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Association between Age-Related Macular Degeneration with Visual Disability and Risk of Dementia: A Nationwide Cohort Study 年龄相关性黄斑变性伴视力障碍和痴呆风险之间的关系:一项全国性队列研究
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105392
Ki Young Son MD , Yong-Jun Choi BS , Bongseong Kim PhD , Kyungdo Han PhD , Sungsoon Hwang MD , Wonyoung Jung MD , Dong Wook Shin MD, DrPH, MBA , Dong Hui Lim MD, PhD

Objectives

To investigate the prospective association between the risk of dementia and age-related macular degeneration (AMD) in patients with related visual disability (VD).

Design

A nationwide population-based cohort study used authorized data provided by the Korean National Health Insurance Service.

Setting and Participants

A total of 1,788,457 individuals aged >50 years who participated in the Korean National Health Screening Program were enrolled.

Methods

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.

Results

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).

Conclusions and Implications

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.
目的:研究相关视力障碍(VD)患者痴呆风险与年龄相关性黄斑变性(AMD)之间的前瞻性关联。设计:一项基于全国人群的队列研究,使用韩国国民健康保险服务机构提供的授权数据。环境和参与者:共有1,788,457名年龄在100至50岁之间的人参加了韩国国家健康筛查计划。方法:从2009年1月到2019年12月,使用来自索赔数据的注册诊断代码跟踪参与者的痴呆症诊断。VD患者被定义为在韩国政府设立的国家残疾登记中登记的人。采用多变量校正Cox比例风险模型,对年龄、性别、体重指数、收入水平、全身合并症、精神疾病和行为因素进行校正,研究AMD和相关VD与新发痴呆的前瞻性关联。结果:在平均9.7±2.16年的随访期间,AMD组21384名参与者中有4260名新诊断为痴呆,对照组1662319名参与者中有137166名新诊断为痴呆。在完全调整模型中,被诊断为AMD的参与者患新发痴呆的风险高于对照组[风险比(HR) 1.11, 95% CI 1.07-1.14]。诊断为AMD和相关VD的参与者患痴呆的风险(HR 1.28, 95% CI 1.15-1.43)高于无VD的参与者(HR 1.09, 95% CI 1.06-1.13)。结论和意义:AMD的诊断与全因痴呆及其主要亚型的风险增加有关。密切监测AMD患者的认知功能,特别是伴有VD的患者,可能有助于早期发现全因痴呆,从而减轻患者的社会经济负担,提高患者的生活质量。
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引用次数: 0
See Me, Feel Me, Touch Me, Heal Me: A Personal Reflection
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105391
Barbara Resnick PhD, CRNP
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引用次数: 0
Changing Trends in Job Satisfaction and Burnout for Care Aides in Long-Term Care Homes: The Role of Work Environment 长期护理院护理员工作满意度和职业倦怠的变化趋势:工作环境的作用。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105380
Yinfei Duan PhD , Trina Thorne MN , Alba Iaconi PhD , Yuting Song PhD , Seyedehtanaz Saeidzadeh PhD , Malcolm Doupe PhD , Peter G. Norton MD , Carole A. Estabrooks PhD

Objectives

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.

Design

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).

Settings and Participants

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.

Methods

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.

Results

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, P < .01) and professional efficacy (B = −0.20, P < .01), along with an increase in exhaustion (B = 0.15, P < .05) and in cynicism (B = 0.27, P < .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, P < .05).

Conclusions and Implications

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.
目的:本研究考察了2014年至2020年初长期护理(LTC)之家护理单位工作环境与护理助理工作满意度和职业倦怠(疲惫、愤世嫉俗、职业效能降低)趋势之间的关系。设计:本研究是一项回顾性纵向研究,使用老年护理研究项目翻译研究收集的护理助理调查数据,共分三个时期:2014年9月- 2015年5月(T1)、2017年5月- 2017年12月(T2)和2019年9月- 2020年3月(T3)。环境和参与者:该研究包括631名护理助理,他们来自加拿大3个省84个LTC家庭的分层随机样本,在所有3个时间点参与数据收集。方法:采用“时间与工作环境”交互作用的混合效应线性回归来评估工作环境是否与工作满意度(密歇根组织评估问卷工作满意度子量表)和职业倦怠(Maslach职业倦怠量表)的趋势相关。我们使用z分数对结果进行标准化。结果:T1和T2之间,在护理单元护理助手少有利工作environments-characterized支持性的领导,较弱的工作文化,团队的有效沟通和反馈机制和结构性资源不足和staffing-experienced工作满意度显著下降(P < . 01)和B = -0.17,专业的功效(B = -0.20, P < . 01),以及增加疲惫(B = 0.15, P < . 05)和犬儒主义(B = 0.27, P <措施)。在同一时期,那些在更有利的工作环境中工作的人在这些变量上没有统计学上的显著变化。此外,在较不利的工作环境中的护理人员从T2到T3的疲劳程度继续增加(B = 0.16, P < 0.05)。结论和启示:在研究期间,护理单位层面的积极工作环境减轻了护理助理工作满意度和倦怠的恶化。改善工作环境的有针对性的干预措施有望维持护理人员队伍的复原力。
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引用次数: 0
Comment on “Adverse Lipid Profiles are Associated With Lower Dementia Risk in Older People” 对“不良脂质谱与老年人痴呆风险降低相关”的评论。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105376
Mehmet Ilkin Naharci PhD
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引用次数: 0
A Team Coaching Intervention for Dementia Care: Acceptability and Feasibility Study in Care Communities 团队指导干预痴呆护理:护理社区的可接受性和可行性研究。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105379
Jessica Welsch MA, MBA , Boeun Kim PhD, RN , Lorna Prophater MS , Basia Belza PhD, RN , Sam Fazio PhD

Objectives

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.

Design

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.

Setting and Participants

A total of 36 care communities in Washington and Montana states were enrolled in this program.

Methods

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.

Results

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.

Conclusions and Implications

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.
目标:2018年,阿尔茨海默病协会发布了《痴呆症护理实践建议》(DCPR),为专业人员提供优质护理指导。本研究旨在探讨咨询辅导计划的可行性和可接受性,以提高DCPR的采用。设计:采用单组岗前设计。实施了为期6个月的团队指导干预,以在(1)政策和程序,(2)教育和培训,或(3)护理实践方面实现组织范围内可衡量的变化,以增加以人为本的护理实践。环境和参与者:华盛顿州和蒙大拿州共有36个护理社区参加了这个项目。方法:采用焦点小组法,探讨项目的可接受性和可行性。在项目前后进行了一项包含35个项目的员工满意度调查。结果:本研究结果提供了初步证据,证明实施辅导计划是护理社区员工所期望的,并且对员工的工作满意度和以人为本的护理的使用有积极的影响。教练模式被员工视为一种支持和肯定的计划。结论与启示:团队指导干预,旨在提高以人为本的护理和员工满意度,是可以接受的。然而,其有效性需要使用随机对照设计在更大的样本中进行测试。
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引用次数: 0
Development and Validation of a Nutritional Frailty Phenotype for Older Adults Based on Risk Prediction Model: Results from a Population-Based Prospective Cohort Study 基于风险预测模型的老年人营养脆弱表型的开发和验证:来自基于人群的前瞻性队列研究的结果。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105425
Hongpeng Liu PhD, RN, Qinqin Liu PhD, RN, Huaxin Si PhD, RN, Jiaqi Yu PhD, RN, Yanyan Li PhD, RN, Wendie Zhou PhD, RN, Cuili Wang PhD

Objectives

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.

Design

A population-based prospective cohort study.

Setting and Participants

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.

Methods

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.

Results

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.

Conclusions and Implications

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.
目的:营养不良通常被研究为涉及概述危险脆弱轨迹,导致不良后果。鉴于脆弱性的多维性,我们旨在评估现有脆弱性工具中营养项目对不良后果的贡献,并基于机器学习开发和验证营养脆弱性表型。设计:基于人群的前瞻性队列研究。背景和参与者:来自中国健康与退休纵向研究(CHARLS)的7641名老年人被纳入培训集,以开发2011年基线至2013年随访期间的营养脆弱表型,并纳入2013年基线至2015年随访期间的8656名老年人进行暂时的外部验证。方法:根据最小的绝对收缩和选择算子,选择2年事件不良结局的重要预测因子,包括全因死亡率、残疾和综合结局。利用2种机器学习模型(随机森林模型和极端梯度增强模型)和改进的泊松回归(稳健(三明治)方差估计)来开发营养脆弱表型。结果:使用最小绝对收缩和选择算子,选择慢速(行走速度)、下肢功能(椅-架测试)和上肢功能(握力)作为每个结果的重要预测因子。对于训练集,全因死亡率预测模型(受试者工作特征曲线下面积[auc], 0.746-0.752;5倍交叉验证的平均auc: 0.746-0.752)和综合结果(auc, 0.706-0.708;5重交叉验证的平均auc, 0.706)显示可接受的歧视,而预测事件残疾的模型具有近似可接受的歧视(auc, 0.681-0.683;5倍交叉验证的平均auc为0.681-0.684)。对于外部验证,所有模型都具有可接受的判别性、总体预测性能和临床实用性,但只有用于预测事件残疾的修正泊松回归模型具有可接受的校准。结论和意义:一种新的营养脆弱表型可能对降低老年人不良后果的风险有直接意义。虚弱和迟钝在营养脆弱的进展中起着重要作用,强调营养补充与运动相结合可能是预防或延缓不良后果的可行途径之一。
{"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}
引用次数: 0
In-Hospital Adverse Events in Older Patients with Hip Fracture: A Multicenter Retrospective Study 老年髋部骨折患者的住院不良事件:一项多中心回顾性研究
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105384
Justine Lessard MD, MSc , Chartelin Jean Isaac MD, Msc , Axel Benhamed MD, MSc , Valérie Boucher MSc , Pierre-Gilles Blanchard MD, PhD , Christian Malo MD, MSc , Mélanie Bérubé PhD , Stephane Pelet MD, PhD , Etienne Belzile MD , Marie-Pierre Fortin MD , Marcel Émond MD, MSc

Objectives

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.

Design

Retrospective database analysis.

Setting and Participants

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.

Methods

The main outcome was a composite of any adverse events defined as extended length of stay (LOS) >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.

Results

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).

Conclusions and Implications

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.
目的:本研究的主要目的是测量在急诊室(ED)出现孤立的外伤性髋部骨折的老年人住院不良事件的发生率。次要目的是确定这些患者不良结局的危险因素。设计:回顾性数据库分析。背景和参与者:2003年至2017年期间,在魁北克3个1级成人创伤中心的急诊科中,有1个出现孤立性髋部骨折的成人≥65岁。方法:主要结局是任何不良事件的综合,定义为延长住院时间(LOS) bbb21天,院内并发症(谵妄,压疮,尿路感染,肺炎,深静脉血栓形成或肺栓塞)和死亡率。结果也分别进行分析。采用多变量logistic回归模型确定与不良事件相关的因素。结果:纳入4569例患者,其中女性占74.8%;平均年龄83.7岁)。低能量机制是最常见的损伤原因(68.4%),中位LOS为13天(四分位数间距为8-21)。共有1829名患者(40.0%)发生了院内不良事件:延长的LOS (n = 1106;24.2%),死亡(n = 365, 8.0%),≥1并发症(n = 892, 19.5%)。院内不良事件的危险因素包括:年龄≥75岁(75-84岁:调整优势比[AOR], 1.44;95% ci, 1.17-1.76;≥85岁:AOR 2.11;95% CI, 1.72-2.58),男性(AOR, 1.35;95% CI, 1.17-1.56),心血管疾病(AOR, 1.47;95% CI, 1.23-1.77),严重认知障碍(AOR, 1.51;95% CI, 1.26-1.80),且合并症≥2例(AOR, 1.40;95% ci, 1.02-1.93)。直接从急诊科进入手术室与任何不良事件的风险降低相关(AOR, 0.87;95% ci, 0.76-0.99)。结论和意义:在1级创伤中心就诊的孤立性髋部骨折患者中,有相当数量的患者出现了不良事件。年龄≥75岁、男性、心血管疾病、严重认知障碍和≥2种合并症是显著危险因素。这些因素可以指导急诊科高危患者的早期识别。
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引用次数: 0
Moderate-to-Vigorous Physical Activity at any Dose Reduces All-Cause Dementia Risk Regardless of Frailty Status 无论身体虚弱与否,任何剂量的中高强度体力活动都能降低全因痴呆风险。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-01-28 DOI: 10.1016/j.jamda.2024.105456
Amal A. Wanigatunga PhD, MPH , Yiwen Dong MS , Mu Jin ScM , Andrew Leroux PhD , Erjia Cui PhD , Xinkai Zhou PhD , Angela Zhao ScM , Jennifer A. Schrack PhD, MS , Karen Bandeen-Roche PhD, MS , Jeremy D. Walston MD , Qian-Li Xue PhD , Martin A. Lindquist PhD, MSc , Ciprian M. Crainiceanu PhD, MS

Objectives

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.

Design

Survival analysis within a prospective cohort study.

Settings and Participants

Participants at risk for all-cause dementia who wore an Axivity AX3 triaxial wrist-worn accelerometer between February 2013 and December 2015.

Methods

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.

Results

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 (P < .05 for all) compared with 0 MVPA minutes per week. All associations were similar across frailty status (interaction P for all models > .21).

Conclusions and Implications

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.
目标:老年人很难达到150分钟/周的中等至高强度体力活动(MVPA)推荐值,尤其是那些身体虚弱且有痴呆风险的老年人。我们在英国生物银行的研究中检查了MVPA与痴呆风险之间的剂量-反应关系。设计:前瞻性队列研究中的生存分析。设置和参与者:2013年2月至2015年12月期间佩戴Axivity AX3三轴腕带加速度计的有全因痴呆风险的参与者。方法:在英国生物银行研究的一个亚群中,通过腕带加速度计估计MVPA。身体脆弱表型的修改版本被用来定义脆弱。使用Cox回归模型分析MVPA剂量(包括与虚弱的相互作用)与首次发生痴呆之间的关系。MVPA连续治疗,分类治疗5个水平,以估计剂量-反应曲线。模型根据人口统计学、虚弱状态和合并症进行了调整。结果:本研究纳入89,667名成人(中位年龄63岁;(56%为女性),735名参与者在平均4.4年的时间里患上了痴呆症。平均每周MVPA为126分钟。MVPA每提高30分钟,全因痴呆的风险降低4%(风险比,0.96;95% ci, 0.93-0.99)。与每周0 MVPA分钟相比,每周0-34.9分钟、35-69.9分钟、70-139.9分钟和≥140 MVPA分钟的风险比分别为0.59、0.40、0.37和0.31(均P < 0.05)。所有的关联在虚弱状态下都是相似的(所有模型的交互P为0.21)。结论和意义:我们的研究结果表明,参与任何额外量的MVPA都可以降低痴呆风险,在没有MVPA的个体中获益最大。这些关联不会因身体虚弱而发生实质性的改变。
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引用次数: 0
Physicians Who Provide Primary Care in US Nursing Homes: Characteristics and Care Patterns.
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-01-27 DOI: 10.1016/j.jamda.2024.105475
Seiyoun Kim, Hyunkyung Yun, Yutong Zhang, Soong-Nang Jang, Mark Aaron Unruh, Hye-Young Jung

Objectives: To examine practice trends and characteristics of primary care physicians providing care in US nursing homes.

Design: Retrospective cohort study using Medicare Fee-for-Service claims.

Setting and participants: Physicians who provided primary care to long-stay nursing home residents.

Methods: 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.

Results: 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.

Conclusions and implications: 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).

目的研究在美国养老院提供医疗服务的初级保健医生的执业趋势和特点:设计:使用联邦医疗保险付费服务索赔进行回顾性队列研究:环境和参与者:为长期入住疗养院的居民提供初级保健服务的医生:方法:根据特定年份中的多次评估和管理访问,将居民归属于医生。采用线性回归法研究了 2012-2019 年间由各初级保健专科医师诊治的疗养院居民比例的变化趋势。使用方差分析检验和χ2检验进行多重比较,比较了2019年居民、医生和养老院的特征:为最大一部分疗养院居民提供护理的是内科专家(47.3%),其次是家庭医生(42.6%)、老年病科医生(4.8%)、全科医生(2.8%)以及物理医学和康复专家(2.5%)。老年病学医生和物理医学与康复医生在疗养院提供服务的平均比例最高(分别为 63.8% 和 73.0%,P < .001),而且更有可能成为专业的疗养院医生(分别为 42.0% 和 61.3%,P < .001)。他们还倾向于为需求更复杂的住院患者提供护理。与由其他类型的医生提供护理的机构相比,老年病科医生更多集中在拥有更多资源的高质量疗养院和大都市地区:在为疗养院居民提供的医疗服务数量、接受治疗的居民特征以及初级保健医生提供医疗服务的疗养院类型方面,与初级保健医生专业相关的差异很大。有必要进一步研究以确定这种差异的来源,包括它是否与养老院护理的系统性问题有关(例如,老年病医生短缺、临床医生报销比例低、养老院临床医生的价值被低估、渎职责任)。
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引用次数: 0
Medication Use in People Aged 90 Years and Older: A Nationwide Study 90岁及以上人群的药物使用:一项全国性研究。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2025-01-27 DOI: 10.1016/j.jamda.2024.105459
Lukshe Kanagaratnam MD, PhD , Laura Semenzato MSc , Edouard-Pierre Baudouin MD , Joël Ankri MD, PhD , Alain Weill MD, PhD , Mahmoud Zureik MD, PhD

Objective

We aimed to describe the medications prescribed to people aged ≥90 years.

Design

A cohort study was performed using data from the year 2022.

Setting and Participants

Using data from the French National Health Data System, people aged ≥90 years affiliated with the general insurance scheme were included.

Methods

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.

Results

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.

Conclusions and Implications

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.
目的:描述≥90岁人群的用药情况。设计:使用2022年的数据进行队列研究。环境和参与者:使用来自法国国家健康数据系统的数据,纳入≥90岁的一般保险计划相关人群。方法:按性别、年龄组别(90 ~ 94岁、95 ~ 99岁、≥100岁)和居住地,对总体用药情况、多药(≥5种药物)、多药(≥10种药物)进行描述。所有的分析都是按季度进行的,因为这一人群的死亡率很高。结果:共纳入696,498名受试者。其中女性占73.2%,年龄在90 ~ 94岁的占75.9%,年龄≥100岁的占2.9%。77%的人接受高血压治疗,50.4%的人患有心血管疾病,17.7%的人患有痴呆症。在第一季度,77.7%的人使用过多种药物。处方药物最多的是降压药(73.8%)、镇痛药(58.8%)、抗血栓药(55.3%)、维生素D(51.1%)和精神药物(42%)。随着年龄的增长,预防药物的使用减少,症状治疗药物的使用增加。疗养院的受试者更有可能服用精神类药物,而接受心血管类药物的可能性更小。其他季度的结果也差不多。结论和意义:我们的研究结果表明,随着年龄的增长,某些药物处方的减少是渐进的,但可能不够,在较小程度上,在养老院。停药应在预期寿命短的情况下讨论,以避免多药的有害影响。
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引用次数: 0
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Journal of the American Medical Directors Association
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