Journal of the American Medical Directors Association最新文献_第5页

Impact of Quality Improvement Interventions on Hospital Admissions from Nursing Homes: A Systematic Review and Meta-Analysis 质量改进干预措施对养老院入院率的影响：系统回顾与元分析》。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-27 DOI: 10.1016/j.jamda.2024.105261

Objective

To synthesize evidence assessing the effectiveness of quality improvement (QI) interventions in reducing hospital service use from nursing homes (NHs).

Design

Systematic review and meta-analysis of randomized controlled trials (RCTs), controlled before-after (CBA), uncontrolled before-after (UBA), and interrupted time series studies. Searches were conducted in MEDLINE, CINAHL, The Cochrane Library, Embase, and Web of Science from 2000 to August 2023 (PROSPERO: CRD42022364195).

Setting and Participants

Long-stay NH residents (>30 days).

Methods

Included QI interventions using a continuous and data-driven approach to assess solutions aimed at reducing hospital service use. Risk of bias was assessed using JBI tools. Delivery arrangements and implementation strategies were categorized through EPOC taxonomy.

Results

Screening of 14,076 records led to the inclusion of 22 studies describing 29 QI interventions from 6 countries across 964 NHs. Ten studies, comprising 4 of 5 RCTs, 3 of 4 CBAs, and 1 of 12 UBAs were deemed to have a low risk of bias. All but 3 QI interventions used multiple component delivery arrangements (median 6; IQR 3-8), focusing on the “coordination of care and management of care processes” alone or combined with “changes in how, when, where, and by whom health care is delivered.” The most frequently used implementation strategies were educational meetings (n = 25) and materials (n = 20). The meta-analysis of 11 studies showed a significant reduction in “all-cause hospital admissions” for QI interventions compared with standard care (rate ratio, 0.60; 95% CI, 0.41-0.87; I² = 99.3%), with heterogeneity due to study design, QI intervention duration, type of delivery arrangements, and number of implementation strategies. No significant effects were found for emergency department (ED) visits or potentially avoidable hospitalizations.

Conclusions and Implications

The study provides preliminary evidence supporting the implementation of QI interventions seeking to reduce hospital admissions from NHs. However, these findings require confirmation through future experimental research.

摘要综合评估质量改进（QI）干预措施在减少疗养院使用医院服务方面的有效性：设计：对随机对照试验（RCT）、前后对照试验（CBA）、前后非对照试验（UBA）和间断时间序列研究进行系统回顾和荟萃分析。搜索范围包括 2000 年至 2023 年 8 月期间的 MEDLINE、CINAHL、The Cochrane Library、Embase 和 Web of Science（PROSPERO：CRD42022364195）：长期住院的 NH 居民（超过 30 天）：纳入的 QI 干预采用持续和数据驱动的方法，以评估旨在减少医院服务使用的解决方案。使用 JBI 工具评估偏倚风险。通过 EPOC 分类法对实施安排和实施策略进行分类：通过对 14,076 份记录的筛选，共纳入了 22 项研究，这些研究描述了来自 6 个国家、964 家 NHs 的 29 项 QI 干预措施。10项研究（包括5项RCT中的4项、4项CBA中的3项和12项UBA中的1项）被认为偏倚风险较低。除 3 项 QI 干预措施外，其他所有干预措施都采用了多组分提供安排（中位数 6；IQR 3-8），重点是 "协调护理和管理护理流程"，或结合 "改变提供医疗服务的方式、时间、地点和人员"。最常用的实施策略是教育会议（n = 25）和材料（n = 20）。对 11 项研究进行的荟萃分析表明，与标准护理相比，QI 干预能显著降低 "全因入院率"（比率比为 0.60；95% CI 为 0.41-0.87；I2 = 99.3%），但由于研究设计、QI 干预持续时间、提供安排类型和实施策略数量的不同，存在异质性。在急诊室就诊或可能避免的住院治疗方面未发现明显效果：本研究提供了初步证据，支持实施 QI 干预措施，以减少来自 NHs 的住院人次。然而，这些发现还需要通过未来的实验研究加以证实。

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引用次数: 0

Detecting Agitated Behaviors in Nursing Home Residents With Dementia Using Electronic Medical Records 利用电子病历检测患有痴呆症的养老院住户的躁动行为。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-27 DOI: 10.1016/j.jamda.2024.105289

Objectives

Agitated behaviors (behaviors) are common in nursing home (NH) residents with Alzheimer's disease and related dementias (ADRD). Pragmatic trials of behavior management interventions rely on routinely collected Minimum Data Set (MDS) data to evaluate study outcomes, despite known underreporting. We describe a method to augment MDS-based behavioral measures with structured and unstructured data from NH electronic medical records (EMR).

Design

Repeated cross-sectional analyses of EMR data from a single multistate NH corporation.

Setting and Participants

Long-stay residents (at least 90 days in NH) with ADRD from January 2020 through August 2022.

Methods

Quarterly and annual assessments of NH residents with ADRD during the study period were identified. For MDS, any behavior was defined as a score of 1 or higher on the Agitated and Reactive Behavior Scale. For structured EMR data, any behavior was defined as increased resident agitation, verbal aggression, or physical aggression on the Interventions to Reduce Acute Care Transfers, Change in Condition form (INTERACT). For unstructured EMR data, any behavior was defined using keyword searches of free-text orders.

Results

A total of 77,936 MDS assessments for 19,705 long-stay residents with ADRD in 322 NHs were identified; 14.8% (SD 35.6) of residents had behaviors per month using MDS alone, 16.2% (SD 36.9) using MDS and INTERACT, and 18.6% (SD 38.9) using MDS, INTERACT, and orders. Supplementing MDS with EMR data increased behavior identification by 3.8 percentage points (a 25.7% relative increase). Less than 0.5% had behaviors noted in all 3 sources consistently across study months.

Conclusions and Implications

Using EMR data increased detectable behaviors vs the MDS alone. The 3 sources captured different types of behaviors and using them together may be a more comprehensive identification strategy. These results are important for better targeting of interventions and allocation of resources to improve the quality of life for NH residents with ADRD-related behaviors.

目的：躁动行为（行为）在患有阿尔茨海默病和相关痴呆症（ADRD）的疗养院（NH）住户中很常见。行为管理干预的务实试验依赖于常规收集的最小数据集（MDS）数据来评估研究结果，尽管已知存在报告不足的情况。我们介绍了一种利用NH电子病历（EMR）中的结构化和非结构化数据来增强基于MDS的行为测量方法：设计：对一家多州 NH 公司的 EMR 数据进行重复横截面分析：从 2020 年 1 月到 2022 年 8 月，患有 ADRD 的长期住院患者（在 NH 至少住院 90 天）：对研究期间患有 ADRD 的 NH 居民进行季度和年度评估。在 MDS 中，任何行为都被定义为 "激动和反应行为量表 "中的 1 分或更高分。对于结构化的 EMR 数据，任何行为的定义是住院患者在 "减少急性护理转院、病情变化干预"（INTERACT）表格上的躁动、言语攻击或身体攻击行为增加。对于非结构化的 EMR 数据，任何行为都是通过自由文本订单的关键字搜索来定义的：共确定了 322 家 NHs 中 19,705 名患有 ADRD 的长期住院患者的 77,936 项 MDS 评估；仅使用 MDS，每月有行为的住院患者占 14.8%（SD 35.6）；使用 MDS 和 INTERACT，每月有行为的住院患者占 16.2%（SD 36.9）；使用 MDS、INTERACT 和医嘱，每月有行为的住院患者占 18.6%（SD 38.9）。使用 EMR 数据对 MDS 进行补充后，行为识别率提高了 3.8 个百分点（相对提高 25.7%）。只有不到 0.5%的患者在研究月中的所有 3 个数据源中都有行为记录：结论与启示：与仅使用 MDS 相比，使用 EMR 数据可增加可检测到的行为。这三种数据源捕获了不同类型的行为，将它们结合使用可能是一种更全面的识别策略。这些结果对于更有针对性地采取干预措施和分配资源以改善有 ADRD 相关行为的 NH 居民的生活质量非常重要。

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引用次数: 0

Intra-Individual Variability of Direct Oral Anticoagulant Levels in Frail Older Patients upon, during, and after Acute Hospitalization: the DOAC-FRAIL Study 虚弱老年患者在急性住院期间和之后的直接口服抗凝剂水平的个体内变异性：DOAC-FRAIL 研究。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-27 DOI: 10.1016/j.jamda.2024.105280

引用次数: 0

Development of a Predictive Hospitalization Model for Skilled Nursing Facility Patients. 为专业护理机构患者开发住院预测模型。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-27 DOI: 10.1016/j.jamda.2024.105288

Ben Kandel, Cheryl Field, Jasmeet Kaur, Dean Slawson, Joseph G Ouslander

Objectives: Identifying skilled nursing facility (SNF) patients at risk for hospitalization or death is of interest to SNFs, patients, and patients' families because of quality measures, financial penalties, and limited clinical staffing. We aimed to develop a predictive model that identifies SNF patients likely to be hospitalized or die within the next 7 days and validate the model's performance against clinician judgment.

Design: Retrospective multivariate prognostic model development study.

Setting and participants: Patients in US SNFs that use the PointClickCare electronic health record (EHR) system. We used data from the first 100 days of skilled stays for 5,642,474 patients in 8440 SNFs, from January 1, 2019, through March 31, 2023.

Methods: We used data collected in the course of clinical care to develop a machine learning model to predict the likelihood of patient hospitalization or death within the next 7 days. The data included vital signs, diagnoses, laboratory results, food intake, and clinical notes. We also asked SNF nurses and hospital case managers to make their own predictions as a comparison. The EHR was used as the source of information on whether the patient died or was hospitalized.

Results: The model had sensitivity of 35%, specificity of 92%, positive predictive value (PPV) of 18%, and area under the receiver operator curve (AUC) of 0.75. A variation of the model in which we did not include progress notes and food intake achieved an AUC of 0.70. Nurse raters achieved a sensitivity of 61%, specificity of 73%, and PPV of 10%.

Conclusions and implications: Machine learning models can accurately predict the likelihood of hospitalization or death within the next 7 days among SNF patients. These models do not require additional SNF staff time and may be useful in readmission reduction programs by targeting more frequent monitoring proactively to those at highest risk.

目的：由于质量标准、经济处罚和临床人员有限等原因，识别有住院或死亡风险的专业护理机构（SNF）患者是 SNF、患者和患者家属关心的问题。我们的目标是开发一种预测模型，用于识别可能在未来 7 天内住院或死亡的 SNF 患者，并根据临床医生的判断验证该模型的性能：设计：回顾性多变量预后模型开发研究：环境和参与者：使用 PointClickCare 电子健康记录 (EHR) 系统的美国 SNF 中的患者。我们使用了从 2019 年 1 月 1 日到 2023 年 3 月 31 日期间 8440 家 SNF 中 5642474 名患者熟练住院头 100 天的数据：我们利用在临床护理过程中收集的数据开发了一个机器学习模型，用于预测患者在未来 7 天内住院或死亡的可能性。这些数据包括生命体征、诊断、实验室结果、食物摄入量和临床笔记。作为对比，我们还请 SNF 护士和医院病案经理进行了预测。电子病历是患者死亡或住院的信息来源：该模型的灵敏度为 35%，特异度为 92%，阳性预测值 (PPV) 为 18%，接收者运算曲线下面积 (AUC) 为 0.75。在该模型的变体中，我们没有将进展记录和食物摄入量包括在内，其 AUC 为 0.70。护士评分员的灵敏度为 61%，特异性为 73%，PPV 为 10%：机器学习模型可以准确预测SNF患者未来7天内住院或死亡的可能性。这些模型不需要SNF员工花费额外的时间，而且可以针对风险最高的患者主动进行更频繁的监测，从而在减少再入院计划中发挥作用。

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引用次数: 0

Reduction of Rehospitalization with Addition of Geriatrics/Transitions of Care Consult Service 增加老年病学/护理过渡咨询服务，减少再住院率。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-26 DOI: 10.1016/j.jamda.2024.105287

Older adults are at high risk of rehospitalization after an acute event and at even higher risk of permanently losing an activity of daily living with each hospitalization. This is especially true in those with encephalopathy, delirium, dementia, falls, and failure to thrive. Although it is widely known that rehospitalization rates are higher in patients who discharge to skilled nursing and long-term care facilities, geriatrics consultations have not been shown to consistently decrease this risk. In this study, we added a novel component specific to transitions of care alongside a traditional geriatrics consultation for patients discharging to a skilled nursing or long-term care facility. Results show evidence of significant rehospitalization reduction for patients with markers of cognitive impairment and frailty.

老年人在急性病后再次住院的风险很高，而每次住院后永久丧失日常生活能力的风险甚至更高。尤其是那些患有脑病、谵妄、痴呆、跌倒和发育不良的患者。尽管众所周知，出院后转入专业护理机构和长期护理机构的患者再次住院率较高，但老年医学咨询并没有证明能持续降低这种风险。在这项研究中，我们在为出院到专业护理机构或长期护理机构的患者提供传统的老年医学咨询的同时，还增加了一项专门针对护理过渡的新内容。结果表明，有证据表明存在认知障碍和虚弱标记的患者再住院率明显降低。

引用次数: 0

Skilled Nursing Facility Rehabilitation Intensity and Successful Discharge in Persons with Dementia 熟练护理机构康复强度与痴呆症患者的成功出院。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-25 DOI: 10.1016/j.jamda.2024.105286

Objectives

Skilled therapies (STs), including audiology, speech-language therapy, occupational therapy, and physical therapy, can address functional deficits in dementia. This study aims to quantify the association between ST and successful discharge after heart failure (HF) hospitalization in persons living with dementia.

Design

Retrospective cohort study.

Setting and Participants

We included veterans with dementia (VwD) hospitalized for HF in Veterans Affairs (VA) medical centers and then admitted to non-VA skilled nursing facilities (SNFs) from January 2011 to June 2019.

Methods

Follow-up continued 120 days after SNF admission. We measured ST hours per week using MDS admission assessments. We defined successful discharge as SNF discharge occurring within 90 days of SNF admission with MDS discharge status not hospital or institutional setting, and 30 days’ survival after discharge without Medicare or VA-paid rehospitalization or reinstitutionalization. We estimated relative risk using multiple variable regression to adjust for measured sources of confounding.

Results

Our final sample included 8255 VwD. The mean (SD) age was 80 (10) years, and 8074 (98%) were male. Successful discharge occurred in 2776 (34%) of the sample. The median (IQR) weekly hours of ST was 10.4 (7.1–12.1). Sextile 1 received less than 5.2 hours per week of ST. The adjusted relative risk (95% CI) for sextiles 2–6 compared with sextile 1 were, respectively, 2.20 (1.85–2.62), 2.48 (2.09–2.94), 2.52 (2.12–2.99), 2.62 (2.21–3.11), and 2.69 (2.27–3.19).

Discussion

During SNF care after HF hospitalization, 5.3 or more hours of STs per week was associated with a higher rate of successful discharge, in a roughly dose-dependent fashion, up to a 170% increase in the highest sextile of ST hours.

Conclusions and Implications

Higher ST hours are associated with successful discharge from SNF after HF hospitalization.

目的：包括听力治疗、言语治疗、职业治疗和物理治疗在内的技能治疗（ST）可以解决痴呆症患者的功能障碍问题。本研究旨在量化痴呆症患者在心力衰竭（HF）住院后接受技能治疗与成功出院之间的关系：设计：回顾性队列研究：我们纳入了 2011 年 1 月至 2019 年 6 月期间在退伍军人事务（VA）医疗中心因心力衰竭住院、随后入住非退伍军人事务专业护理机构（SNF）的痴呆退伍军人（VwD）：入院 120 天后继续随访。我们使用 MDS 入院评估来测量每周 ST 小时数。我们将成功出院定义为：SNF 入院后 90 天内出院，且 MDS 出院状态不是医院或机构环境，出院后存活 30 天，没有发生医疗保险或退伍军人事务部支付的再次住院或重新入院。我们使用多变量回归法估算了相对风险，以调整测量的混杂因素：我们的最终样本包括 8255 名退伍军人。平均（标清）年龄为 80（10）岁，8074（98%）人为男性。2776人（34%）成功出院。每周 ST 小时数的中位数（IQR）为 10.4（7.1-12.1）。六分位数 1 每周接受 ST 的时间少于 5.2 小时。与六分位数 1 相比，六分位数 2-6 的调整后相对风险（95% CI）分别为 2.20（1.85-2.62）、2.48（2.09-2.94）、2.52（2.12-2.99）、2.62（2.21-3.11）和 2.69（2.27-3.19）：讨论：在高血压住院后的SNF护理期间，每周5.3小时或更长时间的ST与更高的成功出院率相关，大致呈剂量依赖性，ST时数最高的六分位数可增加170%：较高的 ST 小时数与高血压住院后成功从 SNF 出院有关。

{"title":"Skilled Nursing Facility Rehabilitation Intensity and Successful Discharge in Persons with Dementia","authors":"","doi":"10.1016/j.jamda.2024.105286","DOIUrl":"10.1016/j.jamda.2024.105286","url":null,"abstract":"<div><h3>Objectives</h3><div>Skilled therapies (STs), including audiology, speech-language therapy, occupational therapy, and physical therapy, can address functional deficits in dementia. This study aims to quantify the association between ST and successful discharge after heart failure (HF) hospitalization in persons living with dementia.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>We included veterans with dementia (VwD) hospitalized for HF in Veterans Affairs (VA) medical centers and then admitted to non-VA skilled nursing facilities (SNFs) from January 2011 to June 2019.</div></div><div><h3>Methods</h3><div>Follow-up continued 120 days after SNF admission. We measured ST hours per week using MDS admission assessments. We defined successful discharge as SNF discharge occurring within 90 days of SNF admission with MDS discharge status not hospital or institutional setting, and 30 days’ survival after discharge without Medicare or VA-paid rehospitalization or reinstitutionalization. We estimated relative risk using multiple variable regression to adjust for measured sources of confounding.</div></div><div><h3>Results</h3><div>Our final sample included 8255 VwD. The mean (SD) age was 80 (10) years, and 8074 (98%) were male. Successful discharge occurred in 2776 (34%) of the sample. The median (IQR) weekly hours of ST was 10.4 (7.1–12.1). Sextile 1 received less than 5.2 hours per week of ST. The adjusted relative risk (95% CI) for sextiles 2–6 compared with sextile 1 were, respectively, 2.20 (1.85–2.62), 2.48 (2.09–2.94), 2.52 (2.12–2.99), 2.62 (2.21–3.11), and 2.69 (2.27–3.19).</div></div><div><h3>Discussion</h3><div>During SNF care after HF hospitalization, 5.3 or more hours of STs per week was associated with a higher rate of successful discharge, in a roughly dose-dependent fashion, up to a 170% increase in the highest sextile of ST hours.</div></div><div><h3>Conclusions and Implications</h3><div>Higher ST hours are associated with successful discharge from SNF after HF hospitalization.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349056","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

Incidence, Prevalence, and Risk for Urinary Incontinence for People with Dementia in the Community in Aotearoa New Zealand: An interRAI Study 新西兰奥特亚罗瓦社区痴呆症患者尿失禁的发生率、患病率和风险：一项 interRAI 研究。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-23 DOI: 10.1016/j.jamda.2024.105285

Objectives

To identify 1-year period prevalence, 5-year incidence rate, and risks for urinary incontinence (UI) for people living with dementia.

Design

Retrospective cohort study.

Setting and Participants

Participants completed an International Residential Assessment Instrument Home Care (interRAI-HC) assessment in a 5-year period between August 1, 2016 and July 31, 2021 in Aotearoa New Zealand (N = 109,964).

Methods

For prevalence analysis, a dementia cohort was selected for a 1-year period from August 1, 2020 to July 31, 2021 (n = 7775). For incidence analysis, participants in the dementia cohort were followed from the first dementia diagnosis during the 5-year period. Dementia was identified by combining diagnoses of “Alzheimer's disease” and “Dementia other than Alzheimer's disease.” Participants were coded with UI if they were infrequently, occasionally, or frequently incontinent or if continence was managed with catheter/ostomy. Univariate and multivariate logistic regression analyses identified risk factors predicting UI onset. Cox regression analysis compared survival curves (months without UI) of the dementia and non-dementia cohorts, adjusting for variables significantly associated with incident UI in either cohort.

Results

The 1-year period (August 1, 2020 to July 31, 2021) prevalence of UI was 50.1% among people with dementia. The 5-year incident UI rate was 30.2 per 100 person-years for the dementia cohort and 24.5 per 100 person-years for the non-dementia cohort. Parkinson's disease posed the greatest risk of UI in both cohorts [dementia cohort odds ratio (OR), 3.0; 95% CI, 2.1–4.2; non-dementia cohort OR, 1.7; 95% CI, 1.4–2.0]. Controlling for risk factors, the hazard ratio for UI was 1.4 for people with dementia.

Conclusions and Implications

UI affects a significant proportion of people with dementia in Aotearoa New Zealand. Health professionals should directly ask about UI and consider living arrangements and comorbidities for people with dementia. Data-driven insights from interRAI-HC can guide resource allocation and service planning.

目的确定痴呆症患者的 1 年患病率、5 年发病率和尿失禁（UI）风险：设计：回顾性队列研究：参与者在 2016 年 8 月 1 日至 2021 年 7 月 31 日的 5 年间在新西兰奥特亚罗瓦完成了国际居住评估工具家庭护理（interRAI-HC）评估（N = 109,964）：为了进行患病率分析，我们选取了 2020 年 8 月 1 日至 2021 年 7 月 31 日这 1 年期间的痴呆症队列（n = 7775）。在发病率分析中，对痴呆症队列中的参与者从首次诊断痴呆症开始进行为期 5 年的随访。痴呆症通过合并 "阿尔茨海默病 "和 "阿尔茨海默病以外的痴呆症 "诊断来确定。如果参与者很少、偶尔或经常大小便失禁，或使用导尿管/造口术控制大小便失禁，则将其编码为 UI。单变量和多变量逻辑回归分析确定了预测尿失禁发病的风险因素。Cox 回归分析比较了痴呆组和非痴呆组的生存曲线（无尿失禁的月数），并调整了任何一组中与尿失禁事件显著相关的变量：痴呆症患者在 1 年内（2020 年 8 月 1 日至 2021 年 7 月 31 日）的尿失禁发生率为 50.1%。痴呆症队列的 5 年尿失禁发生率为每 100 人年 30.2 例，非痴呆症队列为每 100 人年 24.5 例。在两个队列中，帕金森病造成的尿失禁风险最大（痴呆队列奇数比 [OR]，3.0；95% CI，2.1-4.2；非痴呆队列 OR，1.7；95% CI，1.4-2.0）。在控制风险因素后，痴呆症患者的尿失禁危险比为1.4：在新西兰奥特亚罗瓦，有相当一部分痴呆症患者受到尿崩症的影响。医疗专业人员应直接询问尿失禁情况，并考虑痴呆症患者的生活安排和合并症。从interRAI-HC中获得的数据驱动的见解可以指导资源分配和服务规划。

{"title":"Incidence, Prevalence, and Risk for Urinary Incontinence for People with Dementia in the Community in Aotearoa New Zealand: An interRAI Study","authors":"","doi":"10.1016/j.jamda.2024.105285","DOIUrl":"10.1016/j.jamda.2024.105285","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify 1-year period prevalence, 5-year incidence rate, and risks for urinary incontinence (UI) for people living with dementia.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Participants completed an International Residential Assessment Instrument Home Care (interRAI-HC) assessment in a 5-year period between August 1, 2016 and July 31, 2021 in Aotearoa New Zealand (N = 109,964).</div></div><div><h3>Methods</h3><div>For prevalence analysis, a dementia cohort was selected for a 1-year period from August 1, 2020 to July 31, 2021 (n = 7775). For incidence analysis, participants in the dementia cohort were followed from the first dementia diagnosis during the 5-year period. Dementia was identified by combining diagnoses of “Alzheimer's disease” and “Dementia other than Alzheimer's disease.” Participants were coded with UI if they were infrequently, occasionally, or frequently incontinent or if continence was managed with catheter/ostomy. Univariate and multivariate logistic regression analyses identified risk factors predicting UI onset. Cox regression analysis compared survival curves (months without UI) of the dementia and non-dementia cohorts, adjusting for variables significantly associated with incident UI in either cohort.</div></div><div><h3>Results</h3><div>The 1-year period (August 1, 2020 to July 31, 2021) prevalence of UI was 50.1% among people with dementia. The 5-year incident UI rate was 30.2 per 100 person-years for the dementia cohort and 24.5 per 100 person-years for the non-dementia cohort. Parkinson's disease posed the greatest risk of UI in both cohorts [dementia cohort odds ratio (OR), 3.0; 95% CI, 2.1–4.2; non-dementia cohort OR, 1.7; 95% CI, 1.4–2.0]. Controlling for risk factors, the hazard ratio for UI was 1.4 for people with dementia.</div></div><div><h3>Conclusions and Implications</h3><div>UI affects a significant proportion of people with dementia in Aotearoa New Zealand. Health professionals should directly ask about UI and consider living arrangements and comorbidities for people with dementia. Data-driven insights from interRAI-HC can guide resource allocation and service planning.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349052","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

The Diagnostic Accuracy and Cutoff Value of Phase Angle for Screening Sarcopenia: A Systematic Review and Meta-Analysis 相位角筛查 "肌肉疏松症 "的诊断准确性和临界值：系统回顾与元分析》。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-23 DOI: 10.1016/j.jamda.2024.105283

Objectives

Phase angle (PhA) declines with age and is a reliable marker for muscle function, making it a potential screening indicator for sarcopenia. However, studies examined the reliability and validity of PhA for detecting sarcopenia, yielding inconsistent results. This meta-analysis aimed to evaluate the accuracy and cutoff value of PhA for screening sarcopenia and examine the potential confounding factors.

Design

This is a meta-analysis.

Setting and Participants

PubMed, Embase, and Cochrane Library were searched up to September 18, 2023. Eighteen studies (6184 participants) were included reporting the diagnostic accuracy of PhA for screening sarcopenia.

Methods

Pooled accuracy [ie, the computed area under the curve value (AUC)] and cutoff value interval for screening sarcopenia were estimated using a random-effects model. Meta-regression analyses were conducted to identify sources of heterogeneity.

Results

The AUC value was 0.81. Pooled sensitivity and specificity were 80% and 70%. The calculated 95% CI of the cutoff value of PhA for screening sarcopenia falls between 4.54° and 5.25°. The results of meta-regression analyses showed that ethnicity, body mass index (BMI), health status, and diagnostic criteria were the main factors affecting the diagnostic accuracy for screening sarcopenia (with all P values < 0.01).

Conclusion and Implications

PhA may serve as a robust screening tool for sarcopenia, and the recommended cutoff interval falls between 4.54° and 5.25°. Ethnicity, BMI, health status, and diagnostic criteria can affect PhA's efficacy in sarcopenia screening.

目的：相位角（Phase angle，PhA）会随着年龄的增长而减小，是肌肉功能的可靠标记，因此是肌肉疏松症的潜在筛查指标。然而，对相位角检测肌少症的可靠性和有效性的研究结果并不一致。这项荟萃分析旨在评估 PhA 筛查肌少症的准确性和临界值，并研究潜在的混杂因素：设计：这是一项荟萃分析：截至2023年9月18日，共检索了PubMed、Embase和Cochrane图书馆，纳入了18项研究（6184名参与者），报告了PhA筛查肌少症的诊断准确性：采用随机效应模型估算了筛选肌少症的汇总准确率（即计算的曲线下面积值 [AUC]）和临界值区间。进行元回归分析以确定异质性的来源：AUC值为0.81。汇总灵敏度和特异度分别为 80% 和 70%。计算得出的用于筛查肌少症的 PhA 临界值的 95% CI 介于 4.54° 和 5.25°之间。元回归分析结果显示，种族、体重指数（BMI）、健康状况和诊断标准是影响肌少症筛查诊断准确性的主要因素（P 值均小于 0.01）：PhA可作为一种强有力的肌少症筛查工具，推荐的临界值在4.54°和5.25°之间。种族、体重指数、健康状况和诊断标准会影响 PhA 在肌少症筛查中的效果。

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引用次数: 0

Digital Technology Use in US Community-Dwelling Seniors With and Without Homebound Status 美国社区居家和非居家老年人的数字技术使用情况。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-22 DOI: 10.1016/j.jamda.2024.105284

Objectives

To examine (1) the prevalence of digital technology use, including information and communication technology devices, everyday technology use, and digital health technology use among community-dwelling older adults with or without homebound status and (2) the associations of digital technology use with homebound status.

Design

Cross-sectional study.

Setting and Participants

We used the 2022 National Health and Aging Trends Study (NHATS) data that included 5510 community-dwelling older adults.

Methods

Digital technology use was assessed using self-reported outcomes of the technological environment component of the NHATS, including information and communication technology devices, everyday technology use, and digital health technology use. Homebound status was measured with 4 mobility-related questions regarding the frequency, independence, and difficulties of leaving home. Survey-weighted, binomial logistic regression was used to examine the associations of 17 technological-related outcomes and homebound status.

Results

Overall, the prevalence of homebound older adults was 5.2% (95% CI, 4.4%–6.1%), representing an estimated 2,516,403 people. The prevalence of digital technology use outcomes varied according to homebound status. The prevalence of any technology used in homebound, semi-homebound, and non-homebound populations was 88.5%, 93.3%, and 98.5%, respectively. Compared with non-homebound older adults, semi-homebound older adults had lower odds of emailing (OR, 0.71; 95% CI, 0.53–0.94), using the internet for any other reason (OR, 0.70; 95% CI, 0.49–0.99), visiting medical providers (OR, 0.68; 95% CI, 0.48–0.95), and handling insurance (OR, 0.75; 95% CI, 0.56–0.99); homebound older adults had lower odds of using a phone (OR, 0.41; 95% CI, 0.28–0.59), using any everyday technology (OR, 0.58; 95% CI, 0.38–0.89), visiting medical providers (OR, 0.52; 95% CI, 0.35–0.76), and handling insurance (OR, 0.57; 95% CI, 0.38–0.86).

Conclusions and Implications

Non-homebound older adults are more likely to use digital technology than those who are semi-homebound or homebound. Public health care providers should prioritize efforts to enhance digital inclusion to ensure that all older adults can benefit from the advantages of digital technology.

研究目的研究(1)有无居家状态的社区老年人使用数字技术的普遍程度，包括信息和通信技术设备、日常技术使用和数字健康技术使用；(2)数字技术使用与居家状态的关联：横断面研究：我们使用了 2022 年全国健康与老龄化趋势研究（NHATS）的数据，其中包括 5510 名居住在社区的老年人：方法：使用NHATS技术环境部分的自我报告结果来评估数字技术的使用情况，包括信息和通信技术设备、日常技术使用和数字健康技术使用情况。居家状态是通过 4 个与行动相关的问题来衡量的，这些问题涉及离家的频率、独立性和困难程度。采用调查加权二项逻辑回归法研究了 17 项技术相关结果与居家状态之间的关联：总体而言，居家老年人的比例为 5.2%（95% CI，4.4%-6.1%），估计有 2,516,403 人。数字技术使用率因居家状况而异。居家、半居家和非居家人群使用任何技术的比例分别为 88.5%、93.3% 和 98.5%。与不居家的老年人相比，半居家的老年人使用电子邮件（OR，0.71；95% CI，0.53-0.94）、因任何其他原因使用互联网（OR，0.70；95% CI，0.49-0.99）、访问医疗机构（OR，0.68；95% CI，0.48-0.95）和办理保险（OR，0.75；95% CI，0.56-0.99）；居家老年人使用电话（OR，0.41；95% CI，0.28-0.59）、使用任何日常技术（OR，0.58；95% CI，0.38-0.89）、看望医疗提供者（OR，0.52；95% CI，0.35-0.76）和办理保险（OR，0.57；95% CI，0.38-0.86）的几率较低：与半居家或居家的老年人相比，不居家的老年人更有可能使用数字技术。公共医疗服务提供者应优先考虑加强数字包容性，以确保所有老年人都能从数字技术的优势中受益。

{"title":"Digital Technology Use in US Community-Dwelling Seniors With and Without Homebound Status","authors":"","doi":"10.1016/j.jamda.2024.105284","DOIUrl":"10.1016/j.jamda.2024.105284","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine (1) the prevalence of digital technology use, including information and communication technology devices, everyday technology use, and digital health technology use among community-dwelling older adults with or without homebound status and (2) the associations of digital technology use with homebound status.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>We used the 2022 National Health and Aging Trends Study (NHATS) data that included 5510 community-dwelling older adults.</div></div><div><h3>Methods</h3><div>Digital technology use was assessed using self-reported outcomes of the technological environment component of the NHATS, including information and communication technology devices, everyday technology use, and digital health technology use. Homebound status was measured with 4 mobility-related questions regarding the frequency, independence, and difficulties of leaving home. Survey-weighted, binomial logistic regression was used to examine the associations of 17 technological-related outcomes and homebound status.</div></div><div><h3>Results</h3><div>Overall, the prevalence of homebound older adults was 5.2% (95% CI, 4.4%–6.1%), representing an estimated 2,516,403 people. The prevalence of digital technology use outcomes varied according to homebound status. The prevalence of any technology used in homebound, semi-homebound, and non-homebound populations was 88.5%, 93.3%, and 98.5%, respectively. Compared with non-homebound older adults, semi-homebound older adults had lower odds of emailing (OR, 0.71; 95% CI, 0.53–0.94), using the internet for any other reason (OR, 0.70; 95% CI, 0.49–0.99), visiting medical providers (OR, 0.68; 95% CI, 0.48–0.95), and handling insurance (OR, 0.75; 95% CI, 0.56–0.99); homebound older adults had lower odds of using a phone (OR, 0.41; 95% CI, 0.28–0.59), using any everyday technology (OR, 0.58; 95% CI, 0.38–0.89), visiting medical providers (OR, 0.52; 95% CI, 0.35–0.76), and handling insurance (OR, 0.57; 95% CI, 0.38–0.86).</div></div><div><h3>Conclusions and Implications</h3><div>Non-homebound older adults are more likely to use digital technology than those who are semi-homebound or homebound. Public health care providers should prioritize efforts to enhance digital inclusion to ensure that all older adults can benefit from the advantages of digital technology.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349037","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

Short-Term Immunogenicity of Licensed Subunit RSV Vaccines in Residents of Long-Term Care Facilities (LTCF) Compared to Community-Dwelling Older Adults 与居住在社区的老年人相比，长期护理机构 (LTCF) 居民接种特许亚单位 RSV 疫苗的短期免疫原性。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-21 DOI: 10.1016/j.jamda.2024.105281

Objectives

Phase 3 licensing trials for the recently approved respiratory syncytial virus (RSV) vaccines did not include many residents of long-term care facilities (LTCF). Our primary objective was to assess humoral immune responses in LTCF residents, aged 60 and older, to the RSV vaccines, and demonstrate noninferiority to antibody responses in community-dwelling (CD) adults who were representative of the phase 3 trial participants in whom the vaccines were highly efficacious.

Design

Prospective non-randomized intervention trial of RSV vaccines in LTCF residents.

Setting and Participants

Research clinic and 2 LTCFs. Adults aged ≥60 years old, free of immunosuppression and planning to receive an RSV vaccine were eligible.

Methods

LTCF and CD participants received either the GSK or Pfizer RSV vaccine in equal numbers. Blood was collected before and 30 days after vaccination. Total immunoglobulin (Ig)G to the prefusion F protein of RSV group A (F_A) and B (F_B), and neutralizing activity were measured, and geometric mean titer (GMT) and geometric mean fold rise (GMFR) calculated. Intercurrent respiratory illnesses were tracked.

Results

A total of 76 LTCF residents and 76 CD adults were enrolled. Day 30 blood was unavailable from 3 residents and 3 had RSV infection and vaccination was deferred, leaving data for 76 CD and 70 LTCF adults for analysis. Serum IgG GMFR prefusion F_A (9.9 vs 12.5, P = .14), prefusion F_B (8.7 vs 11.0, P = .17) were not statistically different in CD and LTCF cohorts, respectively, and also equivalent for GMFR in viral neutralization titers (12.8 vs. 15.5, P = .32). As measured by GMT or GMFR, RSV vaccine responses of LTCF residents met noninferiority criteria compared with the CD cohort.

Conclusions and Implications

This small immunobridging study demonstrates robust antibody responses to RSV vaccines in LTCF residents providing support for their use in this high-risk population.

目的：最近批准的呼吸道合胞病毒 (RSV) 疫苗的 3 期许可试验并未包括许多长期护理机构 (LTCF) 的居民。我们的主要目标是评估 60 岁及以上的长期护理机构居民对 RSV 疫苗的体液免疫反应，并证明其抗体反应不劣于社区居住（CD）成年人的抗体反应：设计：针对 LTCF 居民的 RSV 疫苗前瞻性非随机干预试验：研究诊所和 2 家 LTCF。年龄≥60 岁、无免疫抑制且计划接种 RSV 疫苗的成年人均符合条件：方法：LTCF 和 CD 参与者接受葛兰素史克或辉瑞 RSV 疫苗的人数相等。在接种前和接种后 30 天采集血液。测量 RSV A 组 (FA) 和 B 组 (FB) 预融合 F 蛋白的总免疫球蛋白 (Ig)G 和中和活性，并计算几何平均滴度 (GMT) 和几何平均折升 (GMFR)。对并发的呼吸道疾病进行了追踪：共有 76 名 LTCF 居民和 76 名 CD 成人参加了研究。有 3 名居民无法获得第 30 天的血液，3 名居民感染了 RSV，因此推迟了疫苗接种，因此只剩下 76 名 CD 成人和 70 名 LTCF 成人的数据可供分析。血清 IgG GMFR 预灌注 FA（9.9 vs 12.5，P = .14）和预灌注 FB（8.7 vs 11.0，P = .17）在 CD 和 LTCF 组群中分别没有统计学差异，病毒中和滴度 GMFR 也相同（12.8 vs 15.5，P = .32）。通过 GMT 或 GMFR 测定，与 CD 群体相比，LTCF 居民的 RSV 疫苗应答符合非劣效性标准：这项小型免疫桥接研究显示了 LTCF 居民对 RSV 疫苗的强大抗体反应，为在这一高风险人群中使用疫苗提供了支持。

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引用次数: 0