Journal of the American Medical Directors Association最新文献_第8页

Nurse Practitioner and Physician Collaboration in the Long-Term Care Setting: Secondary Analysis of a Scoping Review 护士执业医师和医师合作在长期护理环境：二次分析的范围审查。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105418

Lynn Haslam-Larmer NP, PhD , Alexandra Krassikova MSc , Elizabeth Wojtowicz NP-PHC, MHM , Shirin Vellani NP, PhD , Sid Feldman MD , Paul Katz MD , Benoit Robert MD, MBA , Carrie Heer NP-PHC, MN , Ruth Martin-Misener NP, PhD, FAAN, FCAN , Kathryn May BScN, NP-PHC , Katherine S. McGilton RN, PhD

Objective

Over the past decade, the role of nurse practitioners (NPs) in long-term care home (LTCH) settings has significantly expanded. Despite this trend, gaps have been identified in the description of collaborative practices between NPs and physicians in the LTCH sector. This study aimed to characterize the elements of collaboration between NPs and physicians in LTCH settings by applying the “Structured Collaborative Practice Core Model.”

Design

A secondary analysis of a scoping review that focuses on literature where NPs and physicians collaboratively provided care in LTCH settings.

Methods

The initial scoping review followed the Joanna Briggs Institute methodology and PRISMA-ScR guidelines and included 60 peer-reviewed articles. Data relevant to the 7 core elements of the Structured Collaborative Practice Core Model—responsibility and accountability, coordination, communication, cooperation, assertiveness, autonomy, and mutual trust and respect—were extracted and analyzed. We included articles that described at least 1 element in the analysis.

Results

Twenty-nine articles were included in the secondary analysis. The analysis revealed that coordination (n = 25) and communication (n = 23) were the most frequently reported elements. Coordination was often highlighted through descriptions of care delivery organization and decision-making processes, where NPs provided continuous oversight and referred complex cases to physicians. Effective communication pathways, such as joint rounding and face-to-face meetings, were essential for successful collaboration. In contrast, assertiveness (n = 3) was the least frequently discussed element.

Conclusion and Implications

Applying the Structured Collaborative Practice Core Model to the existing literature on NP and physician collaboration in LTCH settings underscores the importance of effective coordination and communication. Future work needs to investigate the historical and hierarchical dynamics influencing the relationship. Understanding these elements will inform strategies to optimize collaborative efforts, ultimately improving patient care outcomes in LTCH settings. The unique dynamics of NP and physician care models need to be considered.

目的：在过去十年中，执业护士（NPs）在长期护理之家（LTCH）环境中的作用显著扩大。尽管存在这一趋势，但在描述长期护理院中护士与医生之间的合作实践方面仍存在差距。本研究旨在通过应用 "结构化协作实践核心模型 "来描述长期护理院中护士与医生之间的协作要素：对范围综述进行二次分析，重点关注护士和医生在LTCH环境中合作提供护理的文献：最初的范围界定综述遵循乔安娜-布里格斯研究所（Joanna Briggs Institute）的方法和 PRISMA-ScR 指南，包括 60 篇同行评审文章。我们提取并分析了与结构化协作实践核心模式的 7 个核心要素--责任与问责、协调、沟通、合作、自信、自主以及相互信任与尊重--相关的数据。我们在分析中纳入了至少描述了一个要素的文章：29 篇文章被纳入二次分析。分析表明，协调（25 篇）和沟通（23 篇）是最常报道的要素。协调通常通过描述护理提供组织和决策过程得到强调，其中护士提供持续监督并将复杂病例转介给医生。有效的沟通途径，如联合查房和面对面会议，对成功合作至关重要。相比之下，自信（n = 3）是讨论最少的要素：将结构化协作实践核心模型应用于现有的关于长期住院治疗环境中护士和医生协作的文献中，强调了有效协调和沟通的重要性。未来的工作需要研究影响这种关系的历史和等级动态。了解这些因素将有助于制定优化合作的策略，最终改善长期住院病区的患者护理效果。需要考虑 NP 和医生护理模式的独特动态。

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引用次数: 0

Risk of Hospitalization Among Assisted Living Residents Dually Enrolled in Medicare and Medicaid 双重参加医疗保险和医疗补助的辅助生活居民的住院风险。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105421

Portia Y. Cornell PhD , Gauri Gadkari MPH , Cassandra L. Hua PhD , Lindsey Smith PhD , Alfred Johnson BS , Lindsay Schwartz PhD , Momotazur Rahman PhD , Kali S. Thomas PhD

Objectives

To examine how risk of hospitalization among assisted living (AL) residents differs by dual enrollment in Medicare and Medicaid and by the percent of dually enrolled individuals in an AL community.

Design

Retrospective cohort study.

Setting and Participants

We used Medicare data from 2008 to 2018 and a national directory of licensed AL communities to identify Medicare beneficiaries with a change in their ZIP+4 code suggesting a new residence in an AL.

Methods

We estimated linear regression models of hospitalization onto interactions of residents' dual enrollment status and categories of the AL community’s percentage of dually enrolled residents. In the models, we adjusted for person-level clinical and demographic characteristics, year-fixed effects, and fixed effects for the AL residents’ prior ZIP code.

Results

Among 620,542 Medicare beneficiaries who moved to an AL community, the 1-year risk of hospitalization was higher for dually enrolled residents compared with Medicare-only residents. In adjusted models, dually enrolled residents in high-dual AL communities (>50% dually enrolled) had an 7.4% higher risk of hospital admission compared with dually enrolled residents in low-dual AL communities. Medicare-only beneficiaries in high-dual AL communities had a 9.4% higher risk of hospitalization than Medicare-only beneficiaries in low-dual ALs.

Conclusions and Implications

The proportion of residents in an AL community who were dually enrolled was associated with residents' risk of hospitalization, regardless of their dual enrollment status. Additional research is needed to understand whether differences observed in residents’ risk of hospitalization are due to differences in the types of services provided, unmeasured resident acuity, or the quality of care delivered in these settings.

目的：研究在辅助生活（AL）居民中，医疗保险和医疗补助的双重登记以及在辅助生活社区中双重登记的个人百分比是如何不同的住院风险的。设计：回顾性队列研究。背景和参与者：我们使用2008年至2018年的医疗保险数据和全国许可的AL社区目录来确定医疗保险受益人，他们的邮政编码发生了变化，表明他们在AL社区有了新的住所。方法：我们估计住院的线性回归模型与居民的双重登记状态和双重登记居民的百分比类别之间的相互作用。在模型中，我们调整了个人水平的临床和人口统计学特征、年度固定效应和AL居民先前邮政编码的固定效应。结果：在620,542名搬到AL社区的Medicare受益人中，双入组居民的1年住院风险高于单入组居民。在调整后的模型中，双入组的高双入组社区居民（50%双入组）入院风险比低双入组社区居民高7.4%。高双AL社区的医疗保险受益人住院的风险比低双AL社区的医疗保险受益人高9.4%。结论和意义：AL社区中双入组的居民比例与居民住院风险相关，无论其双入组状态如何。需要进一步的研究来了解观察到的居民住院风险的差异是否由于所提供服务类型的差异、未测量的居民敏锐度或在这些环境中提供的护理质量的差异。

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引用次数: 0

Effects of Virtual Reality–Based Activities of Daily Living Rehabilitation Training in Older Adults With Cognitive Frailty and Activities of Daily Living Impairments: A Randomized Controlled Trial 基于虚拟现实的日常生活康复训练对认知脆弱和日常生活活动障碍的老年人的影响：一项随机对照试验。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105397

Lishuang Zheng MSc , Xin Li MSc , Yiran Xu MSc , Yali Yang MSc , Xinyu Wan , Xuehan Ma MSc , Gengxin Yao MSc , Guichen Li PhD

Objectives

Cognitive frailty, which is notably prevalent in nursing homes, correlates with a range of adverse health outcomes; however, interventions targeting this population are scarce, particularly those addressing activities of daily living (ADLs). The objective of this study was to evaluate the effects of virtual reality–based ADL rehabilitation training on older adults with cognitive frailty and ADL impairments.

Design

A 2-arm randomized controlled trial.

Setting and Participants

Older adults with cognitive frailty and mild ADL impairments in a nursing home.

Methods

Sixty-six eligible participants were equally randomized into intervention and control groups. The intervention involved 45-minute sessions conducted twice weekly for 12 weeks. Outcomes evaluated included ADL performance, cognition, frailty, depression, and quality of life. Assessments were performed at baseline, 6 weeks (T1), and 12 weeks (T2).

Results

There was no statistically significant difference between the 2 groups at baseline. The mean age of the participants was 80.20 ± 9.14 years, and most were women (54.55%). Compared with the control group, the intervention group showed significant improvements in ADLs (T1: β = 6.33, T2: β = 12.79), basic ADLs (T1: β = 4.09, T2: β = 6.97), instrumental ADLs (T1: β = 2.24, T2: β = 4.12), cognition (T1: β = 3.67, T2: β = 4.42), frailty (T1: β = −0.76, T2: β = −1.27), and mental component summary of quality of life (T1: β = 8.49, T2: β = 16.44) at T1 and T2. By T2, significant improvements were observed in depression (T2: β = −2.06) and physical component summary of quality of life (T2: β = 8.52).

Conclusions and Implications

For older adults with cognitive frailty and mild ADL impairments residing in a nursing home, the virtual reality–based ADL rehabilitation program was safe and effective. Following the 12-week intervention, significant improvements were observed in ADL performance, cognition, frailty, depression, and quality of life.

目标：认知衰弱在养老院尤为普遍，与一系列不良健康结果相关；然而，针对这一人群的干预措施很少，特别是针对日常生活活动（adl）的干预措施。本研究的目的是评估基于虚拟现实的ADL康复训练对认知脆弱和ADL障碍的老年人的影响。设计：两组随机对照试验。环境和参与者：养老院中认知脆弱和轻度ADL障碍的老年人。方法：66名符合条件的参与者平均随机分为干预组和对照组。干预包括每周进行两次，每次45分钟，持续12周。评估的结果包括ADL表现、认知、虚弱、抑郁和生活质量。在基线、6周（T1）和12周（T2）进行评估。结果：两组在基线时差异无统计学意义。参与者平均年龄为80.20±9.14岁，以女性居多（54.55%）。与对照组相比，干预组在T1和T2时的ADLs （T1: β = 6.33, T2: β = 12.79）、基本ADLs （T1: β = 4.09, T2: β = 6.97）、工具性ADLs （T1: β = 2.24, T2: β = 4.12）、认知（T1: β = 3.67, T2: β = 4.42）、虚弱（T1: β = -0.76, T2: β = -1.27）和生活质量心理成分总结（T1: β = 8.49, T2: β = 16.44）均有显著改善。到T2时，抑郁（T2: β = -2.06）和生活质量身体成分综合（T2: β = 8.52）均有显著改善。结论和意义：对于居住在养老院的认知脆弱和轻度ADL损伤的老年人，基于虚拟现实的ADL康复计划是安全有效的。经过12周的干预，在ADL表现、认知、虚弱、抑郁和生活质量方面观察到显著改善。

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引用次数: 0

Directions & Connections

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/S1525-8610(25)00031-3

引用次数: 0

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

Journal of the American Medical Directors Association

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。

{"title":"Association between Age-Related Macular Degeneration with Visual Disability and Risk of Dementia: A Nationwide Cohort Study","authors":"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","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 >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}

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

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105391

Barbara Resnick PhD, CRNP

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

Journal of the American Medical Directors Association

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

Journal of the American Medical Directors Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jamda.2024.105376

Mehmet Ilkin Naharci PhD

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

Journal of the American Medical Directors Association

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

Journal of the American Medical Directors Association

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。

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