Journal of the American Medical Directors Association最新文献

{"title":"Development and Validation of a Skeletal Muscle Prediction Equation From Anthropometric and Demographic Data","authors":"Jianqin Sun MPS, RD ,&nbsp;Yanqiu Chen BS, RD ,&nbsp;Jiajie Zang PhD ,&nbsp;Fei Xiao BS, DTR ,&nbsp;Wuke Yuan MPH, RD ,&nbsp;Xiaoli Wang PhD, RD ,&nbsp;Zhengyuan Wang PhD ,&nbsp;Jurong Zhang BS ,&nbsp;Xin Peng BS ,&nbsp;Yuehong Li BS ,&nbsp;Yi Hou BS ,&nbsp;Haiqin Wang BS ,&nbsp;Hong Chen BS ,&nbsp;Jie Chen PhD ,&nbsp;Zhijun Bao PhD","doi":"10.1016/j.jamda.2025.106065","DOIUrl":"10.1016/j.jamda.2025.106065","url":null,"abstract":"<div><h3>Objectives</h3><div>Appendicular skeletal muscle mass (ASM), a core parameter for sarcopenia diagnosis, is difficult to measure in primary care facilities lacking specialized equipment. This study was conducted to develop and validate an ASM prediction equation based on simple anthropometric and demographic indices.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>The study included 5016 community-dwelling older adults (mean age, 71.0 ± 5.6 years; women, 55.9%).</div></div><div><h3>Methods</h3><div>Anthropometric and demographic data were collected by uniformly trained medical staff. ASM was measured through bioelectrical impedance analysis (BIA). The participants were randomly divided (4:1) into a development group (n = 4013) and a validation group (n = 1003). Stepwise multivariate linear regression was performed to establish the ASM prediction equation.</div></div><div><h3>Results</h3><div>The equation for predicting ASM was as follows: ASM (kg) = 0.232 × height (cm) + 0.128 × weight (kg) + 0.128 × calf circumference (cm) − 2.039 × sex (men: 1, women: 2) − 0.021 × age (years) − 27.129. It exhibited an adjusted <em>R</em>² value of 0.90 and a standard error of estimate value of 1.34 kg. In the validation group, a strong correlation was observed between ASM measured using our equation and that measured through BIA (r = 0.952; <em>P</em> &lt; .001). The Bland-Altman plot showed that the mean difference between the results for our equation and for BIA was −0.03 kg, with limits of agreement (mean 1.96 SD) of −2.4 to 2.3 kg. The intraclass correlation coefficient was 0.951 (95% CI, 0.945–0.957), indicating excellent between-method consistency.</div></div><div><h3>Conclusions and Implications</h3><div>Our equation appears to have high predictive power. With rapid and simple measurement of anthropometric and demographic indices, the equation can be used to evaluate ASM in primary care facilities lacking specialized equipment.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106065"},"PeriodicalIF":3.8,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906178","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":"Changes in Long-Term Care Markets: Assisted Living Capacity and the Prevalence of Nursing Home Residents With Dementia From 2019 to 2023","authors":"Erh-Chi Hsu PhD(c), MPH, RN ,&nbsp;Gauri Gadkari MS ,&nbsp;Jennifer N. Bunker MPH ,&nbsp;Lindsey Smith PhD ,&nbsp;Cassandra L. Hua PhD ,&nbsp;Eric Jutkowitz PhD ,&nbsp;Kali S. Thomas PhD","doi":"10.1016/j.jamda.2025.106068","DOIUrl":"10.1016/j.jamda.2025.106068","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate how changes in assisted living (AL) capacity influence the prevalence of nursing home (NH) residents with dementia.</div></div><div><h3>Design</h3><div>This is a panel study. We used state AL licensing data for 2019, 2021, and 2023, linked with NH data from <span><span>LTCFocus.org</span><svg><path></path></svg></span>. The outcome was the percentage of residents with a dementia diagnosis in each NH. The main exposure variable was the number of AL beds within a 15-mile radius of a given NH.</div></div><div><h3>Setting and Participants</h3><div>11,030 NHs in the contiguous United States operating in 2019, 2021, and 2023 with data on residents’ dementia diagnoses.</div></div><div><h3>Methods</h3><div>We used linear probability models with year and facility fixed effects to examine the relationship between changes in AL capacity and memory care AL capacity and the percentage of NH residents with dementia, adjusting for market and time-varying NH characteristics.</div></div><div><h3>Results</h3><div>On average, dementia prevalence in NHs decreased from 50.8% (SD = 14.6) of residents to 44.6% (SD = 14.6) over the study period. Within markets, total AL beds increased averagely from 2897.8 to 3202.2 between 2019 and 2023; the average number of memory care beds increased from 993.3 to 1222.0. In the adjusted model, a 100-bed increase in AL capacity corresponded with a 0.1 (SE = 0.02)–percentage point reduction in the prevalence of NH residents with dementia (<em>P</em> &lt; .001). A 100-bed increase in memory care AL capacity was associated with a lower, but not statistically significant, share of NH residents with dementia (β = −0.02, SE = 0.02; <em>P</em> = .2).</div></div><div><h3>Conclusions and Implications</h3><div>Findings suggest that increased AL capacity—but not memory care—may postpone entry or divert NH placement among people living with dementia. Future research should explore how AL expansion affects health outcomes, care quality, and lived experiences for individuals with dementia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106068"},"PeriodicalIF":3.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944804","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":"Prevalence and Risk Factors for Falls in Older Adults With Diabetes: A Systematic Review and Meta-Analysis","authors":"Tuonan Liu MS ,&nbsp;Yue Lin MS ,&nbsp;Rui Qi MS ,&nbsp;Xuan Chen MS ,&nbsp;Yingjing Xiao MS ,&nbsp;Wenrong Xu BS ,&nbsp;Jie Yao MS ,&nbsp;Yan Hua PhD","doi":"10.1016/j.jamda.2025.106012","DOIUrl":"10.1016/j.jamda.2025.106012","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the prevalence of falls and to assess risk factors associated with falls in older adults with diabetes.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>Older adults with diabetes (≥60 years).</div></div><div><h3>Methods</h3><div>The literature search encompassed international (PubMed, Web of Science, Embase, Cochrane Library) and Chinese databases (CNKI, Wanfang, VIP, CBM) using systematic methods. The first search was conducted in June 2024, and the search was updated in May 2025. The 2 researchers independently conducted study selection, quality assessments, and data extraction. The meta-analysis was conducted using Stata 16.0 and RevMan 5.3. Pooled incidence rates and odds ratios for the prevalence of falls in older adults with diabetes, as well as for risk factors examined comparably in at least 2 studies, were calculated using fixed or random-effects models.</div></div><div><h3>Results</h3><div>The systematic review screened 5699 articles, ultimately analyzing data from 32 studies that included 23,666 older adults with diabetes. The pooled prevalence of falls in older adults with diabetes was 29.5%. This risk factor synthesis pooled data from 20 eligible studies, 15 distinct factors demonstrated statistically significant associations with falling incidents, including age, gender, timed up and go test, handgrip strength, cognitive dysfunction, depression, use of walking aids, gait issues, balance difficulties, weight loss, visual function abnormalities, diabetic retinopathy, hypoglycemia, diabetic peripheral neuropathy, and sleep quality.</div></div><div><h3>Conclusions and Implications</h3><div>Older adults with diabetes present a higher risk of falls. Health care providers should screen for factors associated with elevated fall risk and implement early interventions targeting modifiable risk factors to mitigate fall incidents in older adults with diabetes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106012"},"PeriodicalIF":3.8,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145635157","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":"Treatment-Resistant Neuropsychiatric Symptoms in Dementia: Development of a Conceptual Framework","authors":"Kevin O'Hara-Veintimilla MD ,&nbsp;Miguel Germán Borda MD, PhD ,&nbsp;Javier Olivera MD, PhD ,&nbsp;Manuel Sánchez-Pérez MD, PhD ,&nbsp;Audun Osland Vik-Mo MD, PhD ,&nbsp;David Hui MD, MSc","doi":"10.1016/j.jamda.2025.106074","DOIUrl":"10.1016/j.jamda.2025.106074","url":null,"abstract":"<div><h3>Objectives</h3><div>To develop 2 practice-informed conceptual frameworks for treatment-resistant neuropsychiatric symptoms (TR-NPS) in dementia—1 for community-based care and 1 for hospital-based care.</div></div><div><h3>Design</h3><div>Qualitative, conceptual study examining the ethical, clinical, and existential dimensions of TR-NPS in dementia.</div></div><div><h3>Setting and Participants</h3><div>The work drew on routine clinical practice in inpatient psychogeriatric units and community-based dementia services.</div></div><div><h3>Methods</h3><div>We conducted a targeted PubMed/MEDLINE review and structured, consensus-based discussions among a multidisciplinary team. Reflexive thematic analysis was used to identify key themes.</div></div><div><h3>Results</h3><div>We developed 2 practice-informed conceptual frameworks (community and hospital) supported by 4 overarching themes: (1) the need for proper recognition of TR-NPS to tailor management; (2) differing trajectories and decision-making processes at home vs in hospital; (3) the importance of addressing multidimensional suffering and preserving dignity; and (4) the need for early integration of palliative care principles, practices, and specialist teams.</div></div><div><h3>Conclusion and Implications</h3><div>TR-NPS in advanced dementia mark a threshold for timely recognition and a shift from further pharmacologic escalation toward proportionate, goal-concordant, dignity-preserving care that explicitly addresses multidimensional suffering and aligns with patient values. Early, collaborative involvement of specialist palliative care teams, together with structured caregiver support, may reduce unwarranted variation and promote consistent, person-centered practice across community and hospital settings. Future work should operationalize criteria and referral triggers for TR-NPS, develop setting-adaptable decision tools and pathways, and evaluate models of early palliative care comanagement using outcomes that emphasize comfort and dignity for patients and caregivers.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106074"},"PeriodicalIF":3.8,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948977","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":"Longitudinal Changes in Long COVID Symptoms by Sex and Age Among Geriatric Residents of Residential Care Facilities: A Multicenter Cohort Study in Hefei, China","authors":"Qiqin Wu MB ,&nbsp;Yuqing Zhao BSc ,&nbsp;Xin Fang MB ,&nbsp;Tong Chen MB ,&nbsp;Chengyuan Zhang MMed ,&nbsp;Zhengkui Liu PhD ,&nbsp;Cui Wang MD","doi":"10.1016/j.jamda.2025.106071","DOIUrl":"10.1016/j.jamda.2025.106071","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate the symptomatic evolution of long COVID and to identify factors influencing its progression in a predominantly older population.</div></div><div><h3>Design</h3><div>This was a prospective cohort study with long-term follow-up, conducting 3 assessment waves between January 8, 2023, and August 15, 2024.</div></div><div><h3>Setting and Participants</h3><div>The study included 228 of an initial cluster sample of 266 residents from 5 long-term care facilities in Hefei, China, all with prior SARS-CoV-2 infection, who completed all follow-ups.</div></div><div><h3>Methods</h3><div>Data were collected via study-specific demographic questionnaires and a long COVID symptom scale. Descriptive statistics, Cochran's Q tests, <em>t</em> tests, partial correlations controlling for age, and generalized estimating equations were used to analyze symptom distribution, comparisons, longitudinal relationships, and influencing factors.</div></div><div><h3>Results</h3><div>At T1, low mood (81.1%) and sleep disturbances (81.1%) were the most common symptoms. At T2, fatigue (54.8%) and pain in other body parts (59.2%) became the main symptoms. Dizziness (44.7%) was the most frequent symptom at T3. Independent samples <em>t</em> tests revealed that women had consistently higher total symptom scores than men (<em>P</em> &lt; .05). Compared with the younger group (&lt;76 years), the older group (≥76 years) had higher scores at T2 across multiple symptoms and in the overall score. Partial correlation analysis showed the correlation was strongest between T1 and T2 (r = 0.224, <em>P</em> = .001). The generalized estimating equations model indicated that men had a lower risk of symptoms in most organ systems (OR = 0.257–0.912).</div></div><div><h3>Conclusions and Implications</h3><div>Long COVID symptoms in predominantly older individuals showed progressive improvement. Women had more severe symptoms and advanced age slowed the recovery process. However, long-term recovery depended on the individual. This study advocates for implementing personalized, stage-specific care models over standardized protocols in residential care facilities, emphasizing the need for targeted monitoring of high-risk subgroups such as women and older residents.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106071"},"PeriodicalIF":3.8,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145912013","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":"Nutritional and Pharmacological Interventions for Sarcopenia in Older Adults: A Systematic Review and Network Meta-Analysis","authors":"Meng Zhang MMSc ,&nbsp;Yanjiao Shen MMSc ,&nbsp;Ya Gao PhD ,&nbsp;Xiaolian Jiang PhD ,&nbsp;Jirong Yue PhD ,&nbsp;Qiukui Hao PhD","doi":"10.1016/j.jamda.2025.106038","DOIUrl":"10.1016/j.jamda.2025.106038","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare the impacts of different nutritional supplements and drugs on older adults with sarcopenia.</div></div><div><h3>Design</h3><div>Systematic review and network meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>Participants with sarcopenia receiving nutritional and pharmacological interventions targeting sarcopenia in any setting.</div></div><div><h3>Methods</h3><div>We systematically searched electronic databases, including Embase, MEDLINE, the Cochrane Central Registry of Controlled Trials, Web of Science, and CINAHL up to April 2022. We included randomized controlled trials (RCTs) that examined the efficiency of nutritional and pharmacological interventions on patient-important outcomes in older adults with sarcopenia. We conducted frequent random-effects network meta-analyses to synthesize the evidence and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework to assess the certainty of the evidence.</div></div><div><h3>Results</h3><div>After screening 12,308 articles, we included 59 RCTs (N = 5543). Multinutrition [standardized mean difference (SMD), 0.65; 95% CI, 0.04–1.26], protein (SMD, 0.77; 95% CI, 0.38–1.17), and protein with vitamin D (SMD, 0.37; 95% CI, 0.03–0.72) probably improve the quality of life compared with usual care (moderate certainty). The combination of protein and vitamin D [mean difference (MD), 2.07 kg; 95% CI, 0.91–3.23] probably enhance handgrip strength (moderate certainty) and multinutrition (MD, 2.32 kg; 95% CI, 0.85–3.79) may improve handgrip strength (low certainty). However, the drug intervention does not yield significant improvements in handgrip strength (MD, 1.72 kg; 95% CI, −0.74 to 4.18), knee extension strength (SMD, 0.49; 95% CI: −0.05 to 1.03), or timed up and go tests (MD, 0.06; 95% CI, −0.98 to 1.11).</div></div><div><h3>Conclusions and Implications</h3><div>Moderate evidence indicating that the combination of protein and vitamin D supplements, along with multiple nutritional intervention measures, probably enhance the quality of life, muscle strength, and muscle mass in older individuals with sarcopenia. Pharmacological therapy may increase muscle mass.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106038"},"PeriodicalIF":3.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Medicaid Payment and Payment-to-Cost Ratio on Nursing Home Five-Star Quality Ratings","authors":"Edward Alan Miller PhD, MPA ,&nbsp;Elizabeth Simpson MPH ,&nbsp;Marc A. Cohen PhD ,&nbsp;John R. Bowblis PhD","doi":"10.1016/j.jamda.2025.106042","DOIUrl":"10.1016/j.jamda.2025.106042","url":null,"abstract":"<div><h3>Objectives</h3><div>Medicaid is the largest payer of nursing home (NH) care in the United States, yet Medicaid payments are not required to cover the full cost of care. Little is known about the relationship between Medicaid payment adequacy and Care Compare's star ratings. This study examined the association between Medicaid payment rate and whether Medicaid payment covered the cost of care and NH 5-star ratings.</div></div><div><h3>Design</h3><div>Cross-sectional study using facility-level national data.</div></div><div><h3>Setting and Participants</h3><div>The analytic sample included 9473 freestanding NHs across 44 states in 2019.</div></div><div><h3>Methods</h3><div>Facility-level Medicaid payment rates were collected from states and matched with Medicaid-related costs to calculate Medicaid payment-to-cost ratios. These measures were linked to Care Compare 5-star ratings (overall, health inspection, quality measures, total staffing) and facility/resident characteristics. Multivariate regressions with state fixed effects and bivariate analysis assessed the relationship between Medicaid payments and Medicaid payment-to-cost ratios and 5-star ratings.</div></div><div><h3>Results</h3><div>Bivariate and regression findings indicate that higher Medicaid payment rates were associated with increased probability of NHs receiving 4- or 5-star ratings for the overall, health inspection, and staffing domains. Bivariate statistics found that higher Medicaid payment-to-cost ratios were associated with lower star ratings, but regression analysis found that Medicaid payment-to-cost ratios close to or exceeding 1.0 had a high probability of receiving 4 or 5 stars on the overall and health inspection star ratings. Neither Medicaid payment measure showed a consistent relationship with the quality measure rating.</div></div><div><h3>Conclusions and Implications</h3><div>Medicaid payment levels and payment-to-cost ratios were associated with Care Compare's 5-star ratings. Findings suggest that inadequate Medicaid payment rates undermine NH quality and that nursing homes need to subsidize Medicaid losses with profits from other sources. Policymakers should consider the adequacy of Medicaid payment when seeking to improve quality of care for long-stay residents, as payment policy remains a critical lever for strengthening NH performance.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 2","pages":"Article 106042"},"PeriodicalIF":3.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819516","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":"Resource Factors Associated With Avoidable Transfers in Nursing Homes","authors":"Matthew S. Farmer PhD, RN,&nbsp;Alisha H. Johnson PhD, RN,&nbsp;Kimberly R. Powell PhD, RN","doi":"10.1016/j.jamda.2025.106040","DOIUrl":"10.1016/j.jamda.2025.106040","url":null,"abstract":"<div><h3>Objectives</h3><div>Reducing avoidable hospital transfers among nursing home (NH) residents remains a critical priority, with 20% to 67% of transfers potentially preventable. Despite evidence that embedded advanced practice registered nurses (APRNs) and enhanced resources reduce transfers, chronic underinvestment leaves NHs with inadequate staffing and limited diagnostic capabilities. This study examined which resource constraints contributed to avoidable transfers among NH residents with dementia.</div></div><div><h3>Design</h3><div>Cross-sectional analysis of transfer events collected during the Missouri Quality Initiative, a Centers for Medicare and Medicaid Services–funded intervention (2016–2020) that embedded APRNs, implemented INTERACT tools, and enhanced health information technology to reduce avoidable hospitalizations.</div></div><div><h3>Setting and Participants</h3><div>Sixteen Missouri NHs participated, encompassing 3683 hospital transfer events from long-term residents. APRNs completed INTERACT surveys documenting resource availability and transfer context.</div></div><div><h3>Methods</h3><div>Eleven resource indicators were extracted from APRN surveys. Exploratory factor analysis identified latent resource domains. Factor scores were analyzed using Bayesian generalized linear mixed models to assess associations with avoidable transfers, accounting for facility-level variation.</div></div><div><h3>Results</h3><div>Half (50.2%) of transfers were avoidable. Four resource domains emerged: Delayed Diagnostics, Lack of Expertise/Staffing, APRN and Registered Nurse (RN) Availability, and On-site Clinical Resources. Limited APRN availability and staff discomfort (factors 2 and 3) significantly increased the odds of avoidable transfers (OR ≈1.7), whereas the lack of on-site clinicians and equipment (factor 4) were associated with nonavoidable transfers (OR ≈0.37). In addition, facility-level differences contributed meaningfully to transfer decisions, suggesting that unmeasured organizational factors influence outcomes.</div></div><div><h3>Conclusions and Implications</h3><div>Avoidable transfers are driven by staff discomfort and limited APRN availability, revealing gaps in nursing jurisdiction and decision-making capacity. Practice and policy reforms should expand APRN access, strengthen diagnostic partnerships, leverage telehealth, and support closed provider models. These interventions are urgently needed to reduce costly, traumatic transfers and improve resident-centered care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 2","pages":"Article 106040"},"PeriodicalIF":3.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810488","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":"COVID-19 Vaccination and Impact on Morbidity Among Nursing Home Residents, October 2024–January 2025: An Ecological Analysis","authors":"Farid L. Khan MPH,&nbsp;Jenny Boucher PharmD,&nbsp;Timothy L. Wiemken PhD,&nbsp;Angela D. Cook MS,&nbsp;Tobias Bergroth PhD,&nbsp;Alon Yehoshua PharmD,&nbsp;Evan J. Zasowski PharmD,&nbsp;Santiago M.C. Lopez MD,&nbsp;Laura A. Puzniak PhD","doi":"10.1016/j.jamda.2025.106029","DOIUrl":"10.1016/j.jamda.2025.106029","url":null,"abstract":"<div><h3>Objectives</h3><div>US nursing home residents experience a disproportionate burden of COVID-19–associated cases and hospitalizations. COVID-19 vaccination may reduce the burden in this population; however, data on the association between vaccine uptake and outcomes for this vulnerable population are lacking.</div></div><div><h3>Design</h3><div>Retrospective, observational ecological study.</div></div><div><h3>Setting and Participants</h3><div>Facility-level nursing home resident information from the Centers for Disease Control and Prevention's National Healthcare Safety Network Long-Term Care Facility COVID-19 Module database from October 5, 2024, to January 5, 2025.</div></div><div><h3>Methods</h3><div>Facility-level COVID-19 vaccination uptake and COVID-19 outcomes were linked with sociodemographic, economic, and facility characteristics. Generalized estimating equations were used to assess associations between vaccination uptake and COVID-19 cases and hospitalizations, controlling for potential confounders.</div></div><div><h3>Results</h3><div>The study included up to 13 weeks of data from 12,665 facilities (168,278 facility-weeks total). COVID-19 vaccination uptake increased from 14.8% to 40.0% over the study period. A 10% increase in vaccination uptake was associated with a significant reduction in COVID-19 cases [adjusted incidence rate ratio (ARR), 0.94; 95% CI, 0.91–0.97] and hospitalizations (ARR, 0.91; 95% CI, 0.86–0.95) among up-to-date residents. Facilities with higher vaccination rates experienced fewer weekly COVID-19 cases and hospitalizations.</div></div><div><h3>Conclusions and Implications</h3><div>Increased COVID-19 vaccination rates among nursing home residents are associated with reduced cases and hospitalizations, underscoring the importance of vaccination as a public health strategy in this vulnerable population. Efforts to improve COVID-19 vaccine uptake are warranted and could include revision of quality measures ratings to align COVID-19 vaccination with flu vaccination requirements.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106029"},"PeriodicalIF":3.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751770","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":"Prescription Patterns and Associated Factors of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors Use Among Patients Worldwide: A Systematic Review and Meta-Analysis of Real-World Studies","authors":"Man Xu MSc,&nbsp;Quanzhi Li MSc,&nbsp;Ning Chen MSc,&nbsp;Xi Zhang PhD,&nbsp;Wei Zhang PhD","doi":"10.1016/j.jamda.2025.106036","DOIUrl":"10.1016/j.jamda.2025.106036","url":null,"abstract":"<div><h3>Objectives</h3><div>The prescribing patterns of sodium-glucose cotransporter 2 (SGLT2) inhibitors in real-world clinical practice remain inadequately characterized. To address this gap, this meta-analysis aims to synthesize evidence on the prescription trends and clinical factors associated with SGLT2 inhibitor use.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>Patients with type 2 diabetes, chronic kidney disease, or cardiovascular disease.</div></div><div><h3>Methods</h3><div>Studies that were conducted to assess SGLT2 inhibitor use among patients were screened. From its inception until November 4, 2024, searches were conducted in PubMed, Web of Science, and Embase. Statistical analyses were performed with Review Manager (RevMan) version 5.4 and Stata 18.0.</div></div><div><h3>Results</h3><div>The study examined data from 102 studies, revealing a compelling global prevalence of SGLT2 inhibitors of 12% (95% CI, 11%-13%). The pooled prevalence of SGLT2 inhibitor use was 13% (95% CI, 11%-14%) in patients with cardiovascular disease, followed by type 2 diabetes at 12% (95% CI, 11%-13%) and chronic kidney disease at 11% (95% CI, 9%-13%). The use of SGLT2 inhibitors was significantly higher in patients who were enrolled after December 2020 compared with those enrolled before that date (20% vs 9%). The prescribing of SGLT2 inhibitors is significantly related to age, sex, body mass index, Medicare, and endocrinology visits.</div></div><div><h3>Conclusions and Implications</h3><div>The meta-analysis indicates that the real-world use of SGLT2 inhibitors increased gradually up to 2020. The synthesized evidence revealed variations in usage across different patient subgroups, which require addressing the identified barriers in the future to ensure optimal prescribing.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 2","pages":"Article 106036"},"PeriodicalIF":3.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810476","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}