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: 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 examine the independent and combined associations of handgrip strength (HGS) and knee extension strength (KES) with global cognition in community-dwelling older adults.

Design: Cross-sectional analysis of baseline data from a prospective cohort.

Setting and participants: A total of 279 community-dwelling adults aged 65 years or older living independently (mean age 76.8 ± 5.9; 26.5% men).

Methods: Low strength was defined as the sex-specific lowest quartile (Q1). Multiple linear regression estimated differences in Mini-Mental State Examination (MMSE) scores adjusting for age, sex, education, and depressive symptoms (GDS-15). We examined (1) HGS and KES together, (2) 4 exclusive groups (low KES only, low HGS only, both low, neither), and (3) sensitivity analyses including skeletal muscle index and sex-stratified analyses using weight-normalized KES.

Results: Low KES related to lower MMSE (Model 1 B, -0.882; 95% CI, -1.542 to -0.223, P = .009; Model 2 B, -0.892; 95% CI, -1.564 to -0.219; P = .010). Low HGS was not significant (P ≥ .27). When both were included, low KES remained significant (B, -0.814; 95% CI, -1.509 to -0.119; P = .022) but low HGS did not. In 4-group analysis, both low KES and HGS vs neither showed lower MMSE (B, -1.054; 95% CI, -1.984 to -0.112; P = .027). Associations for KES persisted after adjusting for skeletal muscle index (B, -0.842; 95% CI, -1.522 to -0.161; P = .016). In sex-stratified models, weight-normalized KES was associated with MMSE in men (B, 6.598; 95% CI, 2.258 to 10.939; P = .004) but not in women.

Conclusions and implications: Lower KES shows a consistent and independent association with global cognition; combined weakness in upper and lower limbs signals greater cognitive deficit. Adding KES to community screening may improve early detection of cognitive vulnerability.

Objectives: Loss of a spouse increases risk for cognitive and functional decline in older age. However, literature examining bereavement effects on cognition and daily functioning in veterans is limited. This study therefore examined differences in cognitive and functional trajectories after spousal loss in older male veterans.

Design: Retrospective cohort study.

Setting and participants: Participants included 3339 male, community-dwelling veterans in the Health and Retirement Study aged >51 years who were married/partnered at enrollment and remained married (n = 2849) or became widowed (n = 490).

Methods: Participants completed biannual cognitive testing (Telephone Interview of Cognitive Status) and basic activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, and reported medical comorbidities and marital status. A generalized additive mixed-effects model compared annual rates of cognitive decline between married and widowed participants. Negative binomial regression evaluated associations between widowhood, ADLs, and IADLs. Poisson regression tested associations between widowhood and medical comorbidities. All models adjusted for age, race, ethnicity, years of education, depression, recent hospitalization, medical comorbidities, body mass index, years worked, income, and mortality.

Results: Results indicated greater cognitive decline after spousal loss between ages 64 to 76 years and after aged 84 years. Widowhood was associated with greater IADL difficulty [incidence rate ratio (IRR), 1.20; 95% CI, 1.01-1.43] and requiring IADL assistance (IRR, 1.38; 95% CI, 1.14-1.68). No associations were found between widowhood and basic ADL difficulty (IRR, 1.14; 95% CI, 0.97-1.34), requiring ADL assistance (IRR, 1.04; 95% CI, 0.77-1.41), or medical comorbidities (IRR, 0.99; 95% CI, 0.94-1.04). Sensitivity analyses including only widowers revealed greater post-loss ADL difficulty (IRR, 1.30; 95% CI, 1.04-1.63), ADL assistance (IRR, 1.76; 95% CI, 1.14-2.73), and medical comorbidities (IRR, 1.12; 95% CI, 1.05-1.20).

Conclusions and implications: Compared with married veterans, widowers had greater rates of cognitive decline, greater difficulty completing IADLs, and increased medical comorbidities. These findings may inform access to mental health services addressing bereavement and other clinical outcomes after widowhood.

Objectives: This study examined the incidence of hospitalizations for urinary tract infections (UTIs) and associated factors among residents of long-term care facilities (LTCFs) during the first 12 months of their LTCF stay.

Design: Population-based retrospective cohort study.

Setting and participants: This study included people aged ≥65 years who first entered an LTCF between 2015 and 2018 using data from the Registry of Senior Australians National Historical Cohort.

Methods: The cumulative incidence of hospitalizations of UTI in the 12 months following LTCF entry was evaluated. Individual, facility, medicine, and service utilization-related factors associated with hospitalizations for UTIs were investigated. A Fine-Gray model was used to estimate subdistribution hazard ratios (sHRs) and 95% CIs.

Results: Of the 180,858 people included from 2464 LTCFs, 59.7% (n = 107,914) were female, with a median age of 85 years. The cumulative incidence of hospitalizations for UTIs in the 12 months after LTCF entry was 3.7% (95% CI 3.7-3.8). Factors associated with a higher rate of hospitalizations for UTIs included long-term urinary catheter use (sHR 3.39, 95% CI 3.16-3.65), history of hospitalizations with UTI (sHR 2.33, 95% CI 2.21-2.46), preferred language other than English (sHR 1.38, 95% CI 1.28-1.48), diabetes (sHR 1.29, 95% CI 1.22-1.37), high (sHR 1.30, 95% CI 1.19-1.41) or medium (sHR 1.21, 95% CI 1.11-1.32) need for assistance with activities of daily living, cerebrovascular disease (sHR 1.14, 95% CI 1.08-1.20), and urinary incontinence (sHR 1.08, 95% CI 1.01-1.15).

Conclusions and implications: A considerable burden of UTI-associated hospitalizations was observed in Australian LTCFs, which can be minimized through implementing effective UTI prevention, detection, and management strategies.