Journal of the American Medical Directors Association最新文献

{"title":"Clinical Decision Support Systems Highlight Medication Risks for Hospitalized Older Patients","authors":"","doi":"10.1016/j.jamda.2024.105302","DOIUrl":"10.1016/j.jamda.2024.105302","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468546","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}

{"title":"Exploring Place of Death Among Individuals With Huntington's Disease in the United States.","authors":"Amy C Ogilvie, Connie S Cole, Benzi M Kluger, Hillary D Lum","doi":"10.1016/j.jamda.2024.105304","DOIUrl":"10.1016/j.jamda.2024.105304","url":null,"abstract":"<p><strong>Objectives: </strong>To describe trends and identify factors associated with place of death among individuals with Huntington's disease (HD).</p><p><strong>Design: </strong>Retrospective cohort of deceased individuals with HD from the Centers for Disease Control and Prevention's National Center for Health Statistics.</p><p><strong>Setting and participants: </strong>A total of 13,350 individuals with HD who died in the United States between 2009 and 2019.</p><p><strong>Methods: </strong>We analyzed place of death, categorized as long-term care (LTC) facility, home, hospital, hospice facility, and other locations. Trends in the places of death from 2009 to 2019 were assessed using linear regression models. Multivariate logistic regression models were used to identify sociodemographic factors associated with place of death.</p><p><strong>Results: </strong>From 2009 to 2019, the greatest proportion of deaths occurred in LTC facilities (48.4%). There was a significantly decreasing trend in the proportion of deaths occurring in LTC facilities (53.5%-43.9%, P < .001). A greater proportion of deaths in rural areas occurred in LTC facilities compared with all other locations (P < .001 for all comparisons). In the multivariate model, age younger than 44 years, Black race, Hispanic ethnicity, some college education or greater, and being married were associated with significantly lower odds of dying in a LTC facility compared with home.</p><p><strong>Conclusions and implications: </strong>Despite a decreasing trend, LTC facilities remain a cornerstone of support for individuals with HD, particularly in rural areas. These results suggest multiple avenues for research to improve accessibility and quality of care for individuals with late stages of HD. Future studies are needed to further understand the impact of rurality and lack of support in the home on the accessibility and quality of LTC and hospice care for individuals with HD. These results may also help inform interventions focused on training and staff education within LTC and hospice facilities to better manage HD progression and symptoms.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468550","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}

{"title":"Navigating Dilemmas on Advance Euthanasia Directives of Patients with Advanced Dementia","authors":"","doi":"10.1016/j.jamda.2024.105300","DOIUrl":"10.1016/j.jamda.2024.105300","url":null,"abstract":"<div><h3>Objectives</h3><div>This study revisited the complexities faced by physicians in meeting due care criteria for euthanasia in patients with advanced dementia in The Netherlands. Despite increasing cases and legal provisions for advance euthanasia directives (AEDs), physicians encounter challenges with ethical issues, including patient communication and assessing unbearable suffering in patients who lack decisional capacity. This study examines the perspectives of elderly care physicians (ECPs), support and consultation on euthanasia in The Netherlands (SCEN) physicians, and euthanasia expertise center (EEC) physicians.</div></div><div><h3>Design</h3><div>A multimethod descriptive study using a questionnaire with both closed and open-ended questions.</div></div><div><h3>Setting and Participants</h3><div>This study explores the complexities faced by physicians in handling AED-based euthanasia requests of patients with advanced dementia.</div></div><div><h3>Methods</h3><div>Baseline characteristics of physician subgroups were analyzed descriptively, and subgroup variations were assessed using univariate regression. Qualitative data underwent thematic content analysis.</div></div><div><h3>Results</h3><div>With a 13.8% response rate, the study included 290 participants: 108 ECPs, 188 SCEN physicians, and 53 EEC physicians. Some had combined roles: ECP and SCEN physicians (n = 29), ECP and EEC physician (n = 1), SCEN physicians and EEC physicians (n = 17), and ECP, SCEN physicians, and EEC physicians (n = 6). ECPs received most AED-based euthanasia requests but only 7 EEC physicians and 1 SCEN physician performed euthanasia. All subgroups stressed the importance of patient communication. ECPs found euthanasia ethically justifiable only when communication was possible, highlighting the need to understand current euthanasia wishes and verify unbearable suffering. Effective communication was deemed crucial for confirming request relevance, identifying obstacles, involving patients, fostering trust, and alleviating fears. Physicians generally agreed that unbearable suffering could be assessed through patient expressions, observations, and family input.</div></div><div><h3>Conclusions and Implications</h3><div>Despite receiving AED-based euthanasia requests, few physicians proceeded. Subgroup analysis showed varying views, with ECPs emphasizing communication and EEC physicians focusing on determining unbearable suffering. All subgroups highlighted the importance of current patient expressions and involvement in the decision-making process.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468553","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}

{"title":"The Effect of Sleep Duration and Excessive Daytime Sleepiness on All-Cause Dementia: A Longitudinal Analysis from the Hunter Community Study","authors":"","doi":"10.1016/j.jamda.2024.105299","DOIUrl":"10.1016/j.jamda.2024.105299","url":null,"abstract":"<div><h3>Objectives</h3><div>It has been proposed that abnormal sleep duration and excessive daytime sleepiness might be risk factors for dementia. This study assessed the interaction between sleep duration and excessive daytime sleepiness, and the effect of sleep duration in the presence or absence of excessive daytime sleepiness on dementia risk in community-dwelling older adults.</div></div><div><h3>Design</h3><div>A longitudinal study.</div></div><div><h3>Setting and Participants</h3><div>Data from 2187 community-dwelling participants with mean age 70 years from the Hunter Community Study were included in this study.</div></div><div><h3>Methods</h3><div>Participants were classified as participants with long sleep duration (slept &gt;8 hours per night), recommended sleep duration (7–8 hours) as per the National Sleep Foundation, or short sleep duration (slept &lt;7 hours per night). The Berlin Questionnaire was used to identify excessive daytime sleepiness. Dementia was defined as per International Classification of Diseases, 10^th Revision codes. To calculate all-cause dementia risk, the Fine-Gray sub-distribution hazard model was computed with death as a competing risk.</div></div><div><h3>Results</h3><div>Over a mean follow-up of 6 years, 64 participants developed dementia and 154 deaths were identified. The average onset of dementia was 5.4 years. Long sleep duration was associated with increased dementia risk only in the presence of excessive daytime sleepiness (adjusted hazard ratio, 2.86; 95% confidence interval 1.03–7.91). A statistically significant interaction was found between excessive daytime sleepiness and sleep duration for all-cause dementia.</div></div><div><h3>Conclusions and Implications</h3><div>Long sleep duration with excessive daytime sleepiness was associated with increased risk of all-cause dementia. This suggests the importance of promoting awareness of healthy sleep and the possible role of nurturing good quantity and quality sleep in reducing the risk of dementia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468570","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}

{"title":"Depressive Signs and Daily Life of Residents When Relocating from a Regular to an Innovative Nursing Home","authors":"","doi":"10.1016/j.jamda.2024.105298","DOIUrl":"10.1016/j.jamda.2024.105298","url":null,"abstract":"<div><h3>Objectives</h3><div>In this study, we examine how residents are affected by moving from a regular nursing home into an innovative living arrangement. In the past decade, a culture change has taken place, leading to rapid developments of innovative living arrangements that aim to change the physical, social, and organizational environment to better suit the needs of older adults needing 24-hour care. This has inevitably led to more group relocations in long-term care. Insight into the change in residents when relocating is lacking.</div></div><div><h3>Design</h3><div>An observational longitudinal study.</div></div><div><h3>Setting and Participants</h3><div>Four Dutch care organizations in which 5 relocations took place from a regular to an innovative living arrangement. Residents (N = 97) requiring 24-hour care who were relocated from a regular nursing home to an innovative living arrangement were included.</div></div><div><h3>Methods</h3><div>Data were collected 1 month before, 2 weeks after, and 6 months after relocating. Depressive signs and symptoms, cognitive functioning, and dependence in activities of daily living were measured using questionnaires. Furthermore, the daily lives of the residents were assessed using ecological momentary assessments.</div></div><div><h3>Results</h3><div>Overall, no long-term change in depressive signs and symptoms, cognitive functioning, and dependence in activities of daily living was found when relocating. Furthermore, the daily life of residents was not different 6 months after moving. Relocating was accompanied by a significant short-term increase in depressive signs and symptoms in 2 out of 4 locations (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions and Implications</h3><div>This study shows that relocating to an innovative living arrangement does not lead to long-term changes in residents. There are indications that there might be a short-term change in depressive signs and symptoms that could be prevented by considering the approach and context. More research is needed into the changes in the physical, social, and organizational environment that are necessary for a positive impact on the daily lives of residents.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468549","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}

{"title":"Effect of Simple Swallowing Training Program on Early Oropharyngeal Dysphagia in Community-Dwelling Older Adults: A Randomized Controlled Study","authors":"","doi":"10.1016/j.jamda.2024.105297","DOIUrl":"10.1016/j.jamda.2024.105297","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;Oropharyngeal dysphagia (OD) in community-dwelling older adults continues to be a challenge due to its insidious onset. This study developed a simple swallowing training program (SSTP) to address these issues and conducted a randomized controlled trial to explore its effect on swallowing function and quality of life.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Two-arm randomized controlled trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting: and Participants&lt;/h3&gt;&lt;div&gt;A total of 248 community-dwelling older adults with OD from were included in 2024 and randomly divided into intervention and control groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The SSTP was developed through expert consultation. A total of 248 community-dwelling older adults with OD were included in 2024 and randomly divided into intervention and control groups. The intervention group underwent the SSTP twice daily for 21 days, with weekends off, and the control group participants did light physical activities by themselves. The primary outcome was the Gugging Swallowing Screen (GUSS), and the secondary outcomes were the Eating Assessment Tool-10 (EAT-10), Swallowing Quality of Life questionnaire (SWAL-QoL), maximum tongue pressure, masticatory ability, bite force, and meal duration. Assessments were conducted on days 1 and 21, while meal duration was assessed every 3 days for lunch.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Twenty-seven participants withdrew halfway. There were no significant differences in baseline assessments (&lt;em&gt;P&lt;/em&gt; &gt; .05). There were significant between-group and interactive effects in the GUSS [(19.07 ± 1.38) vs (17.28 ± 2.17), F&lt;sub&gt;between-group&lt;/sub&gt; = 6.893, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;between-group&lt;/sub&gt; = .009, F&lt;sub&gt;interactive&lt;/sub&gt; = 59.504, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interactive&lt;/sub&gt;&lt;.001], EAT-10 {[4.00 (3.00, 5.00)] vs [9.00 (7.00, 10.00)], z&lt;sub&gt;between-group&lt;/sub&gt; = −3.502, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;between-group&lt;/sub&gt;&lt;.001; z&lt;sub&gt;interactive&lt;/sub&gt; = −6.252, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interactive&lt;/sub&gt;&lt;.001}, SWAL-QoL {[166.00 (163.00, 171.50)] vs [154.00 (150.00, 158.00)], z&lt;sub&gt;between-group&lt;/sub&gt; = 2.681, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;between-group&lt;/sub&gt; = .007; z&lt;sub&gt;interactive&lt;/sub&gt; = 5.475, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interactive&lt;/sub&gt;&lt;.001}, maximum tongue pressure {[33.10 (26.48, 36.86)] vs [28.85 (19.21, 35.77)], z&lt;sub&gt;between-group&lt;/sub&gt; = 3.377, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;between-group&lt;/sub&gt; = .001; z&lt;sub&gt;interactive&lt;/sub&gt; = −6.208, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interactive&lt;/sub&gt;&lt;.001}, masticatory ability {[176.92 (133.10, 212.91) vs [163.33 (116.66, 189.32)], z&lt;sub&gt;between-group&lt;/sub&gt; = 4.801, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;between-group&lt;/sub&gt;&lt;.001; z&lt;sub&gt;interactive&lt;/sub&gt; = 6.979, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interactive&lt;/sub&gt;&lt;.001}. Between-group, time, and interactive effects were significant in the meal duration [(23.39 ± 4.32) vs (27.64 ± 5.63), F&lt;sub&gt;between-group&lt;/sub&gt; = 8.692, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;between-group&lt;/sub&gt; = .004, F&lt;sub&gt;time&lt;/sub&gt; = 138.683, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;time&lt;/sub&gt;&lt; 0.001, &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interactive&lt;/sub&gt; = 73.196, &lt;e","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406550","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}

{"title":"Effectiveness of Horticultural Therapy in Older Adults without Dementia: A Systematic Review and Meta-Analysis","authors":"","doi":"10.1016/j.jamda.2024.105296","DOIUrl":"10.1016/j.jamda.2024.105296","url":null,"abstract":"<div><h3>Objectives</h3><div>Horticultural therapy (HT) has garnered growing interest because of its psychological and physical benefits. Previous reviews have demonstrated its therapeutic effects in older adults with cognitive impairment or mental illnesses. However, its impact on older adults without dementia has not been synthesized. This systematic review studied the effects of HT on the physical and psychosocial functions of older adults without dementia.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Settings and Participants</h3><div>Older adults without dementia ≥60 years of age.</div></div><div><h3>Methods</h3><div>Randomized controlled trials and quasi-experimental studies were systematically searched in 7 databases. The Cochrane Risk of Bias Tool version 2 and the Risk of Bias in Non-randomized Studies of Interventions tool were used to assess study quality. A random-effects meta-analysis with Hedges' <em>g</em> was conducted to estimate the effect size, and Cochran's <em>Q</em> test and <em>I</em>² were used to evaluate heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation approach was applied to determine the overall quality of evidence.</div></div><div><h3>Results</h3><div>Twenty-seven studies, including 11 randomized controlled trials and 16 quasi-experimental studies comprising 1629 older adults from 11 countries, were included. HT tended to improve psychosocial outcomes in older adults, particularly in terms of self-efficacy (<em>g</em> = 0.52; 95% CI, 0.26-0.79) and self-esteem (<em>g</em> = 0.52; 95% CI, 0.26-0.79). In terms of physical benefits, HT appeared to have a greater impact on aerobic endurance, with a large effect size (g = 0.84; 95% CI, 0.54-1.15), compared to agility, which showed a smaller effect size (g = 0.45; 95% CI, −0.90 to −0.01).</div></div><div><h3>Conclusions and Implications</h3><div>This review demonstrated that HT could provide psychosocial and physical benefits to older adults without dementia. These benefits include slight improvements in self-efficacy, self-esteem, aerobic endurance, and agility. However, the certainty of this evidence is very low due to the quasi-experimental design and potential bias in outcome measurements. Further research with well-designed clinical trials is necessary to confirm its effectiveness.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406551","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}

{"title":"A New Hospital-At-Home Model for Integrated Geriatric Care: Data from a Preliminary Italian Experience","authors":"","doi":"10.1016/j.jamda.2024.105295","DOIUrl":"10.1016/j.jamda.2024.105295","url":null,"abstract":"<div><h3>Objective</h3><div>Hospital-at-home (HaH) has emerged as an alternative to conventional in-hospital care in older adults, possibly reducing hospital admissions and related complications. This study aimed to describe the characteristics and outcomes of patients referred to “Gruppo di Intervento Rapido Ospedale-Territorio” (GIROT), a HaH service based on comprehensive geriatric assessment, developed in Florence, Italy, during the postpandemic period.</div></div><div><h3>Design</h3><div>Retrospective longitudinal study.</div></div><div><h3>Setting and Participants</h3><div>GIROT provided home-based care to patients with acute or exacerbated chronic diseases and a high risk of hospital-related complications (ie, patients with moderate-to-severe disability and/or dementia), referred from primary care, emergency departments, or in-hospital units.</div></div><div><h3>Methods</h3><div>All-cause mortality and hospitalization rates were assessed at 1, 3, and 6 months, and predictors of 6-month mortality were investigated.</div></div><div><h3>Results</h3><div>Among 391 patients (mean age, 88.4 years; 62.4% female) referred from emergency departments (58.6%), primary care (27.9%), and acute medical units (13.6%), the main diagnoses were respiratory failure (28.4%), acute heart failure (25.3%), and delirium (13.6%). Patients referred from primary care were older and showed a higher prevalence of severe disability and hypomobility. After 1, 3, and 6 months, mortality rates were 34.5%, 45.6%, and 53.8%, and hospitalization rates 7.2%, 21.5%, and 37.9%, respectively. Predictors of 6-month mortality included age [odds ratio (OR), 1.039], severe disability (OR, 3.446), impossible/assisted walking (OR, 4.450) and referral from primary care (OR, 2.066). High global satisfaction with the service was reported.</div></div><div><h3>Conclusions and Implications</h3><div>The GIROT model may help expanding acute health care capacity for older adults at high risk of hospital-related complications. Customized care plans are needed in patients with severe disability/hypomobility, considering also simultaneous palliative care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391475","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}

{"title":"Comparative Effectiveness and Safety of Direct Oral Anticoagulants vs Warfarin among Nursing Home Residents with Atrial Fibrillation: A Retrospective Cohort Study","authors":"","doi":"10.1016/j.jamda.2024.105294","DOIUrl":"10.1016/j.jamda.2024.105294","url":null,"abstract":"<div><h3>Objective</h3><div>Residents of nursing homes are usually excluded from clinical trials, including trials to assess treatments for common conditions such as nonvalvular atrial fibrillation (NVAF). We aimed to quantify the real-world comparative safety and effectiveness of direct-acting oral anticoagulants (DOACs) vs warfarin among nursing home residents with NVAF.</div></div><div><h3>Design</h3><div>Retrospective cohort study using 100% national Minimum Data Set and linked Medicare claims from January 2011 through December 2018.</div></div><div><h3>Setting and Participants</h3><div>Long-term care nursing home residents aged ≥66 years enrolled in fee-for-service Medicare. We included individuals diagnosed with NVAF newly initiating oral anticoagulants.</div></div><div><h3>Methods</h3><div>We identified exposure to DOACs (apixaban, dabigatran, rivaroxaban, and edoxaban) vs warfarin. Outcomes were hospitalization for ischemic stroke/systemic embolism, major bleeding, pneumonia (negative control outcome), and all-cause death. We used inverse probability of treatment weighting competing risk regression models for clinical outcomes and Cox proportional hazards regression for all-cause death.</div></div><div><h3>Results</h3><div>Of 38,983 individuals newly initiating anticoagulants, 19,366 (49.7%) initiated DOACs and 19,617 (50.3%) initiated warfarin. In the inverse probability of treatment weighting analysis, compared with warfarin, there was no statistically significant association between DOAC use and ischemic stroke/systemic embolism [4.5 vs 4.7 events per 100 person-years; adjusted hazard ratio (aHR), 0.94; 95% CI, 0.84–1.05] or major bleeding (12.6 vs 12.4 events per 100 person-years; aHR, 1.03; 95% CI, 0.96–1.10). DOACs use was associated with a modest but statistically significant lower risk of all-cause death (48.1 vs 49.0 events per 100 person-years; IPTW analysis aHR, 0.95; 95% CI, 0.91–0.98).</div></div><div><h3>Conclusions and Implications</h3><div>Among nursing home residents with NVAF, DOACs and warfarin were associated with a similar risk of ischemic stroke/systemic embolism and major bleeding. However, the use of DOACs was associated with a slightly reduced risk of all-cause mortality.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381103","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}

{"title":"Associations of 2 Established Methods of Measuring Gait Speed and Sit-To-Stand Performance with Frailty and Life-Space Mobility in Community-Dwelling Older Adults","authors":"","doi":"10.1016/j.jamda.2024.105292","DOIUrl":"10.1016/j.jamda.2024.105292","url":null,"abstract":"<div><h3>Objectives</h3><div>The 4-m gait speed (4mGS) and 10-m gait speed (10mGS) tests and the 30-second sit-to-stand (30sSTS) and 5-times sit-to-stand (5xSTS) tests are commonly used and advocated in consensus recommendations. We compared these tests on their predictive and clinical value concerning the risk of prefrailty/frailty and restricted life-space mobility (RLSM).</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>A sample of 1235 community-dwelling adults (mean ± SD, 68 ± 7 years) participated in this prospective cohort study.</div></div><div><h3>Methods</h3><div>At baseline assessment, participants completed a survey and functional assessment, from which gait speed, sit-to-stand performance, self-reported mobility limitation, 40-item Frailty Index, and Life Space Assessment were measured. Participants with a 40-item Frailty Index &gt;0.15 and a Life Space Assessment &lt;60 points were classified as having prefrailty/frailty and RLSM, respectively. At 1-year follow-up assessment, prefrailty/frailty and RLSM were evaluated.</div></div><div><h3>Results</h3><div>Correlations between gait speed and sit-to-stand measures were high (ρ values &gt;0.80). In multivariable ordinal models, these measures added incremental prognostic value beyond a base model comprising demographics and self-reported mobility limitation variables in predicting baseline and 1-year outcomes. Between 10mGS and 4mGS, models with 10mGS had higher concordance indices (differences, 0.005-0.009), and these differences translated to generally greater net benefit in decision curve analyses. Between 30sSTS and 5xSTS measures, no one measure consistently outperformed the other, with small net benefit differences between measures (&lt;0.2%).</div></div><div><h3>Conclusions and Implications</h3><div>In community-dwelling older adults, gait speed and sit-to-stand measures meaningfully predicted prefrailty/frailty and RLSM. 10mGS provided more robust prognostic information than the 4mGS, whereas 5xSTS and 30sSTS measures showed near equivalence of performance. These findings could guide the choice of functional measures in clinical and research settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378032","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}