Journal of the American Medical Directors Association最新文献_第3页

Effectiveness of My Tools for Care-in Care: A Pragmatic Randomized Controlled Trial.

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2025.105484

Hannah M O'Rourke, Jennifer Swindle, Pamela Baxter, Shelley Peacock, Genevieve Thompson, Sunita Ghosh, Dorothy Chacinski, Jayna Holroyd-Leduc, Véronique Dubé, Wendy Duggleby

Objectives: Few supports exist for family/friend care partners when the care recipient is a person living with dementia in a care home. This study assessed the effectiveness of My Tools for Care-In Care (MT4C-In Care), a self-administered, web-based psychoeducational intervention.

Design: The overall study was a mixed methods pragmatic randomized controlled trial, with concurrent process evaluation and an active (educational) control. The intervention group received a link to MT4C-In Care for 2 months.

Setting and participants: Participants were eligible if they were an adult (≥18 years of age) who provided care to an older person (≥65 years of age) living with dementia in a care home in Canada (Alberta, Saskatchewan, Manitoba, or Ontario). An email address and internet access were required to participate.

Methods: Process evaluation included a study participation tracking form and a checklist to assess use of MT4C-In Care. We completed telephone interviews (February 2020 to October 2021) at baseline, 2 months, and 4 months to assess outcomes of social support, hope, grief, self-efficacy, loneliness, and mental health. In an intention-to-treat analysis, generalized estimating equations models were used to assess intervention impact, adjusting for covariates. Sensitivity analysis assessed whether exclusion of nonusers impacted the results.

Results: Participants (N = 234) were primarily white women, and spouses or an adult child of the person living with dementia. No effect between groups was observed for the primary outcome (mental health). We observed a small benefit of MT4C-In Care for a secondary outcome, social support. Use of MT4C-In Care within the intervention group was low (∼1 h/mo). Dropping nonusers from the analysis did not have a substantial impact on the main conclusions.

Conclusions and implications: Future research will explore use of MT4C-In Care by more diverse participant groups, and will clarify its core mechanisms, advancing understanding of impacts of psychoeducational interventions.

{"title":"Effectiveness of My Tools for Care-in Care: A Pragmatic Randomized Controlled Trial.","authors":"Hannah M O'Rourke, Jennifer Swindle, Pamela Baxter, Shelley Peacock, Genevieve Thompson, Sunita Ghosh, Dorothy Chacinski, Jayna Holroyd-Leduc, Véronique Dubé, Wendy Duggleby","doi":"10.1016/j.jamda.2025.105484","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105484","url":null,"abstract":"<p><strong>Objectives: </strong>Few supports exist for family/friend care partners when the care recipient is a person living with dementia in a care home. This study assessed the effectiveness of My Tools for Care-In Care (MT4C-In Care), a self-administered, web-based psychoeducational intervention.</p><p><strong>Design: </strong>The overall study was a mixed methods pragmatic randomized controlled trial, with concurrent process evaluation and an active (educational) control. The intervention group received a link to MT4C-In Care for 2 months.</p><p><strong>Setting and participants: </strong>Participants were eligible if they were an adult (≥18 years of age) who provided care to an older person (≥65 years of age) living with dementia in a care home in Canada (Alberta, Saskatchewan, Manitoba, or Ontario). An email address and internet access were required to participate.</p><p><strong>Methods: </strong>Process evaluation included a study participation tracking form and a checklist to assess use of MT4C-In Care. We completed telephone interviews (February 2020 to October 2021) at baseline, 2 months, and 4 months to assess outcomes of social support, hope, grief, self-efficacy, loneliness, and mental health. In an intention-to-treat analysis, generalized estimating equations models were used to assess intervention impact, adjusting for covariates. Sensitivity analysis assessed whether exclusion of nonusers impacted the results.</p><p><strong>Results: </strong>Participants (N = 234) were primarily white women, and spouses or an adult child of the person living with dementia. No effect between groups was observed for the primary outcome (mental health). We observed a small benefit of MT4C-In Care for a secondary outcome, social support. Use of MT4C-In Care within the intervention group was low (∼1 h/mo). Dropping nonusers from the analysis did not have a substantial impact on the main conclusions.</p><p><strong>Conclusions and implications: </strong>Future research will explore use of MT4C-In Care by more diverse participant groups, and will clarify its core mechanisms, advancing understanding of impacts of psychoeducational interventions.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105484"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189769","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

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105413

Yanmin Tao MSN , Hongyan Wang MSN , Jingsong Luo MPH , Hong Zhang MD , Wen Zhang MSN , Meng Yu MSN , Shuyang Ji MSN , Sihan Peng MD , Xiangeng Zhang MD

引用次数: 0

Life-Space Activities and Incident Dementia Among Older Adults: Insights From a Cohort Study 老年人的生活空间活动与痴呆：来自队列研究的见解。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105416

Takehiko Doi PhD, Keitaro Makino PhD, Kouki Tomida PhD, Kota Tsutsumimoto PhD, Fumio Sakimoto PhD, Soichiro Matsuda PhD, Hiroyuki Shimada PhD

Objectives

This study examined the association between life-space activities and incident dementia among older adults.

Study Design

A prospective study.

Setting and Participants

This study included 2740 older adults (mean age 74.4 years; SD ± 6.2 years; range 65–99 years; 58.8% women).

Methods

Life-space activities were assessed using the Active Mobility Index (AMI). Incident dementia was determined using medical insurance data and long-term care insurance data (mean follow-up, 53.7 months).

Results

During the follow-up period, 326 participants (11.9%) had incident dementia. Participants were classified into 3 groups based on AMI score tertiles: tertile 1, ≤52; tertile 2, 53–77; and tertile 3, ≥78. The Cox proportional hazards model was used to examine the association between AMI scores and incident dementia. Individuals with higher scores had lower hazard ratios (HRs) (tertile 1: reference; tertile 2: adjusted HR, 0.76, 95% CI, 0.59–0.97, P = .027; tertile 3: adjusted HR, 0.49, 95% CI, 0.36–0.68, P < .001; P for trend: <.001). Both the physical and social AMI sub-scores were associated with dementia (P for trend: <.001).

Conclusions and Implications

Restricted life-space activity, as assessed using the AMI, was associated with the risk of dementia. In addition, both the physical and social sub-scores were associated with dementia.

研究目的研究设计：一项前瞻性研究：前瞻性研究：这项研究包括 2740 名老年人（平均年龄 74.4 岁；SD ± 6.2 岁；年龄范围 65-99 岁；58.8% 为女性）：方法：使用积极活动指数（AMI）对生活空间活动进行评估。方法：使用积极活动指数（AMI）评估生活空间活动，使用医疗保险数据和长期护理保险数据确定痴呆症发病情况（平均随访时间为 53.7 个月）：结果：在随访期间，326 名参与者（11.9%）出现了痴呆症。根据 AMI 评分三等分将参与者分为三组：三等分 1，≤52；三等分 2，53-77；三等分 3，≥78。Cox比例危险模型用于研究AMI评分与痴呆症发病之间的关系。得分越高的个体危险比（HRs）越低（三分层 1：参考值；三分层 2：HR，0.67；95% 置信区间 [CI]，0.52-0.87；P = .002；三分层 3：HR，0.38；95% CI，0.27-0.53；P < .001；P 为趋势）：结论和影响：使用 AMI 评估的生活空间活动受限与痴呆症风险有关。此外，体能和社交两个分项都与痴呆症有关。

{"title":"Life-Space Activities and Incident Dementia Among Older Adults: Insights From a Cohort Study","authors":"Takehiko Doi PhD, Keitaro Makino PhD, Kouki Tomida PhD, Kota Tsutsumimoto PhD, Fumio Sakimoto PhD, Soichiro Matsuda PhD, Hiroyuki Shimada PhD","doi":"10.1016/j.jamda.2024.105416","DOIUrl":"10.1016/j.jamda.2024.105416","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examined the association between life-space activities and incident dementia among older adults.</div></div><div><h3>Study Design</h3><div>A prospective study.</div></div><div><h3>Setting and Participants</h3><div>This study included 2740 older adults (mean age 74.4 years; SD ± 6.2 years; range 65–99 years; 58.8% women).</div></div><div><h3>Methods</h3><div>Life-space activities were assessed using the Active Mobility Index (AMI). Incident dementia was determined using medical insurance data and long-term care insurance data (mean follow-up, 53.7 months).</div></div><div><h3>Results</h3><div>During the follow-up period, 326 participants (11.9%) had incident dementia. Participants were classified into 3 groups based on AMI score tertiles: tertile 1, ≤52; tertile 2, 53–77; and tertile 3, ≥78. The Cox proportional hazards model was used to examine the association between AMI scores and incident dementia. Individuals with higher scores had lower hazard ratios (HRs) (tertile 1: reference; tertile 2: adjusted HR, 0.76, 95% CI, 0.59–0.97, <em>P</em> = .027; tertile 3: adjusted HR, 0.49, 95% CI, 0.36–0.68, <em>P</em> < .001; <em>P</em> for trend: <.001). Both the physical and social AMI sub-scores were associated with dementia (<em>P</em> for trend: <.001).</div></div><div><h3>Conclusions and Implications</h3><div>Restricted life-space activity, as assessed using the AMI, was associated with the risk of dementia. In addition, both the physical and social sub-scores were associated with dementia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105416"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837148","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

Over- and Underuse of Proton Pump Inhibitors in Nursing Homes: A Multisite Longitudinal Cohort Study 质子泵抑制剂在养老院的过度和不足使用：一项多地点纵向队列研究。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105393

Nasir Wabe PhD, MScEpid, MScClinPharm, BPharm , Rachel Urwin PhD, MPH , Isabelle Meulenbroeks PhD, MPH, BPhysio , Karla Seaman PhD, MClinEpi, BPharm , Magdalena Z. Raban PhD, MIPH, BPharm , Sangita Neupane MPH , Amy Nguyen PhD, Grad Cert (Research Management and Commercialisation), BMedSc , Sandun M. Silva PhD, BSc , Andrea Timothy PhD, MPhil, ProfCertCR, PGDipSc, BSc, DipLaw , Narjis Batool DPharm, MPhil (Pharm) , Lisa Pont PhD, MSC, BSc, BPharm , Johanna I. Westbrook PhD, MHA, GradDipAppEpid, BAppSc

Objectives

Proton pump inhibitors (PPIs) are used to manage excess stomach acid production and provide gastroprotection from bleeding risk-increasing drugs (BRIDs). We aimed to determine the prevalence of potentially inappropriate PPI use in nursing homes and associated factors.

Design

Longitudinal cohort study using 8 years of electronic data.

Setting and Participants

The study included 6439 permanent residents aged ≥65 years from 34 homes managed by 2 aged care providers in New South Wales.

Method

Continuous PPI use (>12 weeks) in the absence of long-term BRID (>30 days) use was deemed inappropriate overuse whereas long-term BRID use without concomitant PPI for gastroprotection was classified as inappropriate underuse. Binary logistic regression was used to determine factors associated with PPI overuse.

Results

Fifty-four percent of residents (n = 3478) received a PPI, with a median duration of 46 weeks, whereas 58.5% (n = 3770) were long-term BRID users. Four of 5 PPI users (83.6%, n = 2906) used PPIs for >12 weeks, and after accounting for BRID use, the prevalence of inappropriate PPI overuse was 27.1% (n = 944). PPI overuse was 4 times more likely in residents in provider A compared with residents in provider B [odds ratio (OR) 4.08, 95% CI 2.73–6.09]. The prevalence of PPI underuse was 38.5% (n = 1452).

Conclusions and Implications

One in 4 PPI users exceeded the clinically recommended duration, whereas 2 in 5 long-term BRID users did not receive a PPI for gastroprotection. There is a pressing need for tailored interventions, such as medication reviews and deprescribing initiatives, to improve PPI prescribing.

目的：质子泵抑制剂（PPIs）用于控制过量胃酸的产生，并提供胃保护，免受出血风险增加药物（BRIDs）的影响。我们的目的是确定疗养院中潜在的不适当PPI使用的流行程度和相关因素。设计：使用8年电子数据的纵向队列研究。环境和参与者：该研究包括来自新南威尔士州由2名老年护理提供者管理的34个家庭的6439名年龄≥65岁的永久居民。方法：在没有长期BRID（>30天）的情况下，持续使用PPI（>12周）被认为是不适当的过度使用，而长期BRID使用而不同时使用PPI用于胃保护被认为是不适当的使用不足。采用二元逻辑回归确定与PPI过度使用相关的因素。结果：54%的居民（n = 3478）接受了PPI，中位持续时间为46周，而58.5%的居民（n = 3770）是长期BRID使用者。5名PPI使用者中有4名（83.6%,n = 2906）使用PPI长达10至12周，在考虑BRID使用后，不适当PPI过度使用的患病率为27.1% （n = 944）。提供者A的居民PPI过度使用的可能性是提供者B的4倍[比值比（OR） 4.08, 95% CI 2.73-6.09]。PPI未充分使用的患病率为38.5% （n = 1452）。结论和意义：1 / 4的PPI使用者超过了临床推荐的持续时间，而2 / 5的长期BRID使用者没有接受PPI来保护胃。迫切需要量身定制的干预措施，如药物审查和处方减少倡议，以改善PPI处方。

{"title":"Over- and Underuse of Proton Pump Inhibitors in Nursing Homes: A Multisite Longitudinal Cohort Study","authors":"Nasir Wabe PhD, MScEpid, MScClinPharm, BPharm , Rachel Urwin PhD, MPH , Isabelle Meulenbroeks PhD, MPH, BPhysio , Karla Seaman PhD, MClinEpi, BPharm , Magdalena Z. Raban PhD, MIPH, BPharm , Sangita Neupane MPH , Amy Nguyen PhD, Grad Cert (Research Management and Commercialisation), BMedSc , Sandun M. Silva PhD, BSc , Andrea Timothy PhD, MPhil, ProfCertCR, PGDipSc, BSc, DipLaw , Narjis Batool DPharm, MPhil (Pharm) , Lisa Pont PhD, MSC, BSc, BPharm , Johanna I. Westbrook PhD, MHA, GradDipAppEpid, BAppSc","doi":"10.1016/j.jamda.2024.105393","DOIUrl":"10.1016/j.jamda.2024.105393","url":null,"abstract":"<div><h3>Objectives</h3><div>Proton pump inhibitors (PPIs) are used to manage excess stomach acid production and provide gastroprotection from bleeding risk-increasing drugs (BRIDs). We aimed to determine the prevalence of potentially inappropriate PPI use in nursing homes and associated factors.</div></div><div><h3>Design</h3><div>Longitudinal cohort study using 8 years of electronic data.</div></div><div><h3>Setting and Participants</h3><div>The study included 6439 permanent residents aged ≥65 years from 34 homes managed by 2 aged care providers in New South Wales.</div></div><div><h3>Method</h3><div>Continuous PPI use (>12 weeks) in the absence of long-term BRID (>30 days) use was deemed inappropriate overuse whereas long-term BRID use without concomitant PPI for gastroprotection was classified as inappropriate underuse. Binary logistic regression was used to determine factors associated with PPI overuse.</div></div><div><h3>Results</h3><div>Fifty-four percent of residents (n = 3478) received a PPI, with a median duration of 46 weeks, whereas 58.5% (n = 3770) were long-term BRID users. Four of 5 PPI users (83.6%, n = 2906) used PPIs for >12 weeks, and after accounting for BRID use, the prevalence of inappropriate PPI overuse was 27.1% (n = 944). PPI overuse was 4 times more likely in residents in provider A compared with residents in provider B [odds ratio (OR) 4.08, 95% CI 2.73–6.09]. The prevalence of PPI underuse was 38.5% (n = 1452).</div></div><div><h3>Conclusions and Implications</h3><div>One in 4 PPI users exceeded the clinically recommended duration, whereas 2 in 5 long-term BRID users did not receive a PPI for gastroprotection. There is a pressing need for tailored interventions, such as medication reviews and deprescribing initiatives, to improve PPI prescribing.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105393"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792049","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

Adult Day Care in South Carolina: Identification of Need and Opportunity 南卡罗来纳州的成人日托：需求和机会的识别。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105395

LaNaya A. Martin MPH, Janet O'Connor MA, FNU Rubaiya MS, Linda E. Kelemen ScD

Objectives

To investigate pre- and post-pandemic demographic profiles of attendees at adult day care (ADC) facilities in the US South, and survey providers for their experience during the pandemic.

Design

Retrospective analysis and prospective interviews and survey.

Setting and Participants

We received administrative data for South Carolina Medicaid recipients in 2019 (pre-pandemic, n = 21,969) and 2022 (post-pandemic, n = 25,118), prospectively interviewed 6 facility owners and surveyed 62 of 82 ADC facilities in South Carolina (75.6% response).

Methods

We compared age, sex, race, and county distributions between Medicaid recipients who attended facilities in 2019 and 2022. We summarized interviews qualitatively. We assessed attendee and provider profiles using a 55-item survey.

Results

In 2019, 2398 (10.9%) of Medicaid recipients attended ADC facilities at least 24 times, decreasing significantly to 1745 (6.9%) in 2022 (P < .001). Attendees’ median age fell from 62 years in 2019 to 59 years in 2022 (P < .001). Attendance was highest among Black or African American individuals (71.0% in 2019 and 62.2% in 2022, P < .001). Eleven of 46 counties, all rural, did not have a facility. A median of 25 miles was the farthest distance traveled one way by attendees to a facility (range, 4–60). ADC facility nurses were the primary source of medical oversight and COVID-19 information during the 3-month shutdown. More than 90.0% of facilities served adults who had cognitive impairment, multiple chronic conditions, or intellectual or developmental disabilities. Most facilities (53.2%) received government funding during the pandemic. Staffing shortages, decreased attendance, and increased costs were major challenges faced by ADCs post-pandemic.

Conclusions and Implications

These findings demonstrate the importance of ADC facilities to the health and well-being of Black or African American individuals, a population that was disproportionately burdened during the COVID-19 pandemic, and suggests potential underutilization of facilities and more resources allocated to one-on-one in-home care than might be economically feasible.

目的：调查大流行前和大流行后美国南部成人日托（ADC）设施参与者的人口统计资料，并调查大流行期间提供者的经验。设计：回顾性分析和前瞻性访谈和调查。环境和参与者：我们收到了2019年（大流行前，n = 21,969）和2022年（大流行后，n = 25,118）南卡罗来纳州医疗补助接受者的行政数据，前瞻性地采访了6个设施所有者，并调查了南卡罗来纳州82个ADC设施中的62个（75.6%的回应）。方法：我们比较了2019年和2022年医疗补助受助人的年龄、性别、种族和县分布。我们对访谈进行定性总结。我们使用55项调查来评估参与者和提供者的概况。结果：2019年，2398名（10.9%）的医疗补助受助人至少去过ADC机构24次，到2022年，这一数字显著下降至1745名（6.9%）（P < 0.001）。与会者的年龄中位数从2019年的62岁降至2022年的59岁（P < 0.001）。黑人或非裔美国人的出勤率最高（2019年为71.0%，2022年为62.2%,P < 0.001）。46个县中有11个县都是农村，没有医疗设施。25英里的中位数是与会者单程旅行到一个设施的最远距离（范围，4-60）。在三个月的关闭期间，ADC设施护士是医疗监督和COVID-19信息的主要来源。超过90.0%的设施服务于患有认知障碍、多种慢性疾病或智力或发育障碍的成年人。大多数设施（53.2%）在大流行期间获得了政府资助。人员短缺、出勤率下降和费用增加是大流行后adc面临的主要挑战。结论和影响：这些发现表明ADC设施对黑人或非裔美国人的健康和福祉的重要性，这一人群在COVID-19大流行期间承受了不成比例的负担，并表明设施的潜在利用不足，以及分配给一对一家庭护理的资源比经济上可行的要多。

{"title":"Adult Day Care in South Carolina: Identification of Need and Opportunity","authors":"LaNaya A. Martin MPH, Janet O'Connor MA, FNU Rubaiya MS, Linda E. Kelemen ScD","doi":"10.1016/j.jamda.2024.105395","DOIUrl":"10.1016/j.jamda.2024.105395","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate pre- and post-pandemic demographic profiles of attendees at adult day care (ADC) facilities in the US South, and survey providers for their experience during the pandemic.</div></div><div><h3>Design</h3><div>Retrospective analysis and prospective interviews and survey.</div></div><div><h3>Setting and Participants</h3><div>We received administrative data for South Carolina Medicaid recipients in 2019 (pre-pandemic, n = 21,969) and 2022 (post-pandemic, n = 25,118), prospectively interviewed 6 facility owners and surveyed 62 of 82 ADC facilities in South Carolina (75.6% response).</div></div><div><h3>Methods</h3><div>We compared age, sex, race, and county distributions between Medicaid recipients who attended facilities in 2019 and 2022. We summarized interviews qualitatively. We assessed attendee and provider profiles using a 55-item survey.</div></div><div><h3>Results</h3><div>In 2019, 2398 (10.9%) of Medicaid recipients attended ADC facilities at least 24 times, decreasing significantly to 1745 (6.9%) in 2022 (<em>P</em> < .001). Attendees’ median age fell from 62 years in 2019 to 59 years in 2022 (<em>P</em> < .001). Attendance was highest among Black or African American individuals (71.0% in 2019 and 62.2% in 2022, <em>P</em> < .001). Eleven of 46 counties, all rural, did not have a facility. A median of 25 miles was the farthest distance traveled one way by attendees to a facility (range, 4–60). ADC facility nurses were the primary source of medical oversight and COVID-19 information during the 3-month shutdown. More than 90.0% of facilities served adults who had cognitive impairment, multiple chronic conditions, or intellectual or developmental disabilities. Most facilities (53.2%) received government funding during the pandemic. Staffing shortages, decreased attendance, and increased costs were major challenges faced by ADCs post-pandemic.</div></div><div><h3>Conclusions and Implications</h3><div>These findings demonstrate the importance of ADC facilities to the health and well-being of Black or African American individuals, a population that was disproportionately burdened during the COVID-19 pandemic, and suggests potential underutilization of facilities and more resources allocated to one-on-one in-home care than might be economically feasible.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105395"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801343","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

The Impact of Pay-for-Performance Care on the Mortality and Cardiovascular Outcomes in Older Adults with Newly Diagnosed Type 2 Diabetes: A Nationwide Population-Based Cohort Study 绩效付费医疗对新诊断的老年2型糖尿病患者死亡率和心血管结局的影响：一项全国性人群队列研究

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105382

Fu-Shun Yen MD , James Cheng-Chung Wei MD, PhD , Shih-Yi Lin MD , Jeffrey Hsu BS , Yun-Kai Yeh MD , Yu-Han Huang MS , Tzu-Ju Hsu MS , Der-Yang Cho MD , Chii-Min Hwu MD , Chih-Cheng Hsu DrPH

Objectives

To evaluate the long-term effects of pay-for-performance (P4P) care in the geriatric population with newly diagnosed type 2 diabetes (T2D).

Design

Retrospective longitudinal cohort study.

Setting and Participants

A total of 6607 propensity score-matched pairs of patients with newly diagnosed T2D who received either P4P care or standard care as identified from the National Health Insurance Research Database in Taiwan between January 1, 2000, and December 31, 2019.

Methods

Cox regression models were used to assess differences in risk of outcomes between P4P and non-P4P care. Primary outcomes and measures include all-cause mortality, hospital admissions due to cardiovascular events, dialysis initiation, severe hyperglycemia, and severe hypoglycemia. Multivariable Cox regression models were performed to calculate hazard ratios among and within groups.

Results

The multivariable-adjusted model showed that patients with P4P care had a significantly lower risk of all-cause mortality [adjusted hazard ratio (aHR), 0.37; 95% CI, 0.35–0.39], stroke (aHR, 0.80 95% CI, 0.72–0.88), myocardial infarction (aHR, 0.57; 95% CI, 0.48–0.67), heart failure (aHR, 0.75; 95% CI, 0.69–0.81), and dialysis (aHR, 0.66; 95% CI, 0.53–0.82) compared with those not receiving P4P care. However, there were no significant differences in the risk of severe hyperglycemia (aHR, 0.92; 95% CI, 0.82–1.03) and severe hypoglycemia (aHR, 1.04; 95% CI, 0.92–1.17) between the 2 groups.

Conclusions and Implications

This nationwide cohort study suggests that the P4P program may reduce the risk of cardiovascular events, dialysis needs, and mortality in older patients with T2D without increasing the risk of severe hypoglycemia. P4P may be an effective management strategy for older patients with T2D.

目的：评价按绩效付费（P4P）护理在老年新诊断2型糖尿病（T2D）患者中的长期效果。设计：回顾性纵向队列研究。方法：采用Cox回归模型评估P4P和非P4P护理之间结局风险的差异。主要结局和措施包括全因死亡率、因心血管事件住院、开始透析、严重高血糖和严重低血糖。采用多变量Cox回归模型计算组间和组内风险比。结果：多变量校正模型显示，接受P4P护理的患者全因死亡风险显著降低(校正风险比[aHR]， 0.37；95% CI, 0.35-0.39)，卒中（aHR, 0.80 95% CI, 0.72-0.88），心肌梗死(aHR, 0.57；95% CI, 0.48-0.67)，心力衰竭(aHR, 0.75；95% CI, 0.69-0.81)和透析(aHR, 0.66；95% CI, 0.53-0.82)与未接受P4P护理的患者相比。然而，两组发生严重高血糖的风险无显著差异(aHR, 0.92；95% CI, 0.82-1.03)和严重低血糖(aHR, 1.04；95% CI, 0.92-1.17)。结论和意义：这项全国性队列研究表明，P4P方案可以降低老年T2D患者心血管事件、透析需求和死亡率的风险，而不会增加严重低血糖的风险。P4P可能是老年T2D患者有效的治疗策略。

{"title":"The Impact of Pay-for-Performance Care on the Mortality and Cardiovascular Outcomes in Older Adults with Newly Diagnosed Type 2 Diabetes: A Nationwide Population-Based Cohort Study","authors":"Fu-Shun Yen MD , James Cheng-Chung Wei MD, PhD , Shih-Yi Lin MD , Jeffrey Hsu BS , Yun-Kai Yeh MD , Yu-Han Huang MS , Tzu-Ju Hsu MS , Der-Yang Cho MD , Chii-Min Hwu MD , Chih-Cheng Hsu DrPH","doi":"10.1016/j.jamda.2024.105382","DOIUrl":"10.1016/j.jamda.2024.105382","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the long-term effects of pay-for-performance (P4P) care in the geriatric population with newly diagnosed type 2 diabetes (T2D).</div></div><div><h3>Design</h3><div>Retrospective longitudinal cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 6607 propensity score-matched pairs of patients with newly diagnosed T2D who received either P4P care or standard care as identified from the National Health Insurance Research Database in Taiwan between January 1, 2000, and December 31, 2019.</div></div><div><h3>Methods</h3><div>Cox regression models were used to assess differences in risk of outcomes between P4P and non-P4P care. Primary outcomes and measures include all-cause mortality, hospital admissions due to cardiovascular events, dialysis initiation, severe hyperglycemia, and severe hypoglycemia. Multivariable Cox regression models were performed to calculate hazard ratios among and within groups.</div></div><div><h3>Results</h3><div>The multivariable-adjusted model showed that patients with P4P care had a significantly lower risk of all-cause mortality [adjusted hazard ratio (aHR), 0.37; 95% CI, 0.35–0.39], stroke (aHR, 0.80 95% CI, 0.72–0.88), myocardial infarction (aHR, 0.57; 95% CI, 0.48–0.67), heart failure (aHR, 0.75; 95% CI, 0.69–0.81), and dialysis (aHR, 0.66; 95% CI, 0.53–0.82) compared with those not receiving P4P care. However, there were no significant differences in the risk of severe hyperglycemia (aHR, 0.92; 95% CI, 0.82–1.03) and severe hypoglycemia (aHR, 1.04; 95% CI, 0.92–1.17) between the 2 groups.</div></div><div><h3>Conclusions and Implications</h3><div>This nationwide cohort study suggests that the P4P program may reduce the risk of cardiovascular events, dialysis needs, and mortality in older patients with T2D without increasing the risk of severe hypoglycemia. P4P may be an effective management strategy for older patients with T2D.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105382"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142790694","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

Long-Term Care Needs Assessment: From Frameworks to Practice 长期护理需求评估：从框架到实践。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105409

Pablo Villalobos Dintrans DrPH

Objectives

Identify and describe instruments used by countries to perform functional ability assessment as eligibility for their long-term care systems and compare them to existing healthy aging frameworks proposed by the World Health Organization (intrinsic capacity and functionality).

Design

Descriptive, case studies.

Setting and Participants

Country-level long-term care systems in 27 countries.

Methods

Selection of countries with long-term care systems in place and with expected increase in long-term care needs. For each country, data regarding the country features, as well as information of the long-term care systems, and the instruments to assess long-term care needs (functional ability) were collected. Features of the assessment tools were compared with the World Health Organization's intrinsic capacity and functionality domains, identifying the specific activities evaluated and the way the assessment is used to classify people and define benefits.

Results

Countries were classified into those with a long-term care system and a standardized instrument for assessing long-term care needs (group 1; n = 6), those that have long-term care initiatives do not have a standardized instrument to identify needs (group 2; n = 8), and those with no information on their systems or instruments for identify long-term care needs (group 3; n = 13). When looking at countries with standardized tools, instruments include several activities related to intrinsic capacity domains such as cognition, mobility, and psychological capacity; for functional ability, all domains except the ability to “contribute” are covered by the instruments.

Conclusions and Implications

Long-term care needs assessment is a complex but necessary task to be performed by long-term care systems. Countries embarking in the design and redesign of their systems can use the existing instruments, frameworks, and the experience from other countries to better adapt this process to their own needs and contexts.

目标：确定并描述各国用于进行功能能力评估的工具，作为其长期护理系统的资格条件，并将其与世界卫生组织提出的现有健康老龄化框架（内在能力和功能）进行比较：设计：描述性案例研究：环境和参与者：27 个国家的国家级长期护理系统：方法：选择已建立长期护理系统且预计长期护理需求会增加的国家。收集每个国家的国家特征数据、长期护理系统信息以及评估长期护理需求（功能能力）的工具。将评估工具的特点与世界卫生组织的内在能力和功能领域进行了比较，确定了评估的具体活动以及用于对人员进行分类和确定福利的评估方式：结果：我们将各国划分为拥有长期护理系统和用于评估长期护理需求的标准化工具的国家（第 1 组；n = 6）、拥有长期护理措施但没有标准化工具来确定需求的国家（第 2 组；n = 8）以及没有关于其系统或确定长期护理需求的工具的信息的国家（第 3 组；n = 13）。在拥有标准化工具的国家中，工具包括与认知、行动能力和心理能力等内在能力领域相关的几项活动；在功能能力方面，工具涵盖了除 "贡献 "能力之外的所有领域：长期护理需求评估是长期护理系统必须执行的一项复杂而又必要的任务。开始设计和重新设计其系统的国家可以利用现有的工具、框架和其他国家的经验，使这一过程更好地适应本国的需求和环境。

{"title":"Long-Term Care Needs Assessment: From Frameworks to Practice","authors":"Pablo Villalobos Dintrans DrPH","doi":"10.1016/j.jamda.2024.105409","DOIUrl":"10.1016/j.jamda.2024.105409","url":null,"abstract":"<div><h3>Objectives</h3><div>Identify and describe instruments used by countries to perform functional ability assessment as eligibility for their long-term care systems and compare them to existing healthy aging frameworks proposed by the World Health Organization (intrinsic capacity and functionality).</div></div><div><h3>Design</h3><div>Descriptive, case studies.</div></div><div><h3>Setting and Participants</h3><div>Country-level long-term care systems in 27 countries.</div></div><div><h3>Methods</h3><div>Selection of countries with long-term care systems in place and with expected increase in long-term care needs. For each country, data regarding the country features, as well as information of the long-term care systems, and the instruments to assess long-term care needs (functional ability) were collected. Features of the assessment tools were compared with the World Health Organization's intrinsic capacity and functionality domains, identifying the specific activities evaluated and the way the assessment is used to classify people and define benefits.</div></div><div><h3>Results</h3><div>Countries were classified into those with a long-term care system and a standardized instrument for assessing long-term care needs (group 1; n = 6), those that have long-term care initiatives do not have a standardized instrument to identify needs (group 2; n = 8), and those with no information on their systems or instruments for identify long-term care needs (group 3; n = 13). When looking at countries with standardized tools, instruments include several activities related to intrinsic capacity domains such as cognition, mobility, and psychological capacity; for functional ability, all domains except the ability to “contribute” are covered by the instruments.</div></div><div><h3>Conclusions and Implications</h3><div>Long-term care needs assessment is a complex but necessary task to be performed by long-term care systems. Countries embarking in the design and redesign of their systems can use the existing instruments, frameworks, and the experience from other countries to better adapt this process to their own needs and contexts.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105409"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829148","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

Response to Comment on “Adverse Lipid Profiles are Associated With Lower Dementia Risk in Older People” 对“不良脂质谱与老年人痴呆风险降低相关”评论的回应。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105377

Jakob L. Schroevers MD, Jan Willem van Dalen PhD

引用次数: 0

Building a Time-Series Model to Predict Hospitalization Risks in Home Health Care: Insights Into Development, Accuracy, and Fairness 建立时间序列模型预测家庭医疗保健住院风险：对发展、准确性和公平性的洞察。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105417

Maxim Topaz PhD, RN , Anahita Davoudi PhD , Lauren Evans PhD , Sridevi Sridharan MSc , Jiyoun Song PhD, RN , Sena Chae PhD, RN , Yolanda Barrón MA , Mollie Hobensack PhD, RN , Danielle Scharp PhD, RN , Kenrick Cato PhD, RN , Sarah Collins Rossetti PhD, RN , Piotr Kapela MSc , Zidu Xu MSc, RN , Pallavi Gupta PhD , Zhihong Zhang PhD, RN , Margaret V. Mcdonald MA , Kathryn H. Bowles PhD, RN

Objectives

Home health care (HHC) serves more than 5 million older adults annually in the United States, aiming to prevent unnecessary hospitalizations and emergency department (ED) visits. Despite efforts, up to 25% of patients in HHC experience these adverse events. The underutilization of clinical notes, aggregated data approaches, and potential demographic biases have limited previous HHC risk prediction models. This study aimed to develop a time-series risk model to predict hospitalizations and ED visits in patients in HHC, examine model performance over various prediction windows, identify top predictive variables and map them to data standards, and assess model fairness across demographic subgroups.

Setting and Participants

A total of 27,222 HHC episodes between 2015 and 2017.

Methods

The study used health care process modeling of electronic health records, including clinical notes processed with natural language processing techniques and Medicare claims data. A Light Gradient Boosting Machine algorithm was used to develop the risk prediction model, with performance evaluated using 5-fold cross-validation. Model fairness was assessed across gender, race/ethnicity, and socioeconomic subgroups.

Results

The model achieved high predictive performance, with an F1 score of 0.84 for a 5-day prediction window. Twenty top predictive variables were identified, including novel indicators such as the length of nurse-patient visits and visit frequency. Eighty-five percent of these variables mapped completely to the US Core Data for Interoperability standard. Fairness assessment revealed performance disparities across demographic and socioeconomic groups, with lower model effectiveness for more historically underserved populations.

Conclusions and Implications

This study developed a robust time-series risk model for predicting adverse events in patients in HHC, incorporating diverse data types and demonstrating high predictive accuracy. The findings highlight the importance of considering established and novel risk factors in HHC. Importantly, the observed performance disparities across subgroups emphasize the need for fairness adjustments to ensure equitable risk prediction across all patient populations.

目的：家庭保健（HHC）每年为美国500多万老年人提供服务，旨在防止不必要的住院和急诊（ED）就诊。尽管做出了努力，但高达25%的HHC患者经历了这些不良事件。临床记录的利用不足、汇总数据方法和潜在的人口统计学偏差限制了以前的HHC风险预测模型。本研究旨在建立一个时间序列风险模型来预测HHC患者的住院和急诊科就诊，在各种预测窗口中检查模型的性能，确定最佳预测变量并将其映射到数据标准，并评估模型在人口统计亚组中的公平性。环境和参与者：2015年至2017年期间共有27,222例HHC发作。方法：采用电子健康记录的医疗过程建模，包括用自然语言处理技术处理的临床记录和医疗保险索赔数据。采用光梯度增强机（Light Gradient Boosting Machine）算法建立风险预测模型，并通过5次交叉验证对其性能进行评估。模型公平性是在性别、种族/民族和社会经济亚群体中进行评估的。结果：该模型具有较高的预测性能，5天预测窗口的F1得分为0.84。确定了20个最重要的预测变量，包括新的指标，如护患访问的长度和访问频率。85%的这些变量完全映射到美国核心数据互操作性标准。公平评估揭示了人口统计和社会经济群体之间的表现差异，对于历史上服务不足的人群，模型的有效性较低。结论和意义：本研究建立了一个预测HHC患者不良事件的稳健时间序列风险模型，纳入了不同的数据类型，并显示出较高的预测准确性。研究结果强调了在HHC中考虑现有和新的危险因素的重要性。重要的是，观察到的亚组间的表现差异强调了公平调整的必要性，以确保所有患者群体的公平风险预测。

{"title":"Building a Time-Series Model to Predict Hospitalization Risks in Home Health Care: Insights Into Development, Accuracy, and Fairness","authors":"Maxim Topaz PhD, RN , Anahita Davoudi PhD , Lauren Evans PhD , Sridevi Sridharan MSc , Jiyoun Song PhD, RN , Sena Chae PhD, RN , Yolanda Barrón MA , Mollie Hobensack PhD, RN , Danielle Scharp PhD, RN , Kenrick Cato PhD, RN , Sarah Collins Rossetti PhD, RN , Piotr Kapela MSc , Zidu Xu MSc, RN , Pallavi Gupta PhD , Zhihong Zhang PhD, RN , Margaret V. Mcdonald MA , Kathryn H. Bowles PhD, RN","doi":"10.1016/j.jamda.2024.105417","DOIUrl":"10.1016/j.jamda.2024.105417","url":null,"abstract":"<div><h3>Objectives</h3><div>Home health care (HHC) serves more than 5 million older adults annually in the United States, aiming to prevent unnecessary hospitalizations and emergency department (ED) visits. Despite efforts, up to 25% of patients in HHC experience these adverse events. The underutilization of clinical notes, aggregated data approaches, and potential demographic biases have limited previous HHC risk prediction models. This study aimed to develop a time-series risk model to predict hospitalizations and ED visits in patients in HHC, examine model performance over various prediction windows, identify top predictive variables and map them to data standards, and assess model fairness across demographic subgroups.</div></div><div><h3>Setting and Participants</h3><div>A total of 27,222 HHC episodes between 2015 and 2017.</div></div><div><h3>Methods</h3><div>The study used health care process modeling of electronic health records, including clinical notes processed with natural language processing techniques and Medicare claims data. A Light Gradient Boosting Machine algorithm was used to develop the risk prediction model, with performance evaluated using 5-fold cross-validation. Model fairness was assessed across gender, race/ethnicity, and socioeconomic subgroups.</div></div><div><h3>Results</h3><div>The model achieved high predictive performance, with an <em>F</em>1 score of 0.84 for a 5-day prediction window. Twenty top predictive variables were identified, including novel indicators such as the length of nurse-patient visits and visit frequency. Eighty-five percent of these variables mapped completely to the US Core Data for Interoperability standard. Fairness assessment revealed performance disparities across demographic and socioeconomic groups, with lower model effectiveness for more historically underserved populations.</div></div><div><h3>Conclusions and Implications</h3><div>This study developed a robust time-series risk model for predicting adverse events in patients in HHC, incorporating diverse data types and demonstrating high predictive accuracy. The findings highlight the importance of considering established and novel risk factors in HHC. Importantly, the observed performance disparities across subgroups emphasize the need for fairness adjustments to ensure equitable risk prediction across all patient populations.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105417"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846946","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

Oily Fish Intake Is Inversely Associated with Impaired Functionality: A Population-based Study in Frequent Fish Consumers Aged 60 years or More Living in Rural Ecuador 摄入油性鱼类与功能受损呈负相关：一项基于人群的研究，研究对象是生活在厄瓜多尔农村的60岁或以上的经常食用鱼类的人。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105423

Oscar H. Del Brutto MD , Denisse A. Rumbea MHA , Emilio E. Arias MD , Robertino M. Mera MD, PhD

引用次数: 0