Pub Date : 2025-02-01DOI: 10.1016/j.jamda.2024.105419
Fengxue Yang MPH , Linfang Zhu MSc , Bing Cao MMed , Li Zeng MMed , Zhongqing Yuan MMed , Yi Tian PhD, MD , Yuanting Li MSN , Xiaoshan Chen BSc
Objectives
The aim of this systematic review was to assess the diagnostic test accuracy of muscle ultrasound for identifying older patients with sarcopenia and to investigate its association with frailty.
Design
Systematic review and meta-analysis of observational studies. Comprehensive searches were conducted in PubMed, MEDLINE, Cochrane Library, Scopus, and Embase through October 2024.
Setting and Participants
Clinical and community settings across 7 countries, with 2537 adults aged ≥65 years.
Methods
Two reviewers assessed study quality using QUADAS-2. Data on participant characteristics, ultrasound methods, and diagnostic outcomes were extracted. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were calculated with a random-effects model. Sensitivity analyses ensured robustness.
Results
Pooled sensitivity was 0.85 (95% CI, 0.78–0.93), specificity was 0.74 (95% CI, 0.65–0.81), DOR was 16.65 (95% CI, 4.90–96.67), and SROC-area under the curve was 0.87, indicating moderate to high diagnostic accuracy. Association with frailty yielded an odds ratio of 7.91 (95% CI, 6.15–10.17). Most studies received an "unclear" rating in several QUADAS-2 domains, especially in patient selection and reference standards, indicating limitations in study design that may impact the generalizability of results.
Conclusions and Implications
Ultrasound is a reliable, noninvasive, and cost-effective tool for diagnosing sarcopenia in older patients. Further research should standardize cutoffs and explore integration with other methods.
{"title":"Accuracy of Ultrasound Measurements of Muscle Thickness in Identifying Older Patients With Sarcopenia and Its Impact on Frailty: A Systematic Review and Meta-Analysis","authors":"Fengxue Yang MPH , Linfang Zhu MSc , Bing Cao MMed , Li Zeng MMed , Zhongqing Yuan MMed , Yi Tian PhD, MD , Yuanting Li MSN , Xiaoshan Chen BSc","doi":"10.1016/j.jamda.2024.105419","DOIUrl":"10.1016/j.jamda.2024.105419","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this systematic review was to assess the diagnostic test accuracy of muscle ultrasound for identifying older patients with sarcopenia and to investigate its association with frailty.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis of observational studies. Comprehensive searches were conducted in PubMed, MEDLINE, Cochrane Library, Scopus, and Embase through October 2024.</div></div><div><h3>Setting and Participants</h3><div>Clinical and community settings across 7 countries, with 2537 adults aged ≥65 years.</div></div><div><h3>Methods</h3><div>Two reviewers assessed study quality using QUADAS-2. Data on participant characteristics, ultrasound methods, and diagnostic outcomes were extracted. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were calculated with a random-effects model. Sensitivity analyses ensured robustness.</div></div><div><h3>Results</h3><div>Pooled sensitivity was 0.85 (95% CI, 0.78–0.93), specificity was 0.74 (95% CI, 0.65–0.81), DOR was 16.65 (95% CI, 4.90–96.67), and SROC-area under the curve was 0.87, indicating moderate to high diagnostic accuracy. Association with frailty yielded an odds ratio of 7.91 (95% CI, 6.15–10.17). Most studies received an \"unclear\" rating in several QUADAS-2 domains, especially in patient selection and reference standards, indicating limitations in study design that may impact the generalizability of results.</div></div><div><h3>Conclusions and Implications</h3><div>Ultrasound is a reliable, noninvasive, and cost-effective tool for diagnosing sarcopenia in older patients. Further research should standardize cutoffs and explore integration with other methods.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105419"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854274","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}
Pub Date : 2025-02-01DOI: 10.1016/S1525-8610(25)00030-1
{"title":"General Information","authors":"","doi":"10.1016/S1525-8610(25)00030-1","DOIUrl":"10.1016/S1525-8610(25)00030-1","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105513"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094988","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jamda.2024.105464
Jiacheng Yang MPH , Yijiang Ouyang MPH , Wenya Zhang MPH , Xinming Tang MPH , Jiahao Xu MPH , Haoqi Zou MPH , Wenyuan Jing MPH , Xiuping He MPH , Ya Yang MPH , Kechun Che MPH , Jiayan Deng MPH , Congcong Pan MMSc , Jiaqi He PhD , Mingjuan Yin MPH , Jun Wu PhD , Jindong Ni PhD
Objectives
The 3 most frequently utilized frailty assessment measures are the Fried criteria, FRAIL scale, and Frailty Index (FI). This study aimed to compare predictive capabilities of these 3 measures regarding all-cause mortality in the United States and to identify the key predictive variables.
Design
Cross-sectional study.
Setting and Participants
From the National Health and Nutrition Examination Survey (NHANES) 2005–2018 cycles, a total of 39,631 participants aged 20 and older were included.
Methods
Fried status, FRAIL status, and FI status were determined for each individual based on the cutoff values from the continuous scores of their respective scales. Univariate and multivariate models, incorporating 11 covariates—sex, age, body mass index, ethnicity, education, marital status, smoking status, alcohol intake, employment status, poverty-to-income ratio, and total energy intake—were fitted using Cox proportional hazards and 2 machine learning models. Model performance was assessed through Integrated Brier Score (IBS), concordance index (C-index), and area under the curve (AUC) values from 10-fold cross-validation. Key variable analysis was performed using permutation importance and C-index increment. Subgroup analysis was developed according to age.
Results
In univariate analyses, FI consistently outperformed Fried and FRAIL, showing significantly lower IBS, and higher C-index and AUC values. In multivariate analyses, few significant differences were found. Permutation importance analysis identified age as the most important variable, followed by Fried status and FI status. Similarly, in C-index increment analysis, age was the top one variable. Subgroup analyses showed that FI status consistently performed best in all metrics across univariate analyses at least in 40–59 and 60–79 age groups. FI status consistently emerged as the most important variable in permutation analysis across all age groups.
Conclusions and Implications
FI demonstrated the best performance as a single predictor in predicting all-cause mortality, with age being crucial for enhancing predictive performance. Future research should explore the applicability of FI in different populations and its relationship with cause-specific mortality.
{"title":"Comparative Study of Frailty Assessment Measures in Predicting All-Cause Mortality: Insights From NHANES","authors":"Jiacheng Yang MPH , Yijiang Ouyang MPH , Wenya Zhang MPH , Xinming Tang MPH , Jiahao Xu MPH , Haoqi Zou MPH , Wenyuan Jing MPH , Xiuping He MPH , Ya Yang MPH , Kechun Che MPH , Jiayan Deng MPH , Congcong Pan MMSc , Jiaqi He PhD , Mingjuan Yin MPH , Jun Wu PhD , Jindong Ni PhD","doi":"10.1016/j.jamda.2024.105464","DOIUrl":"10.1016/j.jamda.2024.105464","url":null,"abstract":"<div><h3>Objectives</h3><div>The 3 most frequently utilized frailty assessment measures are the Fried criteria, FRAIL scale, and Frailty Index (FI). This study aimed to compare predictive capabilities of these 3 measures regarding all-cause mortality in the United States and to identify the key predictive variables.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>From the National Health and Nutrition Examination Survey (NHANES) 2005–2018 cycles, a total of 39,631 participants aged 20 and older were included.</div></div><div><h3>Methods</h3><div>Fried status, FRAIL status, and FI status were determined for each individual based on the cutoff values from the continuous scores of their respective scales. Univariate and multivariate models, incorporating 11 covariates—sex, age, body mass index, ethnicity, education, marital status, smoking status, alcohol intake, employment status, poverty-to-income ratio, and total energy intake—were fitted using Cox proportional hazards and 2 machine learning models. Model performance was assessed through Integrated Brier Score (IBS), concordance index (C-index), and area under the curve (AUC) values from 10-fold cross-validation. Key variable analysis was performed using permutation importance and C-index increment. Subgroup analysis was developed according to age.</div></div><div><h3>Results</h3><div>In univariate analyses, FI consistently outperformed Fried and FRAIL, showing significantly lower IBS, and higher C-index and AUC values. In multivariate analyses, few significant differences were found. Permutation importance analysis identified age as the most important variable, followed by Fried status and FI status. Similarly, in C-index increment analysis, age was the top one variable. Subgroup analyses showed that FI status consistently performed best in all metrics across univariate analyses at least in 40–59 and 60–79 age groups. FI status consistently emerged as the most important variable in permutation analysis across all age groups.</div></div><div><h3>Conclusions and Implications</h3><div>FI demonstrated the best performance as a single predictor in predicting all-cause mortality, with age being crucial for enhancing predictive performance. Future research should explore the applicability of FI in different populations and its relationship with cause-specific mortality.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105464"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007487","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}
To investigate the effect of preoperative muscle quality on functional outcomes after total hip arthroplasty (THA).
Design
Retrospective cohort study.
Setting and Participants
We included 426 patients who underwent primary THA between 2015 and 2022 to evaluate the relationship between preoperative muscle quality and 1-year functional outcomes following THA.
Methods
The muscle cross-sectional area (CSA) and density at baseline were measured using preoperative computed tomography. The CSA was further divided based on muscle quality into intramuscular adipose tissue (IMAT), normal-density muscle (NDM), and low-density muscle (LDM) based on muscle density thresholds. According to their functional recovery, patients were classified into sufficient functional recovery [Harris hip score (HHS) ≥89] and insufficient functional recovery (HHS <89) groups based on their HHS at 1-year post THA. Propensity score matching was performed to balance the baseline characteristics of the patient groups, including age, sex, body mass index, HHS, University of California, Los Angeles activity scores, and gait speed. The preoperative muscle density, CSA, IMAT, NDM, and LDM of the gluteus maximus, gluteus medius, gluteus minimus, iliopsoas, and rectus femoris muscles were compared between the groups.
Results
Ninety matched pairs were analyzed following covariate adjustment using propensity scores. The insufficient group had significantly more IMAT in all muscles preoperatively than did the sufficient group (P < .05). In addition, the muscle density and NDM of the gluteus maximus, gluteus medius, and iliopsoas in the insufficient group were significantly worse than those in the sufficient group (P < .05). Conversely, the 2 groups showed no significant differences in LDM.
Conclusions and Implications
Our results revealed that patients with a significantly higher IMAT prevalence and reduced NDM preoperatively were less likely to experience significant improvement after THA. Therefore, we propose that undergoing THA with good muscle quality represents the optimal timing for achieving higher functional recovery.
{"title":"Impact of Preoperative Skeletal Muscle Quality on Functional Outcome in Total Hip Arthroplasty","authors":"Takumi Kawano RPT , Manabu Nankaku RPT, PhD , Masanobu Murao RPT, PhD , Takuma Yuri OTR, PhD , Ryota Hamada RPT, MS , Gakuto Kitamura RPT, MS , Yutaka Kuroda MD, PhD , Toshiyuki Kawai MD, PhD , Yaichiro Okuzu MD, PhD , Ryosuke Ikeguchi MD, PhD , Shuichi Matsuda MD, PhD","doi":"10.1016/j.jamda.2024.105396","DOIUrl":"10.1016/j.jamda.2024.105396","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the effect of preoperative muscle quality on functional outcomes after total hip arthroplasty (THA).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>We included 426 patients who underwent primary THA between 2015 and 2022 to evaluate the relationship between preoperative muscle quality and 1-year functional outcomes following THA.</div></div><div><h3>Methods</h3><div>The muscle cross-sectional area (CSA) and density at baseline were measured using preoperative computed tomography. The CSA was further divided based on muscle quality into intramuscular adipose tissue (IMAT), normal-density muscle (NDM), and low-density muscle (LDM) based on muscle density thresholds. According to their functional recovery, patients were classified into sufficient functional recovery [Harris hip score (HHS) ≥89] and insufficient functional recovery (HHS <89) groups based on their HHS at 1-year post THA. Propensity score matching was performed to balance the baseline characteristics of the patient groups, including age, sex, body mass index, HHS, University of California, Los Angeles activity scores, and gait speed. The preoperative muscle density, CSA, IMAT, NDM, and LDM of the gluteus maximus, gluteus medius, gluteus minimus, iliopsoas, and rectus femoris muscles were compared between the groups.</div></div><div><h3>Results</h3><div>Ninety matched pairs were analyzed following covariate adjustment using propensity scores. The insufficient group had significantly more IMAT in all muscles preoperatively than did the sufficient group (<em>P</em> < .05). In addition, the muscle density and NDM of the gluteus maximus, gluteus medius, and iliopsoas in the insufficient group were significantly worse than those in the sufficient group (<em>P</em> < .05). Conversely, the 2 groups showed no significant differences in LDM.</div></div><div><h3>Conclusions and Implications</h3><div>Our results revealed that patients with a significantly higher IMAT prevalence and reduced NDM preoperatively were less likely to experience significant improvement after THA. Therefore, we propose that undergoing THA with good muscle quality represents the optimal timing for achieving higher functional recovery.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105396"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794909","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}
The indoor environment refers to the conditions within a building, including thermal comfort, air quality, lighting, and noise levels. However, the association between the indoor environment and the intention to enter nursing homes among older adults with functional limitations remains unclear. Therefore, this study examined the association of indoor environmental factors with intention to enter nursing homes within this population.
Design
Cross-sectional data from the Japan Gerontological Evaluation Study-Home Care 2022.
Setting and Participants
This study included 3202 adults aged ≥65 years, certified under the Japanese long-term care insurance system, and living at home.
Methods
Intention to enter nursing homes was assessed by asking the participants if they were considering entering a nursing home. The indoor environment was assessed using the Comprehensive Assessment System for Built Environment Efficiency Housing Health Checklist, which includes 5 items: cooling, heating, acoustic, odor, and lighting environments. Logistic regression was used to examine the association between these 5 items and consideration of nursing home admissions.
Results
Approximately 43.0% of participants had considered nursing home admission. After adjusting for sociodemographic factors, economic status, health, and long-term care–related factors, the overall indoor environment score, which includes 5 items, was negatively related to nursing home admission.
Conclusions and Implications
The results of this study revealed that better indoor environments in terms of cooling, heating, acoustics, odor, and lighting could potentially delay nursing home admission. Integrating the assessments of these indoor environmental factors into policy frameworks may enhance the effectiveness of long-term care strategies and promote aging.
{"title":"Association of Indoor Environment with the Intention to Enter Nursing Homes among Older Adults with Functional Limitations in Japan","authors":"Xueying Jin MBA, PhD , Kenjiro Kawaguchi MD, MPH, PhD , Taiji Noguchi PhD , Katsunori Kondo MD, PhD , Tami Saito PhD","doi":"10.1016/j.jamda.2024.105383","DOIUrl":"10.1016/j.jamda.2024.105383","url":null,"abstract":"<div><h3>Objectives</h3><div>The indoor environment refers to the conditions within a building, including thermal comfort, air quality, lighting, and noise levels. However, the association between the indoor environment and the intention to enter nursing homes among older adults with functional limitations remains unclear. Therefore, this study examined the association of indoor environmental factors with intention to enter nursing homes within this population.</div></div><div><h3>Design</h3><div>Cross-sectional data from the Japan Gerontological Evaluation Study-Home Care 2022.</div></div><div><h3>Setting and Participants</h3><div>This study included 3202 adults aged ≥65 years, certified under the Japanese long-term care insurance system, and living at home.</div></div><div><h3>Methods</h3><div>Intention to enter nursing homes was assessed by asking the participants if they were considering entering a nursing home. The indoor environment was assessed using the Comprehensive Assessment System for Built Environment Efficiency Housing Health Checklist, which includes 5 items: cooling, heating, acoustic, odor, and lighting environments. Logistic regression was used to examine the association between these 5 items and consideration of nursing home admissions.</div></div><div><h3>Results</h3><div>Approximately 43.0% of participants had considered nursing home admission. After adjusting for sociodemographic factors, economic status, health, and long-term care–related factors, the overall indoor environment score, which includes 5 items, was negatively related to nursing home admission.</div></div><div><h3>Conclusions and Implications</h3><div>The results of this study revealed that better indoor environments in terms of cooling, heating, acoustics, odor, and lighting could potentially delay nursing home admission. Integrating the assessments of these indoor environmental factors into policy frameworks may enhance the effectiveness of long-term care strategies and promote aging.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105383"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785932","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jamda.2024.105411
Carin M. Wong PhD , Dominique H. Como PhD, OTR/L , Cara Lekovitch CScD, OTR/L, BCG , Felicia Chew MS, OTR/L , Natalie E. Leland PhD, OTR/L, BCG, FAOTA, FGSA
Objectives
To capture nursing home staff perspectives on the benefits and challenges related to caring for residents living with Alzheimer disease and other related dementias. These perspectives will inform the initial development of strategies to help with staff retention.
Design
A secondary qualitative analysis of semistructured interviews conducted with nursing home staff, which was embedded within a pragmatic clinical trial.
Setting and Participants
Purposive sampling was used to capture perspectives of staff spanning across job roles from 23 nursing homes.
Methods
During the parent study primary analysis, staff experiences providing dementia care were consistently described. In response, this study completed a secondary analysis of study data using thematic analysis to identify benefits and challenges of caring for this population.
Results
Analysis of nursing home staff (n = 327) interviews captured benefits and challenges of caring for residents living with dementia. Three themes reflected staff perspectives of the benefits, including valuing interpersonal relationship with residents (eg, learning about residents' likes, dislikes, and history), providing care fosters a sense of purpose, and the variability of the job from day to day (eg, getting to use different strategies to interact with residents). Two themes portrayed the challenges staff articulated, including feeling discouraged because of ineffective care strategies (eg, not being able to manage residents’ behaviors) and the toll that caring for this resident population takes on staff mental health (eg, death of residents).
Conclusions and Implications
Nursing home staff report benefits and challenges to providing care to people with dementia. To assist with staff retention and lower staff turnover, nursing home administrators need to take into consideration how to help their staff manage the challenges and facilitate the benefits through the implementation of organizational strategies.
{"title":"Nursing Home Staff Perspectives of the Benefits and Challenges of Providing Dementia Care","authors":"Carin M. Wong PhD , Dominique H. Como PhD, OTR/L , Cara Lekovitch CScD, OTR/L, BCG , Felicia Chew MS, OTR/L , Natalie E. Leland PhD, OTR/L, BCG, FAOTA, FGSA","doi":"10.1016/j.jamda.2024.105411","DOIUrl":"10.1016/j.jamda.2024.105411","url":null,"abstract":"<div><h3>Objectives</h3><div>To capture nursing home staff perspectives on the benefits and challenges related to caring for residents living with Alzheimer disease and other related dementias. These perspectives will inform the initial development of strategies to help with staff retention.</div></div><div><h3>Design</h3><div>A secondary qualitative analysis of semistructured interviews conducted with nursing home staff, which was embedded within a pragmatic clinical trial.</div></div><div><h3>Setting and Participants</h3><div>Purposive sampling was used to capture perspectives of staff spanning across job roles from 23 nursing homes.</div></div><div><h3>Methods</h3><div>During the parent study primary analysis, staff experiences providing dementia care were consistently described. In response, this study completed a secondary analysis of study data using thematic analysis to identify benefits and challenges of caring for this population.</div></div><div><h3>Results</h3><div>Analysis of nursing home staff (n = 327) interviews captured benefits and challenges of caring for residents living with dementia. Three themes reflected staff perspectives of the benefits, including valuing interpersonal relationship with residents (eg, learning about residents' likes, dislikes, and history), providing care fosters a sense of purpose, and the variability of the job from day to day (eg, getting to use different strategies to interact with residents). Two themes portrayed the challenges staff articulated, including feeling discouraged because of ineffective care strategies (eg, not being able to manage residents’ behaviors) and the toll that caring for this resident population takes on staff mental health (eg, death of residents).</div></div><div><h3>Conclusions and Implications</h3><div>Nursing home staff report benefits and challenges to providing care to people with dementia. To assist with staff retention and lower staff turnover, nursing home administrators need to take into consideration how to help their staff manage the challenges and facilitate the benefits through the implementation of organizational strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105411"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829150","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jamda.2024.105374
Aline Mendes MD , François R. Herrmann MD, PhD , Sverre Bergh MD, PhD , Bruno Mario Cesana MD , Ron Handels PhD , Alfonso Ciccone MD, PhD , Emmanuel Cognat MD, PhD , Andrea Fabbo MD, PhD , Sara Fascendini MD , Giovanni B. Frisoni MD, PhD , Lutz Froelich MD, PhD , Maria Cristina Jori MD, PhD , Patrizia Mecocci MD, PhD , Paola Merlo MD , Oliver Peters MD, PhD , Magdalini Tsolaki MD, PhD , Carlo Alberto Defanti MD, PhD
Objectives
Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD).
Design
A multicentric longitudinal observational study was conducted, comprising clinical assessments at baseline and every 6 months for 3 years.
Setting and Participants
People with severe BPSD (Neuropsychiatric Inventory, NPI ≥32) living at home.
Methods
Data on demographics and clinical characteristics were collected at baseline and during 6-monthly follow-ups over 3 years. The main outcome was mortality, documented over a total period of 4 years and analyzed using the Cox proportional hazards model.
Results
Of the 508 patients with dementia with severe BPSD, 165 (32.5%) died during the 4-year follow-up. Non-survivors were older (79.8 ± 7.7 vs 77.3 ± 8.0; P < .001), more likely to be male (58.8% vs 38.5%; P < .001), and had higher BPSD severity (NPI: 57.2 ± 20.2 vs 50.3 ± 17.9; P < .001), lower cognitive function according to the Mini-Mental State Examination (MMSE) (13.5 ± 6.6 vs 16.4 ± 5.9; P < .001), and worse functional status according to the Alzheimer's Disease Cooperative Study – Activities of Daily Living Scale (ADCS) (28.8 ± 16.4 vs 36.3 ± 17.2; P < .001) at baseline. Significant predictors of mortality included male sex [hazard ratio (HR), 2.03; 95% confidence interval (95% CI), 1.46–2.82; P < .001], older age at diagnosis (HR, 1.05; 95% CI, 1.03–1.07; P < .001), higher NPI scores (HR, 1.01; 95% CI, 1.01–1.02; P = .002), lower MMSE (HR, 0.95; 95% CI, 0.93–0.98; P = .001), lower ADCS (HR, 0.98; 95% CI, 0.98–0.99; P = .015), and lower quality of life rated by proxy (HR, 0.97; 95% CI, 0.95–0.99; P = .021). The use of antidepressants (HR, 0.69; 95% CI, 0.48–0.98; P = .038) was associated with increased survival. Delusions (HR, 1.0; 95% CI, 1.03–1.12; P < .001), hallucinations (HR, 1.07; 95% CI, 1.02–1.11; P = .002), and agitation/aggression (HR, 1.05; 95% CI, 1.01–1.09; P = .021) were significantly linked to increased mortality.
Conclusions and Implications
Older age, male sex, severe BPSD, and lower cognitive and quality of life scores significantly predict increased mortality in patients with severe BPSD.
{"title":"Clinical Predictors of Mortality in People with Severe Behavioral and Psychological Symptoms of Dementia","authors":"Aline Mendes MD , François R. Herrmann MD, PhD , Sverre Bergh MD, PhD , Bruno Mario Cesana MD , Ron Handels PhD , Alfonso Ciccone MD, PhD , Emmanuel Cognat MD, PhD , Andrea Fabbo MD, PhD , Sara Fascendini MD , Giovanni B. Frisoni MD, PhD , Lutz Froelich MD, PhD , Maria Cristina Jori MD, PhD , Patrizia Mecocci MD, PhD , Paola Merlo MD , Oliver Peters MD, PhD , Magdalini Tsolaki MD, PhD , Carlo Alberto Defanti MD, PhD","doi":"10.1016/j.jamda.2024.105374","DOIUrl":"10.1016/j.jamda.2024.105374","url":null,"abstract":"<div><h3>Objectives</h3><div>Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD).</div></div><div><h3>Design</h3><div>A multicentric longitudinal observational study was conducted, comprising clinical assessments at baseline and every 6 months for 3 years.</div></div><div><h3>Setting and Participants</h3><div>People with severe BPSD (Neuropsychiatric Inventory, NPI ≥32) living at home.</div></div><div><h3>Methods</h3><div>Data on demographics and clinical characteristics were collected at baseline and during 6-monthly follow-ups over 3 years. The main outcome was mortality, documented over a total period of 4 years and analyzed using the Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Of the 508 patients with dementia with severe BPSD, 165 (32.5%) died during the 4-year follow-up. Non-survivors were older (79.8 ± 7.7 vs 77.3 ± 8.0; <em>P</em> < .001), more likely to be male (58.8% vs 38.5%; <em>P</em> < .001), and had higher BPSD severity (NPI: 57.2 ± 20.2 vs 50.3 ± 17.9; <em>P</em> < .001), lower cognitive function according to the Mini-Mental State Examination (MMSE) (13.5 ± 6.6 vs 16.4 ± 5.9; <em>P</em> < .001), and worse functional status according to the Alzheimer's Disease Cooperative Study – Activities of Daily Living Scale (ADCS) (28.8 ± 16.4 vs 36.3 ± 17.2; <em>P</em> < .001) at baseline. Significant predictors of mortality included male sex [hazard ratio (HR), 2.03; 95% confidence interval (95% CI), 1.46–2.82; <em>P</em> < .001], older age at diagnosis (HR, 1.05; 95% CI, 1.03–1.07; <em>P</em> < .001), higher NPI scores (HR, 1.01; 95% CI, 1.01–1.02; <em>P</em> = .002), lower MMSE (HR, 0.95; 95% CI, 0.93–0.98; <em>P</em> = .001), lower ADCS (HR, 0.98; 95% CI, 0.98–0.99; <em>P</em> = .015), and lower quality of life rated by proxy (HR, 0.97; 95% CI, 0.95–0.99; <em>P</em> = .021). The use of antidepressants (HR, 0.69; 95% CI, 0.48–0.98; <em>P</em> = .038) was associated with increased survival. Delusions (HR, 1.0; 95% CI, 1.03–1.12; <em>P</em> < .001), hallucinations (HR, 1.07; 95% CI, 1.02–1.11; <em>P</em> = .002), and agitation/aggression (HR, 1.05; 95% CI, 1.01–1.09; <em>P</em> = .021) were significantly linked to increased mortality.</div></div><div><h3>Conclusions and Implications</h3><div>Older age, male sex, severe BPSD, and lower cognitive and quality of life scores significantly predict increased mortality in patients with severe BPSD.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105374"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751169","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jamda.2024.105378
Daniel Jung PhD, Suhang Song PhD, Janani Rajbhandari-Thapa PhD
Objectives
This study investigated the role of patients' neighborhood socioeconomic status (SES) on the relationship between home health agency (HHA) care quality and health outcomes among home health care patients.
Design
Retrospective cohort study.
Setting and Participants
We mainly used 2019 Outcome and Assessment Information Set data, Area Deprivation Index, and Quality of Patient Care Star Rating. We included Medicare beneficiaries (aged ≥ 65 years) who received home health care.
Methods
We used linear probability regression models to examine whether patients' neighborhood SES moderates the association between care quality of HHAs and health outcomes for 1,657,133 home health care patients.
Results
Our findings show that patients in neighborhoods with lower SES were more likely to use low-quality HHAs (lease disadvantaged neighborhoods: 11%, most disadvantaged neighborhoods: 15.2%). Our main model, adjusted by patient- and HHA-level characteristics, reveals patients living in socioeconomically disadvantaged neighborhoods (less disadvantaged: coefficient: −0.017, P < .001; more disadvantaged: coefficient: −0.035, P < .001; most disadvantaged: coefficient: −0.06, P < .001) and receiving care from low-quality HHAs (average-quality HHAs: coefficient: 0.037, P < .001; high-quality HHAs: coefficient: 0.062, P < .001) were less likely to remain in the community during their home health care. Furthermore, our study highlights that patients in the most disadvantaged neighborhoods encounter additional challenges in remaining at their homes and communities when they use low-quality HHAs.
Conclusions and Implications
These findings highlight the need for targeted interventions and policy initiatives aimed at addressing disparities in care quality based on neighborhood SES. Efforts directed at enhancing the quality of care provided by HHAs and access to high-quality HHAs in socioeconomically disadvantaged neighborhoods could substantially impact health equity and outcomes for individuals in these settings.
{"title":"The Importance of Quality of Home Health Agencies for Patients in Socioeconomically Disadvantaged Neighborhoods","authors":"Daniel Jung PhD, Suhang Song PhD, Janani Rajbhandari-Thapa PhD","doi":"10.1016/j.jamda.2024.105378","DOIUrl":"10.1016/j.jamda.2024.105378","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigated the role of patients' neighborhood socioeconomic status (SES) on the relationship between home health agency (HHA) care quality and health outcomes among home health care patients.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>We mainly used 2019 Outcome and Assessment Information Set data, Area Deprivation Index, and Quality of Patient Care Star Rating. We included Medicare beneficiaries (aged ≥ 65 years) who received home health care.</div></div><div><h3>Methods</h3><div>We used linear probability regression models to examine whether patients' neighborhood SES moderates the association between care quality of HHAs and health outcomes for 1,657,133 home health care patients.</div></div><div><h3>Results</h3><div>Our findings show that patients in neighborhoods with lower SES were more likely to use low-quality HHAs (lease disadvantaged neighborhoods: 11%, most disadvantaged neighborhoods: 15.2%). Our main model, adjusted by patient- and HHA-level characteristics, reveals patients living in socioeconomically disadvantaged neighborhoods (less disadvantaged: coefficient: −0.017, <em>P</em> < .001; more disadvantaged: coefficient: −0.035, <em>P</em> < .001; most disadvantaged: coefficient: −0.06, <em>P</em> < .001) and receiving care from low-quality HHAs (average-quality HHAs: coefficient: 0.037, <em>P</em> < .001; high-quality HHAs: coefficient: 0.062, <em>P</em> < .001) were less likely to remain in the community during their home health care. Furthermore, our study highlights that patients in the most disadvantaged neighborhoods encounter additional challenges in remaining at their homes and communities when they use low-quality HHAs.</div></div><div><h3>Conclusions and Implications</h3><div>These findings highlight the need for targeted interventions and policy initiatives aimed at addressing disparities in care quality based on neighborhood SES. Efforts directed at enhancing the quality of care provided by HHAs and access to high-quality HHAs in socioeconomically disadvantaged neighborhoods could substantially impact health equity and outcomes for individuals in these settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105378"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791505","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}
Objectives: Few supports exist for family/friend care partners when the care recipient is a person living with dementia in a care home. This study assessed the effectiveness of My Tools for Care-In Care (MT4C-In Care), a self-administered, web-based psychoeducational intervention.
Design: The overall study was a mixed methods pragmatic randomized controlled trial, with concurrent process evaluation and an active (educational) control. The intervention group received a link to MT4C-In Care for 2 months.
Setting and participants: Participants were eligible if they were an adult (≥18 years of age) who provided care to an older person (≥65 years of age) living with dementia in a care home in Canada (Alberta, Saskatchewan, Manitoba, or Ontario). An email address and internet access were required to participate.
Methods: Process evaluation included a study participation tracking form and a checklist to assess use of MT4C-In Care. We completed telephone interviews (February 2020 to October 2021) at baseline, 2 months, and 4 months to assess outcomes of social support, hope, grief, self-efficacy, loneliness, and mental health. In an intention-to-treat analysis, generalized estimating equations models were used to assess intervention impact, adjusting for covariates. Sensitivity analysis assessed whether exclusion of nonusers impacted the results.
Results: Participants (N = 234) were primarily white women, and spouses or an adult child of the person living with dementia. No effect between groups was observed for the primary outcome (mental health). We observed a small benefit of MT4C-In Care for a secondary outcome, social support. Use of MT4C-In Care within the intervention group was low (∼1 h/mo). Dropping nonusers from the analysis did not have a substantial impact on the main conclusions.
Conclusions and implications: Future research will explore use of MT4C-In Care by more diverse participant groups, and will clarify its core mechanisms, advancing understanding of impacts of psychoeducational interventions.
{"title":"Effectiveness of My Tools for Care-in Care: A Pragmatic Randomized Controlled Trial.","authors":"Hannah M O'Rourke, Jennifer Swindle, Pamela Baxter, Shelley Peacock, Genevieve Thompson, Sunita Ghosh, Dorothy Chacinski, Jayna Holroyd-Leduc, Véronique Dubé, Wendy Duggleby","doi":"10.1016/j.jamda.2025.105484","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105484","url":null,"abstract":"<p><strong>Objectives: </strong>Few supports exist for family/friend care partners when the care recipient is a person living with dementia in a care home. This study assessed the effectiveness of My Tools for Care-In Care (MT4C-In Care), a self-administered, web-based psychoeducational intervention.</p><p><strong>Design: </strong>The overall study was a mixed methods pragmatic randomized controlled trial, with concurrent process evaluation and an active (educational) control. The intervention group received a link to MT4C-In Care for 2 months.</p><p><strong>Setting and participants: </strong>Participants were eligible if they were an adult (≥18 years of age) who provided care to an older person (≥65 years of age) living with dementia in a care home in Canada (Alberta, Saskatchewan, Manitoba, or Ontario). An email address and internet access were required to participate.</p><p><strong>Methods: </strong>Process evaluation included a study participation tracking form and a checklist to assess use of MT4C-In Care. We completed telephone interviews (February 2020 to October 2021) at baseline, 2 months, and 4 months to assess outcomes of social support, hope, grief, self-efficacy, loneliness, and mental health. In an intention-to-treat analysis, generalized estimating equations models were used to assess intervention impact, adjusting for covariates. Sensitivity analysis assessed whether exclusion of nonusers impacted the results.</p><p><strong>Results: </strong>Participants (N = 234) were primarily white women, and spouses or an adult child of the person living with dementia. No effect between groups was observed for the primary outcome (mental health). We observed a small benefit of MT4C-In Care for a secondary outcome, social support. Use of MT4C-In Care within the intervention group was low (∼1 h/mo). Dropping nonusers from the analysis did not have a substantial impact on the main conclusions.</p><p><strong>Conclusions and implications: </strong>Future research will explore use of MT4C-In Care by more diverse participant groups, and will clarify its core mechanisms, advancing understanding of impacts of psychoeducational interventions.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105484"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jamda.2024.105413
Yanmin Tao MSN , Hongyan Wang MSN , Jingsong Luo MPH , Hong Zhang MD , Wen Zhang MSN , Meng Yu MSN , Shuyang Ji MSN , Sihan Peng MD , Xiangeng Zhang MD
{"title":"","authors":"Yanmin Tao MSN , Hongyan Wang MSN , Jingsong Luo MPH , Hong Zhang MD , Wen Zhang MSN , Meng Yu MSN , Shuyang Ji MSN , Sihan Peng MD , Xiangeng Zhang MD","doi":"10.1016/j.jamda.2024.105413","DOIUrl":"10.1016/j.jamda.2024.105413","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105413"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823911","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}
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