Journal of the American Medical Directors Association最新文献

英文中文

Muscle Strength Comparison in Immune-Mediated Rheumatic Disease vs Healthy Adults: A Meta-Analysis 免疫性风湿病与健康成人的肌肉力量比较：一项 Meta 分析。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-02 DOI: 10.1016/j.jamda.2024.105293

Objectives

Patients with immune-mediated rheumatic diseases (IMRDs) often exhibit reduced muscle strength. Therefore, this review aimed to evaluate muscle strength in patients with IMRDs compared with healthy control and to summarize the relationship between low muscle strength and clinical features in patients with IMRDs.

Design

Systematic review with meta-analysis of case-control studies.

Setting and Participants

Patients with IMRDs.

Methods

A comprehensive search was conducted in the Embase, MEDLINE, Web of Science, and Cochrane databases to identify relevant studies published up to November 2023 on rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and spondyloarthritis. Meta-analysis was performed using a random-effects model to determine the mean difference (MD) in muscle strength between patients with IMRDs and an age- and sex-matched healthy control group.

Results

We identified 11,692 studies, and 760 studies were selected for screening. Ultimately, 26 studies met the inclusion criteria, composed of 2661 individuals, mostly women. The IMRDs women group had lower handgrip muscle strength (MD, −9.53; 95% CI, −11.78 to −7.28 kg) than the healthy control group, whereas the handgrip strength men groups did not differ significantly from that of the healthy control group. Similar trend was observed in lower limb muscle strength for the IMRDs women group than the healthy control group (MD, −63.10; 95% CI, −94.18 to −32.01 Nm). Four studies examined muscle strength and clinical features in rheumatoid arthritis: one associated it with age and disease activity, 2 associated it with disease duration, and 3 associated it with physical function. In systemic lupus erythematosus, only 2 studies associated low muscle strength with age, disease activity, and fatigue. No associations were found in spondyloarthritis, and none were found in systemic sclerosis.

Conclusions and Implications

Patients with IMRD exhibit lower muscle strength than healthy counterparts, with low strength moderately associated with longer disease duration, worsening disease activity, and decline in physical function. Targeted interventions are crucial for preventing and managing muscle weakness in IMRDs.

目的：免疫介导的风湿性疾病（IMRDs）患者通常表现出肌肉力量减弱。因此，本综述旨在评估与健康对照组患者相比肌肉力量减弱的免疫介导风湿性疾病患者，并总结低肌肉力量与免疫介导风湿性疾病患者临床特征之间的关系：设计：对病例对照研究进行系统回顾和荟萃分析：环境和参与者：IMRD患者：在Embase、MEDLINE、Web of Science和Cochrane数据库中进行了全面检索，以确定截至2023年11月发表的类风湿关节炎、系统性红斑狼疮、系统性硬化症和脊柱关节炎的相关研究。采用随机效应模型进行了元分析，以验证IMRD患者与年龄和性别匹配的健康组之间的平均肌力差异（MD）：我们确定了 11,692 项研究，筛选出 760 项研究。最终，26 项研究符合纳入标准，共纳入 2661 人，其中大部分为女性。IMRDs女性组的手握肌力（MD，-9.53；95% CI，-11.78 至 -7.28千克）低于健康组，而男性组的手握肌力与健康组没有显著差异。与健康组相比，IMRDs女性组的下肢肌力也出现了类似的趋势（MD，-63.10；95% CI，-94.18至-32.01牛米）。四项研究调查了类风湿性关节炎患者的肌肉力量和临床特征：一项研究将肌肉力量与年龄和疾病活动性相关联，两项研究将肌肉力量与疾病持续时间相关联，三项研究将肌肉力量与身体功能相关联。在系统性红斑狼疮中，只有两项研究将低肌力与年龄、疾病活动性和疲劳相关联。脊柱关节炎和系统性硬化症中没有发现任何关联：IMRD患者的肌力低于健康人，低肌力与病程延长、疾病活动恶化和身体功能下降有一定关系。有针对性的干预措施对于预防和控制IMRD患者的肌无力至关重要。

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引用次数: 0

General Information 一般信息

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-01 DOI: 10.1016/S1525-8610(24)00738-2

引用次数: 0

The Nursing Home Administrator (NHA) Pipeline—Obstacles and Opportunities 疗养院管理员（NHA）管道--障碍与机遇

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jamda.2024.105177

引用次数: 0

Hyperlipidemia, Age of Diagnosis, and Risk of Dementia 高脂血症、诊断年龄与痴呆症风险。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jamda.2024.105214

引用次数: 0

Directions & Connections 路线与连接

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-01 DOI: 10.1016/S1525-8610(24)00737-0

引用次数: 0

Events and Products 活动和产品

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jamda.2024.105332

引用次数: 0

Influences of Social Disengagement and Depressive Symptoms on Sleep Disturbance in Dementia Caregiving Dyads: A Nationally Representative Study 失智症护理双人家庭中社交脱离和抑郁症状对睡眠障碍的影响：一项具有全国代表性的研究。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jamda.2024.105197

Objectives

To examine the influence of social disengagement and depressive symptoms on sleep disturbance among dementia caregiving dyads and the actor-partner interdependence nature of these influences.

Design

Actor-partner interdependence model through structural equation modeling for dyadic analyses.

Setting and Participants

A total of 310 dyads of older adults with dementia and their care partners from 2 national representative studies in the United States, the National Health and Aging Trends Study (NHATS) and its companion study, the National Study of Caregiving (NSOC).

Methods

Data from the NHATS Round 11 and NSOC IV were analyzed using descriptive statistics, Pearson correlation analysis, and the actor-partner interdependence model. Structural equation modeling was used to assess the mediation effects of depressive symptoms within the actor-partner interdependence models.

Results

In the model of caregivers, social disengagement had a direct impact on sleep disturbance (β = 0.49, P < .001) and an indirect impact through depressive symptoms (β = 0.25, P < .001). In the model of older adults with dementia, social disengagement only had an indirect effect on sleep disturbance through depressive symptoms. In models examining partner effects, caregivers' social disengagement directly influenced their care partners' depressive symptoms (β = 0.20, P = .019), which subsequently affected caregivers’ sleep disturbance (β = 0.17, P < .001). Social disengagement (β = 0.17, P = .001) and depressive symptoms (β = 0.17, P < .001) in older adults with dementia directly impacted their caregivers' sleep disturbance. Depressive symptoms of older adults with dementia served as multiple mediators linking one member's social disengagement to both their own and partner's sleep.

Conclusions and Implications

This study represents one of the first attempts to investigate the influencing mechanism of sleep disturbances among older adults with dementia and their informal caregivers through a dyadic perspective. The sleep disturbance of caregivers may be directly influenced by the social disengagement and depressive symptoms exhibited by both members of the dyad, whereas the sleep disturbance experienced by older adults with dementia can only be indirectly influenced by the dyad's social disengagement via their own depressive symptoms. Dyadic social activities targeting depressive symptoms could be designed to address sleep disturbances in dementia caregiving dyads.

目的：研究社会脱离和抑郁症状对痴呆症护理二人组睡眠障碍的影响，以及这些影响的行为者-伴侣相互依存性质：研究社会脱离和抑郁症状对痴呆症护理二人组睡眠障碍的影响，以及这些影响因素的行为者-伙伴相互依赖性质：设计：通过结构方程模型建立行动者-伙伴相互依存模型，进行二元分析：美国两项具有全国代表性的研究--全国健康与老龄化趋势研究（NHATS）及其配套研究--全国护理研究（NSOC）--共收集了310个患有痴呆症的老年人及其护理伙伴的二元组：采用描述性统计、皮尔逊相关分析和行为者-伴侣相互依赖模型对 NHATS 第 11 轮和 NSOC IV 的数据进行了分析。结构方程模型用于评估抑郁症状在行为者-伙伴相互依赖模型中的中介效应：结果：在照顾者模型中，社会脱离对睡眠障碍有直接影响（β = 0.49，P < .001），并通过抑郁症状产生间接影响（β = 0.25，P < .001）。在痴呆症老年人的模型中，脱离社交仅通过抑郁症状对睡眠障碍产生间接影响。在研究伴侣效应的模型中，照顾者的社交脱离直接影响其照顾伴侣的抑郁症状（β = 0.20，P = .019），进而影响照顾者的睡眠障碍（β = 0.17，P < .001）。老年痴呆症患者的社交疏离（β = 0.17，P = .001）和抑郁症状（β = 0.17，P < .001）直接影响了其照顾者的睡眠障碍。患有痴呆症的老年人的抑郁症状是将其中一名成员的社交脱离与他们自己和伴侣的睡眠联系起来的多重中介因素：本研究是首次尝试从伴侣关系的角度研究老年痴呆症患者及其非正式照顾者睡眠障碍的影响机制。照顾者的睡眠障碍可能直接受到二人组中双方成员所表现出的社交疏离和抑郁症状的影响，而患有痴呆症的老年人所经历的睡眠障碍只能通过其自身的抑郁症状间接受到二人组社交疏离的影响。可以设计针对抑郁症状的二人社交活动，以解决痴呆症护理二人组的睡眠障碍问题。

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引用次数: 0

Interest in Dyadic Physical Activity Programs among Informal Caregivers of Patients with Neurocognitive Disorders 神经认知障碍患者的非正式照顾者对双人体育活动计划的兴趣。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jamda.2024.105194

引用次数: 0

Receipt of Home Health and 30-day Outcomes Among Veterans With Dementia Following Inpatient Surgery 患有痴呆症的退伍军人在住院手术后接受家庭医疗服务与 30 天疗效。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-28 DOI: 10.1016/j.jamda.2024.105291

引用次数: 0

Housing Adaptations and Long-Term Care Facility Admissions Among Older Adults With Care Needs in Japan. 日本有护理需求的老年人的住房改造和入住长期护理机构的情况。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-28 DOI: 10.1016/j.jamda.2024.105290

Rumiko Tsuchiya-Ito, Seigo Mitsutake, Satomi Kitamura, Reina Taguchi, Yoshinori Takeuchi, Shinji Hattori, Shota Hamada

Objectives: Housing adaptations may contribute to aging in place for older adults with care needs by reducing the risk of long-term care facility (LTCF) admissions, but this association remains unclear. We examined the association between housing adaptations and LTCF admissions among older adults with care needs.

Design: Retrospective cohort study using data from a Japanese municipality.

Setting/participants: Adults aged ≥65 years who were newly certified with care needs under the public long-term care insurance system between April 2014 and March 2016.

Methods: The study exposure was the implementation of insurance-covered housing adaptations (maximum covered cost: ∖200,000) during the 2 years after certification. Based on this exposure, participants were assigned to a non-implementation group (no housing adaptations), sub-maximum cost group (housing adaptations below the maximum cost), or maximum cost group (housing adaptations at the maximum cost). A Fine-Gray subdistribution hazards model was used to analyze the associations between the exposure groups and new LTCF admissions after adjusting for various risk factors. Death was regarded as a competing risk, and participants were followed until March 2022.

Results: Among 4610 participants, 1261 (27.3%) had implemented housing adaptations. Among these, 943 (74.8%) were in the sub-maximum cost group and 318 (25.2%) were in the maximum cost group. During the follow-up period (median: 51 months), the incidence of LTCF admission was 3.9/1000 person-months in the non-implementation group, 3.8/1000 person-months in the sub-maximum cost group, and 2.8/1000 person-months in the maximum cost group. The adjusted subdistribution hazard ratio of LTCF admission (reference: non-implementation) was 0.90 (95% CI: 0.75-1.08) for the sub-maximum cost group and 0.67 (0.49-0.93) for the maximum cost group.

Conclusions and implications: Housing adaptations can support aging in place for older adults with care needs. Health care professionals and policymakers should consider the suitability of housing environments to reduce the risk of institutionalization.

目的：对住房进行改造可能会降低有护理需求的老年人入住长期护理机构（LTCF）的风险，从而有助于实现居家养老，但这种关联性尚不明确。我们研究了有护理需求的老年人住房改造与入住长期护理机构之间的关系：设计：回顾性队列研究，使用日本一个市镇的数据：环境/参与者：2014年4月至2016年3月期间在公共长期护理保险制度下新被证明有护理需求的年龄≥65岁的成年人：研究暴露是在获得认证后的 2 年内实施由保险承保的住房改造（最高承保费用：20 万英镑）。在此基础上，参与者被分配到未实施组（无住房改造）、低于最高成本组（低于最高成本的住房改造）或最高成本组（最高成本的住房改造）。在对各种风险因素进行调整后，采用 Fine-Gray subdistribution hazards 模型来分析暴露组别与新入住 LTCF 之间的关联。死亡被视为竞争风险，参与者的随访一直持续到2022年3月：在 4610 名参与者中，有 1261 人（27.3%）进行了住房改造。其中，943 人（74.8%）属于次高成本组，318 人（25.2%）属于高成本组。在随访期间（中位数：51个月），未实施组的长者入住长者护理院的发生率为3.9/1000人月，次高成本组为3.8/1000人月，最高成本组为2.8/1000人月。经调整后，次高成本组入住 LTCF（参考：未实施）的危险比为 0.90（95% CI：0.75-1.08），最高成本组为 0.67（0.49-0.93）：住房改造可以帮助有护理需求的老年人实现居家养老。医疗保健专业人员和政策制定者应考虑住房环境的适宜性，以降低入住养老院的风险。

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Journal of the American Medical Directors Association

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