Journal of the American Medical Directors Association最新文献

{"title":"Accelerated Cognitive Decline in Pain-Insomnia-Depression Syndrome: Longitudinal Evidence and Protective Effects of Healthy Lifestyles","authors":"Yuanjun Zeng MS ,&nbsp;Zhenxue Song MS ,&nbsp;Ling Zhang MS ,&nbsp;Shengxia Fang MS ,&nbsp;Jianguo Xie MS ,&nbsp;Wenqi Zhao MS ,&nbsp;Dongfeng Zhang MD ,&nbsp;Suyun Li PhD","doi":"10.1016/j.jamda.2025.106069","DOIUrl":"10.1016/j.jamda.2025.106069","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the longitudinal association between Pain-Insomnia-Depression Syndrome (PIDS) and cognitive decline, assess the dose-response relationship associated with cumulative symptom load, and examine the potential protective role of healthy lifestyles.</div></div><div><h3>Design</h3><div>Population-based prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 7565 participants aged 50 years and older from the English Longitudinal Study of Ageing, with a follow-up period of up to 9 years.</div></div><div><h3>Methods</h3><div>PIDS burden was defined in 2 complementary ways: the presence of PIDS (all 3 conditions present) and cumulative symptom load (ranging from 0 to 3 conditions). Cognitive domains, including episodic memory, executive function, and temporal orientation, were assessed using standardized <em>z</em> scores. Lifestyle factors (smoking, alcohol intake, physical activity, diet) were combined into a composite score and categorized as healthy (3–4 factors) or unhealthy (0–2 factors). Linear mixed-effects models were used to estimate baseline differences and rates of cognitive change.</div></div><div><h3>Results</h3><div>Participants with PIDS exhibited significantly lower baseline global cognitive function (β, −0.171; 95% CI, −0.245 to −0.098) and experienced a more rapid cognitive decline (β, −0.050 SD/year; 95% CI, −0.069 to −0.031). For cumulative symptom load, a clear dose-response pattern was observed in global cognition: 1 symptom predicted a decline of β, −0.019 SD/year; 95% CI, −0.030 to −0.008, 2 symptoms predicted β, −0.031 SD/year; 95% CI, −0.044 to −0.018, and 3 symptoms β, −0.064 SD/year; 95% CI, −0.084 to −0.044. Notably, adherence to healthy lifestyles attenuated these negative effects, with PIDS participants maintaining healthy lifestyles exhibiting a slower rate of cognitive decline (β, 0.055 SD/year; 95% CI, 0.015 to 0.095).</div></div><div><h3>Conclusion and Implications</h3><div>PIDS and higher cumulative symptom load are associated with accelerated cognitive decline in middle-aged and older adults. Healthy lifestyle adherence mitigates these effects, underscoring integrated strategies combining symptom management with lifestyle interventions to reduce dementia risk.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106069"},"PeriodicalIF":3.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145912020","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":"Predictors and Perceptions of mHealth App Engagement in Older Adults: A Mixed-Methods Study on Nurse-Supported Interventions.","authors":"Jia Zheng, Wubin He","doi":"10.1016/j.jamda.2025.106101","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.106101","url":null,"abstract":"<p><strong>Objectives: </strong>To examine nurse-supported interventions on sustained mobile health (mHealth) engagement and identify predictors of long-term use in community-dwelling older adults.</p><p><strong>Design: </strong>Explanatory sequential mixed methods.</p><p><strong>Setting and participants: </strong>Twelve clinical sites in Liaoning, China (March 2023 to February 2024). Included 1532 participants (quantitative); 32 for qualitative interviews.</p><p><strong>Methods: </strong>Quantitative: XGBoost machine learning on longitudinal behavioral data. Qualitative: Thematic analysis of in-depth interviews. Integration via joint display.</p><p><strong>Results: </strong>Morning (8-10 am) notification responsiveness was the strongest retention predictor (mean SHapley Additive exPlanations = 0.34). \"Digital companionship\" emerged qualitatively (58% anthropomorphized features; χ2 = 9.32, P = .002). Nurse mediation increased data-sharing willingness by 16% vs commercial platforms (P < .001); 89% of high-adherence users valued clinical integration (P < .001).</p><p><strong>Conclusions and implications: </strong>Nurse support enhances engagement via optimized timing, trust, and integration. Implement nurse-led coaching, electronic health record integration, and supportive reimbursement. Future studies should assess long-term outcomes and cross-cultural applicability.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"106101"},"PeriodicalIF":3.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106024","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 Advance Care Planning for Individuals With Young-Onset Dementia: A Systematic Review","authors":"Chun Yang BA,&nbsp;Yijin Wu PhD","doi":"10.1016/j.jamda.2025.106081","DOIUrl":"10.1016/j.jamda.2025.106081","url":null,"abstract":"<div><h3>Objectives</h3><div>Advance care planning (ACP) is a critical component of dementia care. Given the relatively rapid progression of young-onset dementia (YOD), which impairs cognitive abilities and decision-making capacity, it is especially vital to initiate ACP discussions early in the disease course for individuals with YOD. The aim of this review was to synthesize the existing literature on ACP for individuals with YOD.</div></div><div><h3>Research Design</h3><div>A systematic review was conducted.</div></div><div><h3>Setting and Participants</h3><div>Individuals with YOD were involved in this review.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in Web of Science MEDLINE, and PubMed in May 2025, yielding a total of 5080 articles. After removing 2803 duplicates, titles and abstracts were screened, followed by a full-text review of the articles that met the inclusion and exclusion criteria. Only peer-reviewed studies published in English before May 25, 2025, that focused on ACP for individuals with YOD were included in the review.</div></div><div><h3>Results</h3><div>Through database and manual searches, 8 eligible studies were identified. The thematic analysis revealed 3 main themes: (1) factors influencing ACP engagement among individuals with YOD; (2) characteristics of ACP among individuals with YOD; and (3) preferences for and needs of ACP in YOD.</div></div><div><h3>Conclusions and Implications</h3><div>These findings contribute to a deeper understanding of the current application of ACP and offer insights into strategies for its enhancement. The review underscores the need for targeted strategies to improve ACP engagement in individuals with YOD and provides implications for clinical practice and future research.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106081"},"PeriodicalIF":3.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989811","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":"How Housing Influences Nursing Home Utilization in the United States: An Integrative Review","authors":"Marissa Bergh BSN, RN ,&nbsp;Abraham A. Brody PhD, RN ,&nbsp;Tina R. Sadarangani PhD, RN ,&nbsp;Safiyyah Okoye PhD, MSN, RN ,&nbsp;Jasmine Travers Altizer PhD, RN","doi":"10.1016/j.jamda.2025.106077","DOIUrl":"10.1016/j.jamda.2025.106077","url":null,"abstract":"<div><h3>Objectives</h3><div>Given the growing housing crisis, researchers increasingly point to housing as a possible risk factor for nursing home utilization, yet the exact pathways from housing to nursing home utilization are unclear. The purpose of this review is to describe how housing acts as a mechanism that influences nursing home utilization in the United States.</div></div><div><h3>Design</h3><div>Integrative review.</div></div><div><h3>Setting and Participants</h3><div>Studies involving individuals at risk for long-term nursing home placement or residents at risk for continued nursing home use in the United States.</div></div><div><h3>Methods</h3><div>Five databases were searched in April 2024. Articles were included if they (1) operationalized housing pathways as factors in nursing home utilization, (2) focused on long-term nursing home utilization, (3) used data after 1999, and (4) were based in the United States. The quality of articles was assessed and constant-comparative approach guided data synthesis.</div></div><div><h3>Results</h3><div>Sixteen articles met inclusion criteria. Three themes were identified describing housing's influence on nursing home utilization: (1) <em>Housing as Financial Asset vs Strain</em> represents how housing operates as either a protective financial asset or a financial strain that can act as a risk factor for nursing home use; (2) <em>(Mis)match Between Needs and Housing</em> represents how evolving functional needs create misalignments with housing environments, potentially leading to nursing home use; (3) <em>Compounding Systemic Inequities</em> represents how socioeconomic disparities related to housing contribute to risk of nursing home utilization among marginalized communities.</div></div><div><h3>Conclusions and Implications</h3><div>This review provides evidence of the relationship between housing and nursing home utilization; however, because of a weak quality of evidence and limited methodologic diversity, more research is needed to strengthen the evidence base. Clinicians, researchers, and policy makers should still recognize the significance of the role housing plays in nursing home utilization and target policies and interventions toward improving housing conditions for older adults and people with disabilities.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106077"},"PeriodicalIF":3.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994164","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":"Should We Make Influenza and SARS-CoV-2 Vaccinations Mandatory in Medicalized Nursing Homes? An Opinion Survey of French Health Care Professionals","authors":"Nathalie Weil MD,&nbsp;Gaëtan Gavazzi MD, PhD,&nbsp;Thibaut Fraisse MD,&nbsp;Elisabeth Botelho Nevers MD, PhD,&nbsp;Claire Roubaut-Baudron MD, PhD,&nbsp;Odile Reynaud-Levy MD, PhD,&nbsp;Alain Putot MD, PhD,&nbsp;Emmanuel Forestier MD,&nbsp;Jean-Philippe Lanoix MD, PhD","doi":"10.1016/j.jamda.2025.106080","DOIUrl":"10.1016/j.jamda.2025.106080","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106080"},"PeriodicalIF":3.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989788","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":"Psychotherapy and Problematic Behavior Reduction in Long-Stay Nursing Home Residents With Alzheimer's Disease and Related Dementias.","authors":"Tianwen Huan, Orna Intrator, Adam Simning, Kenneth Boockvar, David C Grabowski, Shubing Cai","doi":"10.1016/j.jamda.2025.106106","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.106106","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the association between receipt of psychotherapy and behavior reduction among long-stay nursing home residents with Alzheimer's disease and related dementias (ADRD).</p><p><strong>Design: </strong>Retrospective cohort study using Minimum Data Set assessments linked to Medicare: Master Beneficiary Summary File, Part B Carrier, and Part D Event file (2017-2018).</p><p><strong>Setting and participants: </strong>All US Medicare- or Medicaid-certified nursing homes. Traditional Medicare beneficiaries enrolled in Medicare Parts B and D, aged ≥65 with ADRD and any problematic behaviors (physical, verbal, or other), stratified to residents with both ADRD and co-occurring psychiatric disorders, and ADRD only.</p><p><strong>Methods: </strong>The unit of analysis was 2 consecutive quarters with indication of a problematic behavior in the first. Outcomes were reductions in any, physical, verbal, or other behaviors. The treatment was receipt of psychotherapy in both quarters vs neither. Covariates included predisposing, enabling, and need factors. Propensity score weighting balanced resident characteristics, and generalized estimating equation logistic models were applied.</p><p><strong>Results: </strong>The cohort included 175,165 resident-quarter observations from 99,584 unique long-stay residents with ADRD and problematic behaviors. Psychotherapy was received in 9% of observations, most often in short (73%), quarterly (59%), or monthly (35%) sessions delivered by psychologists (56%) or social workers (34%). After weighting, psychotherapy was associated with greater likelihood of behavior reduction (ADRD + psychiatric disorders: 17%, P < .01; ADRD only: 33%, P < .05). In ADRD-only residents, psychotherapy was associated with 36% reduction in physical behaviors and 28% in verbal behaviors. In those with ADRD + psychiatric disorders, reductions were seen in physical (31%) and other behaviors (18%).</p><p><strong>Conclusions and implications: </strong>Fewer than 10% of nursing home residents with ADRD and problematic behaviors received psychotherapy, yet its receipt was significantly associated with behavior reduction. Findings underscore the need to expand access to psychotherapy in nursing homes and to further investigate the psychotherapy characteristics that contribute to effectiveness.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"106106"},"PeriodicalIF":3.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105969","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":"Hearing Loss and Aggressive Behavior: Results From a Large, Retrospective Study of Older Adults Receiving Home Care Services in 2 US States","authors":"Heidi S. Kinsell PhD ,&nbsp;Kali S. Thomas PhD ,&nbsp;Jasminka Z. Ilich PhD, RDN ,&nbsp;Andrew Reilly BS ,&nbsp;Jeffrey S. Harman PhD ,&nbsp;Melanie Thomasson PhD, MPH","doi":"10.1016/j.jamda.2025.106076","DOIUrl":"10.1016/j.jamda.2025.106076","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the relationship between hearing difficulty and aggressive behavior among adults aged ≥65 years receiving Medicaid home care services in 2 US states.</div></div><div><h3>Design</h3><div>A cross-sectional analysis was conducted using secondary data collected from the interRAI Home Care and Community Health Assessment.</div></div><div><h3>Setting and Participants</h3><div>Participants included 134,382 adults aged ≥65 years who received home care services in New York and Michigan in 2017 and had an initial interRAI assessment and independent living status.</div></div><div><h3>Methods</h3><div>The association of hearing loss with the odds of exhibiting aggressive behavior was estimated using ordered logistic regression controlling for age, sex, and presence of Alzheimer's disease or dementia. Hearing difficulty had 4 levels, and aggressive behaviors was a 3-level variable.</div></div><div><h3>Results</h3><div>Individuals with hearing difficulties had higher odds of showing signs of aggressive behaviors than those with no difficulty in hearing. The odds of aggressive behaviors increased as hearing worsened. After adjustment, compared with individuals without hearing loss, older adults with severe or total hearing loss had twice the odds of displaying signs of aggressive behavior (odds ratio, 2.02; 95% CI, 1.81-2.26). Additionally, individuals with moderate hearing loss had almost 1.5 times the odds of showing aggressive behaviors (OR, 1.44; 95% CI, 1.34-1.55)</div></div><div><h3>Conclusions and Implications</h3><div>This research suggests that hearing loss is an important factor to assess and address among older adults. Results of this study illustrate that age-related sensory declines can impact other health-related behavioral conditions. In home care settings, sensory and behavioral changes should be monitored and assessed at regular intervals as part of multidisciplinary care planning. Performing routine hearing tests may result in earlier intervention and better management of care for home care populations, reducing caregiver burden particularly in individuals with multiple comorbidities. Early interventions may include incorporating routine hearing screenings, behavioral monitoring linked to sensory decline, and greater use of assistive devices or other enhanced communication strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106076"},"PeriodicalIF":3.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966435","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":"Comment on “Multicomponent Interventions for Functional Outcomes in Hospitalized Older Patients: A Systematic Review and Meta-Analysis”","authors":"Patricia Álvarez-Rodríguez,&nbsp;Nicolás Martínez-Velilla PhD","doi":"10.1016/j.jamda.2025.106091","DOIUrl":"10.1016/j.jamda.2025.106091","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106091"},"PeriodicalIF":3.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994105","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":"Osteosarcopenia Is Associated With Mild Cognitive Impairment in Chinese Community-Dwelling Older Adults","authors":"Peipei Han PhD ,&nbsp;Pingping Cai MSc ,&nbsp;Yuechao Sun MSc ,&nbsp;Xiaoyu Chen PhD ,&nbsp;Cheng Lin MSc ,&nbsp;Cheng Chen MSc ,&nbsp;Gaowa Siqin MSc ,&nbsp;Qi Guo MD, PhD","doi":"10.1016/j.jamda.2025.106062","DOIUrl":"10.1016/j.jamda.2025.106062","url":null,"abstract":"<div><h3>Objectives</h3><div>The study aimed to explore the association between the combination of osteoporosis and sarcopenia and the prevalence of mild cognitive impairment (MCI) in Chinese community-dwelling older adults.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Older adults aged ≥65 years in the Shanghai community participated in this physical examination.</div></div><div><h3>Methods</h3><div>The dual-energy X-ray image of the forearm bone of each participant whose T score is equal to or less than −2.5 is defined as osteoporosis. Sarcopenia was diagnosed according to the 2019 Asia Working Group for Sarcopenia (AWGS) standard. The Mini Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scales were used to diagnose patients with MCI.</div></div><div><h3>Results</h3><div>This study was conducted on 1058 (47.0% male) Chinese community-dwelling participants with a mean age of 71.79 ± 5.31 years. Participants were classified into mutually exclusive groups based on sarcopenia and osteoporosis: normal, osteoporosis alone, sarcopenia alone, and co-occurring groups. We found that the MCI prevalence of the 4 groups was 9.0% (n = 47), 11.1% (n = 44), 22.7% (n = 10), and 28.3% (n = 26) in the normal, osteoporosis alone, sarcopenia alone, and co-occurring groups, respectively. The prevalence of MCI was significantly greater in the co-occurring group [odds ratio (OR), 4.00; 95% confidence interval (CI), 2.32–6.89] than in the sarcopenia alone group (OR, 2.99; 95% CI, 1.39–6.42). After adjusting for potential confounding factors, the co-occurring group remained the only statistically significant group (OR, 2.29; 95% CI, 1.17–4.48).</div></div><div><h3>Conclusions and Implications</h3><div>In our study, although sarcopenia and osteoporosis did not independently affect the prevalence of MCI, the co-occurrence of osteoporosis and sarcopenia can synergistically increase the prevalence of MCI in Chinese community-dwelling older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106062"},"PeriodicalIF":3.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933863","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":"Falls in the Nursing Home: The Impact of Staffing Levels and Agency Staff Use on Injurious Falls","authors":"Jenna S. Khoja MSc ,&nbsp;Kylee G. MacLean BS ,&nbsp;Yoojin Lee MS, MPH ,&nbsp;Richa Joshi MS ,&nbsp;Lori A. Daiello Pharm D, ScM ,&nbsp;Sarah D. Berry MD, MPH","doi":"10.1016/j.jamda.2025.106083","DOIUrl":"10.1016/j.jamda.2025.106083","url":null,"abstract":"<div><h3>Objectives</h3><div>A recent investigation between staffing patterns in nursing homes (NH) and quality outcomes has not occurred. Our objective was to examine whether staffing levels and utilization of agency staff are associated with injurious falls in NHs.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>A total of 11,183 NHs with 1,115,304 long-stay residents enrolled in Medicare fee-for-service were included (July 1, 2019–December 31, 2019).</div></div><div><h3>Methods</h3><div>Staffing data and agency utilization by discipline (eg, Certified Nursing Assistants, CNAs) were obtained from Payroll Based Journal reports. Staff minutes were averaged per discipline, and agency staff percentage was calculated weekly as contract hours divided by total hours worked, per discipline. Injurious falls among long-stay residents during the 24-week study period were ascertained through Medicare Provider Analysis and Review claims. Poisson regression models were used to estimate rate of injurious falls with staff levels and agency staffing, respectively, adjusting for NH and patient-level characteristics. Models were stratified according to whether the NH had low certified nursing assistant (CNA) coverage (&lt;2.45 hours per resident per day) vs recommended coverage (≥2.45 h/resident/d) according to the 2024 Centers for Medicare &amp; Medicaid Service Minimum Staffing Standards for Long-Term Care Facilities.</div></div><div><h3>Results</h3><div>Of the 11,183 NHs analyzed, 3320 (29.7%) met the proposed CNA coverage, whereas 7863 (70.3%) did not. Among NHs that achieved the recommended CNA coverage, increased CNA [incidence rate ratio (IRR), 0.84; 95% CI, 0.74–0.96] and registered nurse (IRR, 0.61; 95% CI, 0.52–0.72) staffing hours were associated with a decrease in injurious falls. In NHs that did not achieve the recommended CNA coverage, increased CNA staffing was associated with an increase in injurious falls (IRR, 1.20; 95% CI, 1.09–1.31). No association was found between agency staff use and injurious falls, except for low registered nurse agency use, defined as &gt;0% but ≤10% of agency staff use, which was modestly associated with more falls in NHs that achieved the suggested CNA coverage (IRR, 1.15; 95% CI, 1.03–1.29).</div></div><div><h3>Conclusions and Implications</h3><div>Although increased CNA staff levels were associated with fewer injurious falls in NHs that were well staffed, increased CNA levels were associated with an increase in injurious fall rates in low-staffed facilities. Utilization of agency staff had little impact on injurious falls. Efforts to improve quality outcomes in NHs through increasing staff hours may have a variable effect depending on an NH's baseline resource availability.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106083"},"PeriodicalIF":3.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989722","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}