Journal of the American Medical Directors Association最新文献

{"title":"Evaluating Emergency Department Transfers for Falls in Skilled Nursing Facilities: A Single-Site Observational Study of Witnessed and Unwitnessed Falls","authors":"Katherine D. Mayes MD, PhD ,&nbsp;Nicole E.-P. Stark PhD ,&nbsp;Brianna Reilly BS ,&nbsp;Ethan Henley BS ,&nbsp;Steve Rowson PhD ,&nbsp;Damon R. Kuehl MD","doi":"10.1016/j.jamda.2025.106072","DOIUrl":"10.1016/j.jamda.2025.106072","url":null,"abstract":"<div><h3>Objectives</h3><div>Falls are a leading cause of morbidity and mortality among older adults, with residents of skilled nursing facilities (SNFs) at a particularly high risk. Although emergency department (ED) transfers after falls are common, they carry risks of delirium, infection, and care fragmentation. The objective of this study is to compare ED transfer rates between witnessed and unwitnessed falls in SNFs.</div></div><div><h3>Design</h3><div>Single-site, observational study.</div></div><div><h3>Setting and Participants</h3><div>A 120-bed SNF in the greater Roanoke area, serving both long-term and short-term rehabilitation residents. Data were collected prospectively on 212 fall events between November 2023 and April 2025.</div></div><div><h3>Methods</h3><div>Falls were reported through a structured workflow integrating QR (Quick Response) code–based logging and REDCap documentation. Reports included witnessed status, fall location, injury documentation, and whether emergency medical services (EMS) were activated. Incidence rates were calculated as the number of falls per bed-days. Descriptive statistics and Fisher exact tests were used to compare fall characteristics (witnessed status, injury presence, and fall location). The primary outcome was transfer to the ED.</div></div><div><h3>Results</h3><div>Of 212 fall events (4.1 falls per 1000 bed-days), 81.1% were unwitnessed and 83.0% occurred in resident rooms. Witnessed falls were more common in common areas (50.0%) compared with in-room falls (12.5%) (OR 6.91; <em>P</em> &lt; .001). EMS was activated in 9.9% of all cases. Witnessed falls were more than twice as likely to prompt EMS compared with unwitnessed falls (17.5% vs 8.1%; OR 2.21; <em>P</em> = .145). Injuries were reported in 17.0% of falls, and EMS was called in 53.8% of these. Head trauma was the strongest driver of transfer, present in all transported injuries (OR 490.5; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion and Implications</h3><div>Unwitnessed falls represented the majority of events and were associated with lower rates of ED transfer. This highlights the need for more objective data to reduce uncertainty about fall mechanisms and potential injuries, particularly when head strike is not directly observed. Head injuries were the strongest predictor of transport. These findings underscore the diagnostic challenges surrounding unwitnessed falls and emphasize the importance of standardized postfall protocols, decision-support tools, and passive fall detection technologies to guide ED transfer decisions in SNFs.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106072"},"PeriodicalIF":3.8,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911987","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":"Differential Associations of Total and Added Sugar Intake With Frailty in Older Adults: Analysis From a National Survey","authors":"Woo-young Shin PhD, MD","doi":"10.1016/j.jamda.2025.106086","DOIUrl":"10.1016/j.jamda.2025.106086","url":null,"abstract":"<div><h3>Objectives</h3><div>To elucidate the differential associations between total and added sugar consumption and frailty risk in older Korean adults.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Data from 2806 adults aged ≥60 years were obtained from the Korea National Health and Nutrition Examination Survey (2016–2019).</div></div><div><h3>Methods</h3><div>Dietary sugar intake was assessed using 24-hour recall data. Total (natural plus added) and added (processing/cooking only) sugar intakes were categorized into &lt;10%, 10% to 20%, and ≥20% and &lt;5%, 5% to 10%, and ≥10% of total energy, respectively. Frailty was assessed using modified Fried criteria. Multivariate logistic regression analyses were used to examine the association between sugar intake and frailty. Restricted cubic spline analyses were conducted to explore potential nonlinear relationships.</div></div><div><h3>Results</h3><div>Participants with a total sugar intake of ≥20% of total energy showed significantly lower odds of frailty compared to those with &lt;10% intake [adjusted odds ratio (OR) 0.47, 95% CI 0.26–0.85, <em>P</em> = .036]. For added sugar intake, the 5% to 10% group demonstrated significantly lower odds of frailty compared with the &lt;5% group (adjusted OR 0.60, 95% CI 0.41–0.89, <em>P</em> = .033), with no significant difference in the ≥10% group (<em>P</em> &gt; .05). Nonlinearity tests showed no statistical significance.</div></div><div><h3>Conclusions and Implications</h3><div>Higher total sugar intake and moderate added sugar intake were associated with lower frailty risk in older Korean adults. These findings highlight the importance of considering both the amount and source of dietary sugars when developing nutritional guidelines for healthy aging. Future policies should focus on nuanced dietary recommendations rather than universal restriction for the older adult population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106086"},"PeriodicalIF":3.8,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989785","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":"Association of Cancer Status, Functional Outcomes, and Mortality in Australian Geriatric Rehabilitation Patients, RESORT","authors":"Amanda M. Tan MBBS (Hons) ,&nbsp;Claire Maddison MD ,&nbsp;Farhan Ishraq BBMed (Hons) ,&nbsp;Wen Kwang Lim MD, PhD ,&nbsp;Andrea B. Maier MD, PhD","doi":"10.1016/j.jamda.2025.105487","DOIUrl":"10.1016/j.jamda.2025.105487","url":null,"abstract":"<div><h3>Objectives</h3><div>Increased cancer survival has led to a growing population of geriatric patients with cancer. The post-acute rehabilitation outcomes of these patients are poorly understood. This study aimed to investigate whether cancer status is associated with functional outcomes, new institutionalization, and mortality in Australian geriatric rehabilitation patients.</div></div><div><h3>Design</h3><div>Observational longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort.</div></div><div><h3>Setting and Participants</h3><div>Geriatric rehabilitation patients in a tertiary hospital in Australia.</div></div><div><h3>Methods</h3><div>Patients were allocated to “no,” “past,” and “active” cancer status groups. Function was measured at geriatric rehabilitation admission and discharge using Katz Activities of Daily Living (ADL) and Lawton-Brody Instrumental ADL (IADL) scores. Logistic regression and Cox regression were performed to investigate the association between functional change with new institutionalization and 1-year mortality, respectively.</div></div><div><h3>Results</h3><div>Of 1890 patients, 77.7% had “no,” 13.3% had “past,” and 9.0% had “active” cancer. ADL and IADL scores improved in all groups, with no significant difference between groups in functional outcomes or new institutionalization. Compared with “no” cancer (2.9%), a significantly higher proportion of “active” (8.2%) and “past” (6.0%) cancer patients died during the hospital admission, <em>P</em> &lt; .001. Active cancer was associated with higher 3- and 12-month mortality (20% and 40.6%). ADL and IADL improvement were significantly associated with reduced risk of 12-month mortality in “no” and “active” groups, and lower incidence of institutionalization in all groups.</div></div><div><h3>Conclusions and Implications</h3><div>Although inpatient mortality is higher in active cancer patients, older adults with active cancer who survive until inpatient geriatric rehabilitation discharge achieve similar functional gains and rates of discharge to the community. Functional improvement is of prognostic value in active cancer patients.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 105487"},"PeriodicalIF":3.8,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414587","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":"Association Between Constipation and Fecal Incontinence in Community-Dwelling Older Adults in Japan","authors":"Hiroaki Nakagawa MD, PhD ,&nbsp;Hajime Yamazaki MD, PhD ,&nbsp;Akihiro Ozaka MD, MPH ,&nbsp;Ryohei Yamamoto MD, PhD ,&nbsp;Sho Sasaki MD, DrPH ,&nbsp;Sugihiro Hamaguchi MD, PhD ,&nbsp;Shunichi Fukuhara MD, MACP","doi":"10.1016/j.jamda.2025.105581","DOIUrl":"10.1016/j.jamda.2025.105581","url":null,"abstract":"<div><h3>Objectives</h3><div>With a close relation between constipation and fecal incontinence, constipation is thought to be a risk factor for fecal incontinence in older adults. However, the limited number of studies available have provided inconsistent results. We conducted a large-sample population-based study to evaluate the association between constipation and fecal incontinence.</div></div><div><h3>Design</h3><div>Cross-sectional community-based survey.</div></div><div><h3>Setting and Participants</h3><div>Independent community-dwelling older adults in Japan ≥75 years of age in 2023 who were not using laxatives, enemas, or undergoing fecal disimpaction.</div></div><div><h3>Methods</h3><div>Constipation and fecal incontinence were measured using a self-administered questionnaire. Constipation severity was evaluated using the Constipation Scoring System. Constipation-related symptoms were assessed based on the Roma IV criteria and Constipation Scoring System. Logistic regression models were used to evaluate the odds ratio (OR) and 95% CI for fecal incontinence, with adjustment for potential confounders.</div></div><div><h3>Results</h3><div>We enrolled 2561 participants with a median age of 79 years (interquartile range, 76-83 years), with similar numbers of male and female participants. The prevalence of fecal incontinence was 7.4% (122 of 1658) in the group without constipation, and 18.3% (165 of 903) in the group with constipation. Constipation was associated with fecal incontinence (adjusted OR, 2.29; 95% CI, 1.76-2.98; <em>P</em> &lt; .001). Constipation severity was associated with fecal incontinence in a dose-response manner. Of constipation-related symptoms, a sensation of incomplete evacuation was most strongly associated with fecal incontinence (adjusted OR, 2.51; 95% CI, 1.81-3.47; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions and Implications</h3><div>Constipation was significantly associated with fecal incontinence in older adults ≥75 years of age. To reduce the risk of fecal incontinence, appropriate constipation management may be important.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 105581"},"PeriodicalIF":3.8,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Laboratory-Based Gait Speed and Daily-Life Gait Speed With Frailty, Sarcopenia, and Life-Space Mobility in Community-Dwelling Older Adults","authors":"Yong Hao Pua PhD ,&nbsp;Sapphire Lin PhD ,&nbsp;Joy Mei-Ling Tan MSc ,&nbsp;Nicole Yong Ting Leung BSc ,&nbsp;Fang Zhao PhD ,&nbsp;Yee Sien Ng MD","doi":"10.1016/j.jamda.2025.106014","DOIUrl":"10.1016/j.jamda.2025.106014","url":null,"abstract":"<div><h3>Objectives</h3><div>Although daily-life gait speed (DGS) may better reflect real-world walking than laboratory- or clinic-based gait speed (LGS), it is unclear whether DGS provides superior discriminatory value for clinical outcomes. We compared LGS and DGS on their discriminative abilities concerning the risk of prefrailty/frailty, probable sarcopenia, and restricted life-space mobility (RLSM) in community-dwelling middle-aged and older adults.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>A sample of 1025 participants (mean [SD], 63 [7.3]years) completed a survey and fitness assessment, from which LGS, DGS, FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) score, handgrip strength, and life-space assessment were measured.</div></div><div><h3>Methods</h3><div>LGS was measured by the 10-m gait speed test and average DGS was computed from walking trips recorded in a 14-day travel diary on a geospatial tracking mobile application. Participants with a FRAIL score ≥1, a weak handgrip strength (&lt;18 kg for women and &lt;28 kg for men), and a life-space assessment &lt;60 points were classified as having prefrailty/frailty, probable sarcopenia, and RLSM, respectively.</div></div><div><h3>Results</h3><div>LGS and DGS were weakly correlated (Spearman rho = 0.22), and their difference (mean ±2 SD) was 0.33 ± 0.48 m/s. Across outcomes, LGS showed higher areas under the curve (AUCs) (0.63 to 0.74) than did DGS (AUCs, 0.59 to 0.73). Adding DGS to LGS did not significantly increase the AUCs for the discrimination of all outcomes (differences in AUCs, 0.00 to 0.01; <em>P</em> values, 0.15 to 0.70).</div></div><div><h3>Conclusions and Implications</h3><div>In a sample of generally well-functioning adults, although LGS and DGS were not interchangeable, sufficient discrimination accuracy for the prefrailty/frailty, probable sarcopenia, and RLSM outcomes could be achieved with LGS alone. These findings suggest that routine laboratory gait speed assessment may be sufficient for risk stratification in community-dwelling adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106014"},"PeriodicalIF":3.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145635181","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":"Burden of Invasive Escherichia coli Disease Among Veterans Residing in Community Living Centers","authors":"Benjamin Skov PharmD, MS ,&nbsp;Vrishali V. Lopes BS, MS ,&nbsp;James L. Rudolph MD, SM ,&nbsp;Lisa Han MPH ,&nbsp;H. Edward Davidson PharmD, MPH ,&nbsp;Kevin W. Mcconeghy PharmD, PhD, MS ,&nbsp;Stefan Gravenstein MD, MPH","doi":"10.1016/j.jamda.2025.106041","DOIUrl":"10.1016/j.jamda.2025.106041","url":null,"abstract":"<div><h3>Objectives</h3><div>Infectious diseases are a major concern for patients dwelling in long-term care facilities and cause significant morbidity and mortality. <em>Escherichia coli</em> is a leading bacterial pathogen in this population, and infection can lead to invasive <em>E coli</em> disease (IED) such as complicated urinary tract infection (UTI) or sepsis. Despite this, IED has not been well characterized in the nursing home setting. Our objective is to present rates of complications and bacterial resistance patterns of IED in the nursing home population.</div></div><div><h3>Design</h3><div>This study is a retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Long-stay residents of the Veterans Affairs–operated community living centers were monitored for <em>E coli</em> infections over a 3-year period.</div></div><div><h3>Methods</h3><div>Individuals with positive cultures for <em>E coli</em> were assessed for IED and further characterized based on site of infection and antibiotic resistance–testing results.</div></div><div><h3>Results</h3><div>Among 20,392 resident veterans, there were 10,175 <em>E coli</em> infections. Of those, 6840 infections met criteria for IED; 85% of IED cases met criteria for complicated UTI and 60% met criteria for Sepsis. Outcomes among cases of IED within 30 days of positive culture included hospitalization (23.5%), death (5.8%), and reinfection at the same site (12%). Cultures were tested and fluoroquinolone resistance was present in 52.7% of cases, cephalosporin resistance in 23.3%, and resistance to multiple classes of antibiotics in 12%.</div></div><div><h3>Conclusions and Implications</h3><div>The high prevalence of IED in this population along with concerning rates of complications emphasize that preventative interventions and treatments are a pressing need.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106041"},"PeriodicalIF":3.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804851","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":"The Willingness to Provide Private Care in the Future: Findings Based on a Nationwide, Representative Study in Germany","authors":"André Hajek PhD ,&nbsp;Larissa Zwar PhD ,&nbsp;Supa Pengpid DrPH ,&nbsp;Karl Peltzer PhD ,&nbsp;Hans-Helmut König MD","doi":"10.1016/j.jamda.2025.106048","DOIUrl":"10.1016/j.jamda.2025.106048","url":null,"abstract":"<div><h3>Objectives</h3><div>This primarily exploratory study aimed to describe the willingness to provide private care in the future and to identify factors associated with it in Germany (also stratified by sex). This knowledge is important for planning adequate care in the future.</div></div><div><h3>Design</h3><div>A large, nationwide, cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Wave 50 of the representative GESIS Panel (late 2022 to beginning of 2023, N = 3915 adults).</div></div><div><h3>Methods</h3><div>The willingness to provide private care in the future was quantified in detail (ie, general willingness, persons for whom this care would be provided, duration, and type of care activity).</div></div><div><h3>Results</h3><div>Approximately 4 of 5 respondents would be willing to provide such private care in the future. Most people would prioritize caring for their partner, mother, and father. Respondents would be willing to spend on average 12.4 hours per week for providing such support in the future. Nearly 95% would assist with shopping and 70% to 80% with transportation, medication, finances, and meals. About two-thirds would supervise and help with housework; less than 40% would offer basic care. Regressions showed that the general willingness to provide private care in the future was significantly associated with being female, higher education, higher household net income, being married/partner living together, currently caring for a person in need of care, having children, and higher satisfaction with health. Sex-stratified regressions mainly revealed similar results for both women and men.</div></div><div><h3>Conclusions and Implications</h3><div>In conclusion, there appears to be a certain potential for future private care in the German adult population, which presumably needs to be supported by professional assistance (especially to cover basic care). This could help those in need of care to live at home for as long as possible, in accordance with their preferences.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106048"},"PeriodicalIF":3.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846210","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":"Supportive Smart Homes: Is It Time to Get Serious About Aging in Place?","authors":"Frank D. Knoefel MD ,&nbsp;R. Bruce Wallace PhD ,&nbsp;Rafik A. Goubran PhD ,&nbsp;Heidi Sveistrup PhD ,&nbsp;Neil W.D. Thomas MD","doi":"10.1016/j.jamda.2025.106032","DOIUrl":"10.1016/j.jamda.2025.106032","url":null,"abstract":"<div><div>Worldwide, the population is aging. Most older adults would prefer not to move from their current residence; however, there are human resource challenges in home care service provision. Smart home technology has evolved over the past decades and could provide an adjunct to home care and potentially delay moving to a higher level of care. This paper provides an overview of supportive smart home technology, which expands smart home technology to enable feedback and action based on daily functioning. The first section reviews some of the technological components required. The second section provides sample support systems for persons living with declines in cognition and mobility, and those needing support in activities of daily living. Ethical and public policy elements are reviewed, and finally future considerations are presented.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106032"},"PeriodicalIF":3.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145763017","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":"The Intervention Effect of Serious Games on Upper Limb Motor Function and Activities of Daily Living in Stroke Patients: A Systematic Review and Meta-Analysis","authors":"Tingting Zhang MSN,&nbsp;Hong Yan MMed,&nbsp;Yan Liu MSN,&nbsp;Yuanyuan Tang MSN,&nbsp;Shijin Wang MSN,&nbsp;Zhehui Yang MSN,&nbsp;Yuling Luo MSN","doi":"10.1016/j.jamda.2025.106064","DOIUrl":"10.1016/j.jamda.2025.106064","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate the intervention effect of serious games on upper limb motor function and activities of daily living in patients with stroke.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting and participants</h3><div>Patients with motor dysfunction in the upper limb following a stroke.</div></div><div><h3>Methods</h3><div>The Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure Wanfang Data, Chinese Scientific and Technical Periodicals Database (VIP), and Chinese Biomedical Literature Database (CBM) were searched. The search targeted randomized controlled trials evaluating the effects of serious games on upper limb motor function and activities of daily living in patients with stroke. The search period spanned from the inception of each database to May 2025. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies in accordance with the predefined inclusion and exclusion criteria. Data analysis was conducted with Stata 17.0 software and evidence quality was evaluated via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</div></div><div><h3>Results</h3><div>Twenty-five studies were included. Meta-analysis results demonstrated that, compared with conventional rehabilitation alone, serious games combined with conventional rehabilitation significantly improved upper limb motor function (mean difference: 7.64; 95% CI, 6.19–9.09; <em>I</em>² = 64.7%; <em>P</em> &lt; .001) and activities of daily living (standardized mean difference: 1.20; 95% CI, 0.86–1.54; <em>I</em>² = 81.3%; <em>P</em> &lt; .001) in patients with stroke, with statistically significant differences.</div></div><div><h3>Conclusion and Implications</h3><div>This study demonstrates that serious games combined with conventional rehabilitation exercises can improve upper limb motor function and activities of daily living in patients with stroke. However, the evidence was of low quality, limited by the risk of bias and heterogeneity. Subgroup analysis revealed that a protocol with a duration of ≥4 weeks, a frequency of ≥5 sessions/week, and a single session of ≤30 minutes was more advantageous, although the between-group differences did not reach statistical significance, and the optimal protocol remains to be determined. It is recommended to initiate the intervention as early as possible in the acute/subacute stage, while its effectiveness in the chronic stage requires further validation through high-quality studies. Future research should involve large-sample randomized controlled trials to define the optimal protocol and evaluate its long-term efficacy, safety, and cost-effectiveness.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106064"},"PeriodicalIF":3.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933909","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":"Leveraging an AI-Driven Voice Companion to Enhance Mental Health in Older Adults in Post-Acute and Long-Term Care Settings: A Feasibility Study","authors":"Zachary J. Palace MD, CMD, FACP ,&nbsp;Joshua Sachemechian BA ,&nbsp;Nathaniel J. Shams BS","doi":"10.1016/j.jamda.2025.106047","DOIUrl":"10.1016/j.jamda.2025.106047","url":null,"abstract":"<div><div>Loneliness, depression, and anxiety are prevalent among older adults in post-acute and long-term care settings and are associated with adverse health outcomes. Existing psychosocial interventions often face challenges related to scalability and sustained engagement.</div><div>This preliminary feasibility study assessed an artificial intelligence–based, voice-driven telephone intervention designed to facilitate conversational engagement with older adults. Thirty-three residents were approached, and 28 enrolled, primarily from skilled nursing facilities and assisted living facilities, with additional participation from independent living settings; 23 completed both baseline and follow-up assessments over a 4-week assessment period.</div><div>Participants demonstrated reductions in depressive and anxiety symptoms, with larger changes observed among those with higher baseline severity. Participants with Patient Health Questionnaire–9 scores ≥10 showed an average reduction of 5.7 points, and overall, Generalized Anxiety Disorder 7-item scale scores decreased by a median of 2.3 points.</div><div>Given the exploratory nature and methodologic limitations of the study, these initial findings should be interpreted cautiously. Further research is warranted to assess the intervention’s effectiveness and generalizability in larger, controlled trials.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106047"},"PeriodicalIF":3.8,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145856772","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}