Journal of the American Medical Directors Association最新文献

{"title":"Association between Age-Related Macular Degeneration with Visual Disability and Risk of Dementia: A Nationwide Cohort Study","authors":"Ki Young Son MD ,&nbsp;Yong-Jun Choi BS ,&nbsp;Bongseong Kim PhD ,&nbsp;Kyungdo Han PhD ,&nbsp;Sungsoon Hwang MD ,&nbsp;Wonyoung Jung MD ,&nbsp;Dong Wook Shin MD, DrPH, MBA ,&nbsp;Dong Hui Lim MD, PhD","doi":"10.1016/j.jamda.2024.105392","DOIUrl":"10.1016/j.jamda.2024.105392","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the prospective association between the risk of dementia and age-related macular degeneration (AMD) in patients with related visual disability (VD).</div></div><div><h3>Design</h3><div>A nationwide population-based cohort study used authorized data provided by the Korean National Health Insurance Service.</div></div><div><h3>Setting and Participants</h3><div>A total of 1,788,457 individuals aged &gt;50 years who participated in the Korean National Health Screening Program were enrolled.</div></div><div><h3>Methods</h3><div>From January 2009 to December 2019, participants were tracked for a diagnosis of dementia using registered diagnostic codes from claims data. Participants with VD were defined as those registered in a national disability registration established by the Korean government. The prospective association of AMD and related VD with new-onset dementia was investigated using a multivariate-adjusted Cox proportional hazard model adjusted for age, sex, body mass index, income level, systemic comorbidities, psychiatric diseases, and behavioral factors.</div></div><div><h3>Results</h3><div>During the average follow-up period of 9.7 ± 2.16 years, 4260 of 21,384 participants in the AMD cohort and 137,166 of 1,662,319 participants in the control cohort were newly diagnosed with dementia, respectively. Participants diagnosed with AMD showed a higher risk of new-onset dementia than those in the control group in the fully adjusted model [hazard ratio (HR) 1.11, 95% CI 1.07–1.14]. The risk of dementia was higher in participants diagnosed with AMD and associated VD (HR 1.28, 95% CI 1.15–1.43) compared to those without VD (HR 1.09, 95% CI 1.06–1.13).</div></div><div><h3>Conclusions and Implications</h3><div>A diagnosis of AMD was associated with an increased risk of all-cause dementia and its major subtypes. Close monitoring of cognitive function in patients with AMD, especially those with VD, may help in early detection of all-cause dementia, which could reduce the socioeconomic burden and improve the quality of life of patients.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105392"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792044","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":"See Me, Feel Me, Touch Me, Heal Me: A Personal Reflection","authors":"Barbara Resnick PhD, CRNP","doi":"10.1016/j.jamda.2024.105391","DOIUrl":"10.1016/j.jamda.2024.105391","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105391"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094991","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":"Changing Trends in Job Satisfaction and Burnout for Care Aides in Long-Term Care Homes: The Role of Work Environment","authors":"Yinfei Duan PhD ,&nbsp;Trina Thorne MN ,&nbsp;Alba Iaconi PhD ,&nbsp;Yuting Song PhD ,&nbsp;Seyedehtanaz Saeidzadeh PhD ,&nbsp;Malcolm Doupe PhD ,&nbsp;Peter G. Norton MD ,&nbsp;Carole A. Estabrooks PhD","doi":"10.1016/j.jamda.2024.105380","DOIUrl":"10.1016/j.jamda.2024.105380","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examined the association between care unit work environments in long-term care (LTC) homes and trends in care aides’ job satisfaction and burnout (exhaustion, cynicism, reduced professional efficacy) from 2014 to early 2020.</div></div><div><h3>Design</h3><div>This was a retrospective longitudinal study using data from care aide surveys collected by the Translating Research in Elder Care research program over 3 periods: September 2014–May 2015 (T₁), May 2017–December 2017 (T₂), and September 2019–March 2020 (T₃).</div></div><div><h3>Settings and Participants</h3><div>The study included 631 care aides from a stratified random sample of 84 LTC homes in 3 Canadian provinces, who participated in data collection at all 3 time points.</div></div><div><h3>Methods</h3><div>We used mixed-effects linear regression with a “time by work environment” interaction to assess whether work environment is associated with trends in job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale) and burnout (Maslach Burnout Inventory-General Survey). We standardized the outcomes using z-scores.</div></div><div><h3>Results</h3><div>Between T₁ and T₂, care aides in care units with less favorable work environments—characterized by less supportive leadership, weaker work culture, less effective team communication and feedback mechanisms, and insufficient structural resources and staffing—experienced a statistically significant decline in job satisfaction (B = −0.17, <em>P</em> &lt; .01) and professional efficacy (B = −0.20, <em>P</em> &lt; .01), along with an increase in exhaustion (B = 0.15, <em>P</em> &lt; .05) and in cynicism (B = 0.27, <em>P</em> &lt; .001). Those in more favorable work environments exhibited no statistically significant changes in these variables during the same period. Moreover, care aides in less favorable work environments continued to experience an increase in exhaustion from T₂ to T₃ (B = 0.16, <em>P</em> &lt; .05).</div></div><div><h3>Conclusions and Implications</h3><div>A positive work environment at the care unit level mitigated the deterioration in care aides’ job satisfaction and burnout over the period studied. Targeted interventions to improve work environments show promise in sustaining the resilience of the care aide workforce.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105380"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792045","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}

{"title":"Comment on “Adverse Lipid Profiles are Associated With Lower Dementia Risk in Older People”","authors":"Mehmet Ilkin Naharci PhD","doi":"10.1016/j.jamda.2024.105376","DOIUrl":"10.1016/j.jamda.2024.105376","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105376"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792046","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":"A Team Coaching Intervention for Dementia Care: Acceptability and Feasibility Study in Care Communities","authors":"Jessica Welsch MA, MBA ,&nbsp;Boeun Kim PhD, RN ,&nbsp;Lorna Prophater MS ,&nbsp;Basia Belza PhD, RN ,&nbsp;Sam Fazio PhD","doi":"10.1016/j.jamda.2024.105379","DOIUrl":"10.1016/j.jamda.2024.105379","url":null,"abstract":"<div><h3>Objectives</h3><div>In 2018, the Alzheimer's Association published the Dementia Care Practice Recommendations (DCPR) to provide guidance on quality care for professionals. This study aimed to examine the feasibility and acceptability of a consultative coaching program to increase adoption of the DCPR.</div></div><div><h3>Design</h3><div>A single-group pre-post design was employed. A 6-month team coaching intervention was implemented to make organization-wide and measurable changes in the areas of (1) policies and procedures, (2) education and training, or (3) care practices to increase person-centered care practices.</div></div><div><h3>Setting and Participants</h3><div>A total of 36 care communities in Washington and Montana states were enrolled in this program.</div></div><div><h3>Methods</h3><div>Focus groups were conducted with participants to explore the acceptability and feasibility of the program. A 35-item employees satisfaction survey was administered both before and after the program.</div></div><div><h3>Results</h3><div>The findings offer preliminary evidence that implementing a coaching program is desired by care community staff and has a positive impact on staff job satisfaction and the use of person-centered care. The coaching model was received by staff as a supportive and affirming program.</div></div><div><h3>Conclusions and Implications</h3><div>The team coaching intervention, designed to improve person-centered care and employee satisfaction, is acceptable. However, its efficacy needs to be tested with a larger sample using a randomized controlled design.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105379"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755290","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}

{"title":"Development and Validation of a Nutritional Frailty Phenotype for Older Adults Based on Risk Prediction Model: Results from a Population-Based Prospective Cohort Study","authors":"Hongpeng Liu PhD, RN,&nbsp;Qinqin Liu PhD, RN,&nbsp;Huaxin Si PhD, RN,&nbsp;Jiaqi Yu PhD, RN,&nbsp;Yanyan Li PhD, RN,&nbsp;Wendie Zhou PhD, RN,&nbsp;Cuili Wang PhD","doi":"10.1016/j.jamda.2024.105425","DOIUrl":"10.1016/j.jamda.2024.105425","url":null,"abstract":"<div><h3>Objectives</h3><div>Malnutrition is generally studied to be involved in outlining hazard frailty trajectories, resulting in adverse outcomes. In view of frailty's multidimensional nature, we aimed to assess the contribution of nutritional items in existing frailty tools to adverse outcomes, and develop and validate a nutritional frailty phenotype based on machine learning.</div></div><div><h3>Design</h3><div>A population-based prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 7641 older adults from the China Health and Retirement Longitudinal Study (CHARLS) were included as the training set to develop the nutritional frailty phenotype between 2011 at baseline and 2013 at follow-up, and 8656 older adults between 2013 at baseline and 2015 at follow-up were included for temporally external validation.</div></div><div><h3>Methods</h3><div>The important predictors for 2-year incident adverse outcomes including all-cause mortality, disability, and combined outcomes were selected based on the least absolute shrinkage and selection operator. The nutritional frailty phenotype was developed using 2 machine learning models (random forest and eXtreme Gradient Boosting), and modified Poisson regression with the robust (sandwich) estimation of variance.</div></div><div><h3>Results</h3><div>Slowness (walking speed), lower extremity function (chair-stand test), and upper limb function (grip strength) were selected as important predictors for each outcome using least absolute shrinkage and selection operator. For the training set, the models for predicting all-cause mortality [area under the receiver operating characteristics curves (AUCs), 0.746–0.752; mean AUCs of the 5-fold cross validation: 0.746–0.752] and combined outcome (AUCs, 0.706–0.708; mean AUCs of the 5-fold cross validation, 0.706) showed acceptable discrimination, whereas the models for predicting incident disability had approximately acceptable discrimination (AUCs, 0.681–0.683; mean AUCs of the 5-fold cross validation, 0.681–0.684). For external validation, all models had acceptable discrimination, overall prediction performance, and clinical usefulness, but only the modified Poisson regression model for predicting incident disability had acceptable calibration.</div></div><div><h3>Conclusions and Implications</h3><div>A novel nutritional frailty phenotype may have direct implications for decreasing risk of adverse outcomes in older adults. Weakness and slowness play a major role in the progression of nutritional frailty, emphasizing that nutritional supplementation combined with exercise may be one of the feasible pathways to prevent or delay adverse outcomes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105425"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877436","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":"In-Hospital Adverse Events in Older Patients with Hip Fracture: A Multicenter Retrospective Study","authors":"Justine Lessard MD, MSc ,&nbsp;Chartelin Jean Isaac MD, Msc ,&nbsp;Axel Benhamed MD, MSc ,&nbsp;Valérie Boucher MSc ,&nbsp;Pierre-Gilles Blanchard MD, PhD ,&nbsp;Christian Malo MD, MSc ,&nbsp;Mélanie Bérubé PhD ,&nbsp;Stephane Pelet MD, PhD ,&nbsp;Etienne Belzile MD ,&nbsp;Marie-Pierre Fortin MD ,&nbsp;Marcel Émond MD, MSc","doi":"10.1016/j.jamda.2024.105384","DOIUrl":"10.1016/j.jamda.2024.105384","url":null,"abstract":"<div><h3>Objectives</h3><div>The main objective of this study was to measure the incidence of in-hospital adverse events in older adults presenting to the emergency department (ED) with an isolated traumatic hip fracture. The secondary objective was to identify the risk factors of adverse outcomes in those patients.</div></div><div><h3>Design</h3><div>Retrospective database analysis.</div></div><div><h3>Setting and Participants</h3><div>Adults aged ≥65 years presenting to 1 of the 3 Quebec level 1 adult trauma centers’ ED between 2003 and 2017 with an isolated hip fracture.</div></div><div><h3>Methods</h3><div>The main outcome was a composite of any adverse events defined as extended length of stay (LOS) &gt;21 days, in-hospital complications (delirium, pressure ulcers, urinary tract infection, pneumonia, deep venous thrombosis, or pulmonary embolism), and mortality. Outcomes were also analyzed separately. Multivariable logistic regression modeling was used to identify factors associated with adverse events.</div></div><div><h3>Results</h3><div>We included 4569 patients (female: 74.8%; mean age: 83.7 years). Low energy mechanisms were the most frequent cause of injury (68.4%), and the median LOS was 13 days (interquartile range, 8-21). A total of 1829 patients (40.0%) suffered an in-hospital adverse event: extended LOS (n = 1106; 24.2%), death (n = 365, 8.0%), and ≥1 complications (n = 892, 19.5%). Risk factors of any in-hospital adverse event included aged ≥75 years [75-84 years: adjusted odds ratio (AOR), 1.44; 95% CI, 1.17–1.76; ≥85 years: AOR, 2.11; 95% CI, 1.72–2.58], male sex (AOR, 1.35; 95% CI, 1.17–1.56), cardiovascular disease (AOR, 1.47; 95% CI, 1.23–1.77), major cognitive disorder (AOR, 1.51; 95% CI, 1.26–1.80), and ≥2 comorbidities (AOR, 1.40; 95% CI, 1.02–1.93). Direct admission from ED to the operating room was associated with decreased risk of any adverse event (AOR, 0.87; 95% CI, 0.76–0.99).</div></div><div><h3>Conclusions and Implications</h3><div>Two out of five patients presenting to a level-1 trauma center with an isolated hip fracture suffered from an adverse event. Aged ≥75 years, male sex, cardiovascular diseases, major cognitive disorder, and ≥2 comorbidities were significant risk factors. These factors may guide early identification of high-risk patients in the ED.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105384"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792047","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":"Moderate-to-Vigorous Physical Activity at any Dose Reduces All-Cause Dementia Risk Regardless of Frailty Status","authors":"Amal A. Wanigatunga PhD, MPH ,&nbsp;Yiwen Dong MS ,&nbsp;Mu Jin ScM ,&nbsp;Andrew Leroux PhD ,&nbsp;Erjia Cui PhD ,&nbsp;Xinkai Zhou PhD ,&nbsp;Angela Zhao ScM ,&nbsp;Jennifer A. Schrack PhD, MS ,&nbsp;Karen Bandeen-Roche PhD, MS ,&nbsp;Jeremy D. Walston MD ,&nbsp;Qian-Li Xue PhD ,&nbsp;Martin A. Lindquist PhD, MSc ,&nbsp;Ciprian M. Crainiceanu PhD, MS","doi":"10.1016/j.jamda.2024.105456","DOIUrl":"10.1016/j.jamda.2024.105456","url":null,"abstract":"<div><h3>Objectives</h3><div>Reaching the moderate-to-vigorous physical activity (MVPA) recommendations of 150 min/wk is difficult for older adults, particularly among those living with frailty and its associated risk of dementia. We examined the dose-response relationship between MVPA and dementia risk among at-risk persons living with and without frailty enrolled in the UK Biobank study.</div></div><div><h3>Design</h3><div>Survival analysis within a prospective cohort study.</div></div><div><h3>Settings and Participants</h3><div>Participants at risk for all-cause dementia who wore an Axivity AX3 triaxial wrist-worn accelerometer between February 2013 and December 2015.</div></div><div><h3>Methods</h3><div>MVPA was estimated from wrist-worn accelerometry in a subpopulation of the UK Biobank study. A modified version of the physical frailty phenotype was used to define frailty. Associations between MVPA dose (including interactions with frailty) and first-time incident dementia were analyzed using Cox regression models. MVPA was treated continuously and categorically across 5 levels to estimate the dose-response curve. Models were adjusted for demographics, frailty status, and comorbidities.</div></div><div><h3>Results</h3><div>This study included 89,667 adults (median age, 63 years; 56% women), with 735 participants developing dementia over an average of 4.4 years. Average weekly MVPA was 126 minutes. Each 30 minutes higher MVPA was associated with a 4% reduction in the risk of all-cause dementia (hazard ratio, 0.96; 95% CI, 0.93–0.99). The hazard ratios for engaging in 0–34.9, 35–69.9, 70–139.9, and ≥140 MVPA minutes per week were 0.59, 0.40, 0.37, and 0.31, respectively (<em>P</em> &lt; .05 for all) compared with 0 MVPA minutes per week. All associations were similar across frailty status (interaction <em>P</em> for all models &gt; .21).</div></div><div><h3>Conclusions and Implications</h3><div>Our results suggest engaging in any additional amount of MVPA reduces dementia risk, with the highest benefit appearing among individuals with no MVPA. These associations are not substantially modified by frailty status.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105456"},"PeriodicalIF":4.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007515","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":"Physicians Who Provide Primary Care in US Nursing Homes: Characteristics and Care Patterns.","authors":"Seiyoun Kim, Hyunkyung Yun, Yutong Zhang, Soong-Nang Jang, Mark Aaron Unruh, Hye-Young Jung","doi":"10.1016/j.jamda.2024.105475","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105475","url":null,"abstract":"<p><strong>Objectives: </strong>To examine practice trends and characteristics of primary care physicians providing care in US nursing homes.</p><p><strong>Design: </strong>Retrospective cohort study using Medicare Fee-for-Service claims.</p><p><strong>Setting and participants: </strong>Physicians who provided primary care to long-stay nursing home residents.</p><p><strong>Methods: </strong>Residents were attributed to physicians based on a plurality of evaluation and management visits in a given year. Trends in the proportion of nursing home residents seen by physicians in each primary care specialty over the period 2012-2019 were examined using linear regression. Comparisons of resident, physician, and nursing home characteristics in 2019 were made using analysis of variance tests and χ² tests for multiple comparisons.</p><p><strong>Results: </strong>Internal medicine specialists provided care to the largest portion of nursing home residents (47.3%), followed by family practitioners (42.6%), geriatricians (4.8%), general practice physicians (2.8%), and physical medicine and rehabilitation specialists (2.5%). Geriatricians and physical medicine and rehabilitation physicians had the highest average percentage of services provided in nursing homes (63.8% and 73.0%, P < .001) and were more likely to be specialized nursing home physicians (42.0% and 61.3%, P < .001). They also tended to care for residents with more complex needs. Geriatricians were more frequently concentrated in higher-quality nursing homes with more resources, and in metropolitan areas, compared with facilities where other types of physicians provided care.</p><p><strong>Conclusions and implications: </strong>There is wide variation associated with physician primary care specialty in the amount of care provided to nursing homes residents, in the characteristics of residents treated, and in the types of nursing homes where primary care physicians provide care. Further study is warranted to determine the sources of this variation, including whether it is associated with systemic problems in nursing home care (eg, shortages of geriatricians, low clinician reimbursements, undervaluation of nursing home clinicians compared with their counterparts, malpractice liability).</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105475"},"PeriodicalIF":4.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066528","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":"Medication Use in People Aged 90 Years and Older: A Nationwide Study","authors":"Lukshe Kanagaratnam MD, PhD ,&nbsp;Laura Semenzato MSc ,&nbsp;Edouard-Pierre Baudouin MD ,&nbsp;Joël Ankri MD, PhD ,&nbsp;Alain Weill MD, PhD ,&nbsp;Mahmoud Zureik MD, PhD","doi":"10.1016/j.jamda.2024.105459","DOIUrl":"10.1016/j.jamda.2024.105459","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to describe the medications prescribed to people aged ≥90 years.</div></div><div><h3>Design</h3><div>A cohort study was performed using data from the year 2022.</div></div><div><h3>Setting and Participants</h3><div>Using data from the French National Health Data System, people aged ≥90 years affiliated with the general insurance scheme were included.</div></div><div><h3>Methods</h3><div>Medications dispensed, polypharmacy (≥5 drugs), and hyperpolypharmacy (≥10 drugs) were described in the total population and according to sex, age group (90–94 years, 95–99 years, ≥100 years), and place of residence. All analyses were conducted by quarter because of the high mortality rate in this population.</div></div><div><h3>Results</h3><div>In total, 696,498 subjects were included in the study. Among them, 73.2% were women, 75.9% were aged 90–94 years, and 2.9% were ≥100 years. Treatment for hypertension was prescribed to 77%, 50.4% had cardiovascular disease, and 17.7% had dementia. During the first quarter, 77.7% experienced polypharmacy. The most prescribed drugs were antihypertensive medications (73.8%), analgesics (58.8%), antithrombotics (55.3%), vitamin D (51.1%), and psychotropics (42%). There was a decrease in preventive drugs and an increase in symptom management drugs with increasing age. Subjects in nursing homes were more likely to take psychotropics and less likely to receive cardiovascular drugs. The results for the other quarters were similar.</div></div><div><h3>Conclusions and Implications</h3><div>Our results suggest a progressive, but probably insufficient decrease in the prescription of certain medications with age and to a lesser extent, in nursing homes. The discontinuation of treatments should be discussed in the context of short life expectancy to avoid the harmful effects of polypharmacy.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105459"},"PeriodicalIF":4.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978700","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}