systems. These results suggest potential for expanding POCUS in PALTC. Further work is required to ascertain if POCUS use can improve patient outcomes in this health care setting.

目的：护理点超声检查（POCUS）是超声造影的一种新兴应用，正在被纳入许多医疗专科的患者护理中。急性期后和长期护理（PALTC）环境有机会采用 POCUS 作为诊断辅助工具，以改善患者的预后。我们的目标是：（1）描述目前 POCUS 在 PALTC 中的使用情况；（2）研究如何在 PALTC 环境中推进 POCUS 的使用：设计：范围综述：环境和参与者：PALTC 机构和住院医师：由一名医学图书管理员在 MEDLINE、Embase、CINAHL Complete 和 Web of Science 数据库中检索有关在 PALTC 中使用 POCUS 的研究。所有研究均经过两个阶段的双重独立审查。我们纳入了所有由床边医疗服务提供者获取并解释 POCUS 的研究设计：结果：六项研究符合纳入标准。大多数研究都是在养老院和社区爆发 COVID19 时进行的。使用 POCUS 检查的器官系统为肺部和血管。研究表明，肺部超声在评估 COVID19 继发性肺损伤方面具有不同的诊断和预后作用。血管超声测量对预测水合状态没有帮助：在 PALTC 中实施 POCUS 是可行的，但目前的文献仅限于在两个器官系统中使用。这些结果表明了在 PALTC 中推广 POCUS 的潜力。要确定在这种医疗环境中使用 POCUS 是否能改善患者的预后，还需要进一步的工作。

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引用次数: 0

Predictors, Diagnoses, and Costs of Emergency Department Visits Among Home Care Clients. 家庭护理客户急诊就诊的预测因素、诊断和费用。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-17 DOI: 10.1016/j.jamda.2024.105308

Eeva Björkstedt, Ari Voutilainen, Virva Hyttinen-Huotari, Johanna Jyrkkä, Pekka Mäntyselkä, Eija Lönnroos

Objectives: To examine factors, diagnoses, and costs associated with emergency department (ED) visits among home care clients.

Design: A prospective 1-year follow-up study.

Settings and participants: More information is needed regarding the reasons and costs associated with ED visits by home care clients. Participants were persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293).

Methods: Data collection included clients' demographics, health status (Charlson Comorbidity Index), medication use, assessments of physical (Timed Up and Go) and cognitive functioning (Mini-Mental State Examination), Basic and Instrumental Activities of Daily Living, mood (Geriatric Depression Scale, GDS-15) and health-related quality of life (HRQoL, EuroQol [EQ-5D-3 L]). Logistic regression and univariate analyses of variance were conducted. The costs (total and per person-year) of ED visits were calculated.

Results: The number of ED visits was 775 during the follow-up (mean 350 days). The likelihood of ED visits was reduced by better HRQoL and increased by a higher GDS-15 score, longer TUG times, and a history of heart failure and decreased glomerular infiltration. The most common primary diagnoses for ED visits were heart failure (8.4%), atrial fibrillation (4.0%), respiratory infection (4.0%), and cystitis (3.5%). The total costs of all ED visits during the follow-up were 251,247 € and internal medicine and surgery accounted for 142,726 € and 89,212 € of the cost, respectively. The costs per person-year were 981 €.

Conclusions and implications: HRQoL, depressive symptoms, mobility, and heart and renal failure were associated with the number of ED visits. The most common reasons for ED visits were chronic heart conditions and infectious diseases and the highest costs were incurred by internal medicine treatment. With advanced care planning and active symptom screening and cooperation of home care nurses and physicians, some of the ED visits, for example due to heart failure, might be preventable.

目的：研究与家庭护理客户急诊就诊相关的因素、诊断和费用：研究与家庭护理客户急诊室就诊相关的因素、诊断和费用：设计：为期一年的前瞻性跟踪研究：需要更多有关居家护理客户到急诊室就诊的原因和相关费用的信息。参与者为居住在芬兰东部、年龄≥65 岁、定期接受家庭护理服务的人员（n = 293）：收集的数据包括客户的人口统计学特征、健康状况（夏尔森合并症指数）、药物使用情况、身体（定时起立和走动）和认知功能评估（迷你精神状态检查）、基本和工具性日常生活活动、情绪（老年抑郁量表，GDS-15）以及与健康相关的生活质量（HRQoL，EuroQol [EQ-5D-3 L]）。研究人员进行了逻辑回归和单变量方差分析。计算了急诊室就诊费用（总费用和每人每年费用）：随访期间的急诊室就诊次数为 775 次（平均 350 天）。较好的 HRQoL 会降低 ED 就诊的可能性，而较高的 GDS-15 分数、较长的 TUG 时间、心衰病史和肾小球浸润减少则会增加 ED 就诊的可能性。急诊室就诊最常见的主要诊断是心力衰竭（8.4%）、心房颤动（4.0%）、呼吸道感染（4.0%）和膀胱炎（3.5%）。随访期间所有急诊就诊的总费用为 251,247 欧元，其中内科和外科的费用分别为 142,726 欧元和 89,212 欧元。每人每年的费用为 981 欧元：心身健康状况、抑郁症状、活动能力、心力衰竭和肾衰竭与急诊就诊次数有关。急诊室就诊最常见的原因是慢性心脏病和传染病，内科治疗的费用最高。通过预先制定护理计划、积极筛查症状以及家庭护理护士和医生的合作，部分急诊室就诊（如心力衰竭）是可以避免的。

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引用次数: 0

A 3-Wave Longitudinal Study of eHealth Literacy and Older People's Health-Related Quality of Life in China: The Mediating Role of General Self-Efficacy 中国老年人电子健康素养与健康相关生活质量的三阶段纵向研究：一般自我效能感的中介作用》。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-16 DOI: 10.1016/j.jamda.2024.105310

Background and Objectives

Health-related quality of life (HRQoL) is an important indicator to reflect the independence and well-being of older adults in their later life. Improving the HRQoL of older adults is of great importance for achieving healthy aging. The internet provides extensive health information and being able to effectively use the electronic health (eHealth) resources (reflected as “eHealth literacy”) potentially empowers older adults to manage health and improve HRQoL. However, there is limited evidence about the relationship between eHealth literacy and HRQoL in this population. This study aims to examine the longitudinal association and temporal relationship between eHealth literacy and HRQoL among older adults, and to explore potential underlying mechanisms.

Design

A 3-wave longitudinal study.

Setting and Participants

Chinese older adults aged 55 or older in Jiangxi Province, China.

Methods

Data were collected at baseline (T1) and 3-month (T2) and 6-month (T3) follow-ups during February to December 2022, using online self-reported questionnaires. eHealth literacy, HRQoL, and general self-efficacy were measured using validated tools. Statistical analyses, including longitudinal Tobit regression, cross-lagged panel model (CLPM), and longitudinal mediation analysis were performed.

Results

A total of 611 participants were included at T1, and 464 (75.9%) completed both 3- and 6-month follow-ups. Longitudinal Tobit regression suggested that older individuals with higher eHealth literacy showed better HRQoL over time (adjusted β, 0.023; 95% CI, 0.011–0.035; P < .001), after accounting for covariates. The CLPM supported that higher eHealth literacy significantly predicts improved HRQoL over time (standardized β, 0.09, P = .008), but not the reverse. In addition, general self-efficacy at T2 fully mediated the relationship from eHealth literacy at T1 and HRQoL at T3, with mediated proportion of 28.3%.

Conclusions and Implications

This study highlighted the importance of eHealth literacy and self-efficacy in improving HRQoL among older adults, supporting the development of tailored interventions to promote their HRQoL.

背景和目的：与健康相关的生活质量（HRQoL）是反映老年人晚年生活独立性和幸福感的重要指标。提高老年人的 HRQoL 对实现健康老龄化具有重要意义。互联网提供了广泛的健康信息，能够有效使用电子健康（eHealth）资源（体现为 "电子健康素养"）可能会增强老年人管理健康和改善 HRQoL 的能力。然而，关于这一人群的电子健康素养与 HRQoL 之间关系的证据却很有限。本研究旨在研究老年人的电子健康素养与 HRQoL 之间的纵向关联和时间关系，并探索潜在的内在机制：设计：一项三波纵向研究：环境和参与者：中国江西省 55 岁及以上的中国老年人：方法：在2022年2月至12月期间，使用在线自我报告问卷收集基线（T1）、3个月（T2）和6个月（T3）随访数据。统计分析包括纵向托比特回归、跨滞后面板模型（CLPM）和纵向中介分析：结果：共有 611 名参与者参加了第一阶段的研究，其中 464 人（75.9%）完成了 3 个月和 6 个月的随访。纵向托比特回归表明，在考虑了协变量后，随着时间的推移，具有较高电子健康素养的老年人显示出更好的 HRQoL（调整后的β，0.023；95% CI，0.011-0.035；P < .001）。CLPM证实，较高的电子健康素养可显著预测随着时间的推移HRQoL的改善（标准化β，0.09，P = .008），但反之亦然。此外，T2时的一般自我效能感完全介导了T1时的电子健康素养与T3时的HRQoL之间的关系，介导比例为28.3%：本研究强调了电子健康素养和自我效能感在改善老年人 HRQoL 方面的重要性，有助于制定有针对性的干预措施来提高老年人的 HRQoL。

{"title":"A 3-Wave Longitudinal Study of eHealth Literacy and Older People's Health-Related Quality of Life in China: The Mediating Role of General Self-Efficacy","authors":"","doi":"10.1016/j.jamda.2024.105310","DOIUrl":"10.1016/j.jamda.2024.105310","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Health-related quality of life (HRQoL) is an important indicator to reflect the independence and well-being of older adults in their later life. Improving the HRQoL of older adults is of great importance for achieving healthy aging. The internet provides extensive health information and being able to effectively use the electronic health (eHealth) resources (reflected as “eHealth literacy”) potentially empowers older adults to manage health and improve HRQoL. However, there is limited evidence about the relationship between eHealth literacy and HRQoL in this population. This study aims to examine the longitudinal association and temporal relationship between eHealth literacy and HRQoL among older adults, and to explore potential underlying mechanisms.</div></div><div><h3>Design</h3><div>A 3-wave longitudinal study.</div></div><div><h3>Setting and Participants</h3><div>Chinese older adults aged 55 or older in Jiangxi Province, China.</div></div><div><h3>Methods</h3><div>Data were collected at baseline (T1) and 3-month (T2) and 6-month (T3) follow-ups during February to December 2022, using online self-reported questionnaires. eHealth literacy, HRQoL, and general self-efficacy were measured using validated tools. Statistical analyses, including longitudinal Tobit regression, cross-lagged panel model (CLPM), and longitudinal mediation analysis were performed.</div></div><div><h3>Results</h3><div>A total of 611 participants were included at T1, and 464 (75.9%) completed both 3- and 6-month follow-ups. Longitudinal Tobit regression suggested that older individuals with higher eHealth literacy showed better HRQoL over time (adjusted β, 0.023; 95% CI, 0.011–0.035; <em>P</em> < .001), after accounting for covariates. The CLPM supported that higher eHealth literacy significantly predicts improved HRQoL over time (standardized β, 0.09, <em>P</em> = .008), but not the reverse. In addition, general self-efficacy at T2 fully mediated the relationship from eHealth literacy at T1 and HRQoL at T3, with mediated proportion of 28.3%.</div></div><div><h3>Conclusions and Implications</h3><div>This study highlighted the importance of eHealth literacy and self-efficacy in improving HRQoL among older adults, supporting the development of tailored interventions to promote their HRQoL.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468615","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}

引用次数: 0

Defining and Categorizing Nonpharmacologic Interventions in the Older Population: A Systematic Review. 界定和分类老年人口中的非药物干预措施：系统回顾。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-15 DOI: 10.1016/j.jamda.2024.105306

Eline C M Kooijmans, Emiel O Hoogendijk, Natalia Drapała, Olena Antonenko, George L Burchell, Ilona Barańska, Jitka Pokladníková, Katarzyna Szczerbińska, Daniela Fialová, Hein P J van Hout, Karlijn J Joling

Objectives: Nonpharmacologic interventions (NPIs) constitute an important part of treatment for older adults, cover a broad and diverse range of interventions, and have advantages over pharmacologic interventions (eg, limited adverse side effects). However, an unambiguous definition of NPIs is still lacking. Defining NPIs may facilitate research on this topic and enhance comparability of results between studies, and might help to face the challenges of recognition, acceptation, funding, and implementation. Therefore, the aim of this review was to provide an overview and comparison of the definitions of NPIs used in the current literature on older adults.

Design: A systematic review was performed to provide an overview of the definitions of NPIs that are used in the current literature on older populations and to organize the characteristics involved in the definitions.

Setting and participants: People ≥60 years of age were included, not limited to a specific setting.

Methods: A systematic search was performed in the following 5 databases: PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature, and Wiley/Cochrane Library. The time frame within the databases was from inception to December 4, 2023. Review articles, editorials and consensus papers were included.

Results: We included 28 articles. We organized the definitions of NPI according to 4 different aspects: types of interventions involved, target population, goals the interventions addressed, and requirements of the interventions. Definitions in the current literature can generally be divided into 2 groups: NPIs described as not involving medication, and more elaborated multidomain definitions. Based on the results, we formulated criteria for types of interventions that can be considered an NPI.

Conclusions and implications: Using current descriptions and characteristics, elements for a new definition for NPIs were proposed. To improve research in this field, consensus needs to be reached regarding elements covered by a definition of NPIs.

目的：非药物干预（NPIs）是老年人治疗的重要组成部分，涵盖广泛且多样的干预措施，与药物干预相比具有优势（例如，不良副作用有限）。然而，目前仍缺乏对 NPI 的明确定义。定义 NPIs 可促进对该主题的研究，提高研究结果之间的可比性，并有助于应对认可、接受、资助和实施方面的挑战。因此，本综述旨在概述和比较目前有关老年人的文献中使用的 NPI 定义：进行系统性综述，概述目前有关老年人口的文献中使用的 NPI 定义，并整理定义中涉及的特征：包括年龄≥60 岁的人群，不限于特定环境：方法：在以下 5 个数据库中进行了系统检索：方法：在以下 5 个数据库中进行了系统检索：PubMed、Embase、Clarivate Analytics/Web of Science Core Collection、Cumulative Index to Nursing and Allied Health Literature 和 Wiley/Cochrane Library。数据库的时间范围从开始到 2023 年 12 月 4 日。结果：我们收录了 28 篇文章。我们根据以下 4 个不同方面对 NPI 的定义进行了整理：涉及的干预类型、目标人群、干预所针对的目标以及干预的要求。目前文献中的定义一般可分为两类：描述为不涉及药物治疗的 NPI，以及更为详尽的多领域定义。根据研究结果，我们制定了可被视为 NPI 的干预类型的标准：利用当前的描述和特征，提出了 NPI 新定义的要素。为了改进这一领域的研究，需要就非营利组织定义所涵盖的要素达成共识。

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引用次数: 0

Medical Care Provider Involvement in Ontario Assisted Living Homes: A Descriptive Cross-Sectional Survey Analysis 安大略省生活辅助之家的医疗服务提供者参与情况：描述性横断面调查分析。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-15 DOI: 10.1016/j.jamda.2024.105309

Objectives

Assisted living is growing in Ontario. Medical services are not regulated in Ontario, resulting in variability of physician involvement. We described medical service provider involvement and practice characteristics in assisted living homes.

Design

Descriptive cross-sectional study.

Setting and Participants

A total of 88 assisted living homes in Ontario, Canada, which responded to a survey in 2023.

Methods

Administrators responded to questions on recruiting various health professionals, their involvement in the retirement home, support available, documentation in the home, and availability of palliative care. We reported absolute and relative proportions for survey items. We used regression analysis to assess if there is a statistically significant difference in the proportion of patients accessing care from the community in homes with and without a recruited medical service provider.

Results

Fifty-four (61.4%) of homes had a medical service provider, primarily an attending medical doctor. Attending medical doctors cared for more than 50 patients in 36% of homes, and 46% visited homes weekly. Administrators reported that medical providers spent most of the time providing appointments, responding to phone calls and faxes, conducting medication reviews, and discussing with residents’ families. Nearly two-thirds of homes had nurses accompany physicians on rounds and provided medical service providers with clinic space and equipment. Two-thirds of homes provided residents with palliative care, primarily through community support. Residents of homes with a recruited medical service provider had 76% lower odds of seeking care from their physician in the community than those without a recruited provider (P < .001).

Conclusions and Implications

Our findings describe high variability in recruiting medical service providers in assisted living homes and their practice characteristics. Residents may benefit from on-site accessible and patient-centered medical care. This study provides contextual information to inform future research on assisted living in Ontario and enables policy comparisons to other provinces and countries.

目标：辅助生活在安大略省不断发展。在安大略省，医疗服务不受监管，因此医生的参与程度也不尽相同。我们描述了生活辅助设施中医疗服务提供者的参与情况和实践特点：设计：描述性横断面研究：加拿大安大略省共有 88 家生活护理院在 2023 年接受了调查：管理者回答了有关招聘各种医疗专业人员、他们在养老院的参与情况、可提供的支持、养老院的文件记录以及姑息治疗的可用性等问题。我们报告了调查项目的绝对比例和相对比例。我们使用回归分析法来评估在有和没有招募医疗服务提供者的养老院中，患者从社区获得护理的比例是否存在显著的统计学差异：54所（61.4%）养老院有医疗服务提供者，主要是主治医生。在 36% 的安老院中，主治医生照顾的病人超过 50 人，46% 的主治医生每周都会到安老院看望病人。据管理者称，医疗服务提供者的大部分时间用于提供预约服务、回复电话和传真、进行药物审查以及与住客家属进行讨论。近三分之二的安老院让护士陪同医生查房，并为医疗服务提供者提供诊所空间和设备。三分之二的安养院主要通过社区支持为住客提供姑息治疗。与没有招募医疗服务提供者的安养院相比，招募了医疗服务提供者的安养院居民在社区寻求医生护理的几率要低 75%（P < .001）：我们的研究结果表明，辅助生活护理院在招募医疗服务提供者及其执业特点方面存在很大差异。居民可能会受益于现场可及和以患者为中心的医疗服务。这项研究为安大略省未来的辅助生活研究提供了背景信息，并可与其他省份和国家的政策进行比较。

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引用次数: 0

Inequalities in Transitions to Home Care: A Longitudinal Analysis of the Canadian Longitudinal Study on Aging 向家庭护理过渡中的不平等：加拿大老龄化纵向研究纵向分析》。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-15 DOI: 10.1016/j.jamda.2024.105307

Objectives

To investigate inequalities in transitions to home care across a broad set of demographic and socioeconomic factors in Canadian middle-aged and older adults.

Design

Longitudinal, retrospective cohort study.

Setting and Participants

A total of 51,338 community-dwelling adults aged 45+ years, using national data from the Canadian Longitudinal Study on Aging across 3 timepoints from 2011 to 2021.

Methods

We analyzed transitions in home care use using multistate Markov models, with home care use and nonuse as transient states, and loss to follow-up as a terminal state. We calculated hazard ratios for transitions between states adjusting for factors related to home care need (ie, functional limitations, chronic conditions) within the following equity strata: income, education, immigration history, sex, gender, rurality, racial background, and tangible social support.

Results

Across all timepoints, 5.4% of non–home care users transitioned to home care by the next timepoint and 33.2% of home care users continued to use home care at the next timepoint. Among non–home care users, identifying as a woman, female, white, completing higher levels of education, having higher income, and having less support available was associated with an increased likelihood of transitioning to home care use. Among home care users, higher income was also associated with a greater likelihood to discontinue using home care compared with lower income users. The association between income and home care use was stronger among female individuals.

Conclusions and Implications

We found meaningful differences in home care transitions across several equity strata. Individuals with higher income have greater ability to access to private care, creating inequity in access to home care services. Gendered factors such as income and social support have important associations with home care use. Home care planning and policy must address the unique barriers and disadvantages diverse populations face to ensure equitable use of home care and promote healthy aging.

目标：调查加拿大中老年人在向家庭护理过渡过程中，因人口和社会经济因素而产生的不平等：调查加拿大中老年人在向家庭护理过渡过程中因一系列人口和社会经济因素而产生的不平等现象：设计：纵向、回顾性队列研究：利用加拿大老龄化纵向研究（Canadian Longitudinal Study on Aging）提供的全国数据，从 2011 年到 2021 年的 3 个时间点，共收集了 51338 名 45 岁以上居住在社区的成年人：我们使用多态马尔可夫模型分析了家庭护理使用的过渡情况，将家庭护理使用和不使用作为瞬态，将失去随访作为终态。我们计算了各州之间过渡的危险比，并对以下公平阶层中与家庭护理需求相关的因素（即功能限制、慢性病）进行了调整：收入、教育、移民史、性别、性别、乡村、种族背景和有形社会支持：在所有时间点上，5.4% 的非居家护理用户在下一个时间点过渡到居家护理，33.2% 的居家护理用户在下一个时间点继续使用居家护理。在非居家护理使用者中，女性、白人、教育程度较高、收入较高和可获得的支持较少与过渡到使用居家护理的可能性增加有关。在家庭护理使用者中，与收入较低的使用者相比，收入较高的使用者停止使用家庭护理的可能性也更大。收入与使用家庭护理之间的关系在女性中更为密切：我们发现，在家庭护理过渡方面，不同收入阶层之间存在着显著差异。收入越高的人越有能力获得私人护理，这就造成了在获得家庭护理服务方面的不平等。收入和社会支持等性别因素与家庭护理的使用有着重要的关联。家庭护理规划和政策必须解决不同人群面临的独特障碍和不利因素，以确保公平使用家庭护理并促进健康老龄化。

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引用次数: 0

Clinician Perspectives on Supporting Advance Care Planning in Long-Term Care Homes. 临床医生对支持长期护理院预先护理规划的看法。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-11 DOI: 10.1016/j.jamda.2024.105303

George A Heckman, Anooshah Nasim, Heather Keller, Patrick Quail, Clare Ramsey, Veronique Boscart, Allan Garland

引用次数: 0

Associations of Regular Internet Usage with All-Cause and Cause-Specific Mortality: A Prospective Cohort Study 经常上网与全因和特定原因死亡率的关系：一项前瞻性队列研究

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-11 DOI: 10.1016/j.jamda.2024.105301

Objectives

The impact of internet usage on mortality is not widely known. This study intended to investigate the associations between regular internet usage and the risks of all-cause and cause-specific mortality, while also ascertaining potential factors that may modify these correlations.

Design

A community-based prospective cohort study.

Setting and Participants

The study included 21,481 individuals [mean (SD) age, 64.1 (11.0) years] from the Health and Retirement Study, with data collected between 2006 and 2020.

Methods

The Cox proportional hazards regression model was used to evaluate the associations between regular internet usage and the risks of all-cause and cause-specific mortality, adjusting for demographic factors, lifestyle behaviors, and other potential confounding factors. Moreover, we explored the association between daily hours of internet usage and the risk of outcomes.

Results

Regular internet usage was significantly associated with a lower risk of all-cause mortality (hazard ratio, 0.78; 95% CI, 0.74-0.83) and cardiovascular mortality (hazard ratio, 0.72; 95% CI, 0.64-0.82). No significant interaction effects were observed for age, sex, regular exercise, or current alcohol consumption (all P interactions > .05). Additionally, estimations for daily hours of usage indicated a U-shaped relationship with all-cause mortality. Adults who used 2.1 to 4 hours per day had the lowest risk; however, not all estimations showed their significance on account of the limited sample size.

Conclusions and Implications

Regular internet usage was associated with a lower risk of all-cause and cardiovascular mortality, which may prompt consideration of the beneficial impact of internet usage on lifespan.

目的：互联网使用对死亡率的影响尚未广为人知。本研究旨在调查经常使用互联网与全因和特定原因死亡风险之间的关联，同时确定可能改变这些关联的潜在因素：设计：一项基于社区的前瞻性队列研究：研究纳入了健康与退休研究中的 21,481 人（平均 [SD] 年龄，64.1 [11.0] 岁），数据收集时间为 2006 年至 2020 年：在调整了人口统计学因素、生活方式行为和其他潜在混杂因素后，我们使用 Cox 比例危险回归模型评估了定期使用互联网与全因和特定原因死亡风险之间的关系。此外，我们还探讨了每天使用互联网的时数与结果风险之间的关联：结果：经常使用互联网与较低的全因死亡风险（危险比为 0.78；95% CI，0.74-0.83）和心血管死亡风险（危险比为 0.72；95% CI，0.64-0.82）明显相关。在年龄、性别、经常锻炼或目前饮酒量方面没有观察到明显的交互作用（所有交互作用的 P 均大于 0.05）。此外，对每日使用时数的估计表明，使用时数与全因死亡率呈 U 型关系。每天使用 2.1 到 4 小时的成年人风险最低；然而，由于样本量有限，并非所有估计值都具有显著性：经常使用互联网与较低的全因和心血管死亡风险有关，这可能会促使人们考虑使用互联网对寿命的有益影响。

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引用次数: 0

Clinical Practice Guideline for Diabetes Management in the Post-Acute and Long-Term Care Setting 急性期后和长期护理环境中的糖尿病管理临床实践指南》（Clinical Practice Guideline for Diabetes Management in Post-Acute and Long Term Care Setting）。

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Journal of the American Medical Directors Association

Pub Date : 2024-10-11 DOI: 10.1016/j.jamda.2024.105342

引用次数: 0