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.
{"title":"In-Hospital Adverse Events in Older Patients with Hip Fracture: A Multicenter Retrospective Study","authors":"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","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) >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}
Pub Date : 2025-01-28DOI: 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.
{"title":"Moderate-to-Vigorous Physical Activity at any Dose Reduces All-Cause Dementia Risk Regardless of Frailty Status","authors":"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","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> < .05 for all) compared with 0 MVPA minutes per week. All associations were similar across frailty status (interaction <em>P</em> for all models > .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}
Pub Date : 2025-01-27DOI: 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).
{"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 χ<sup>2</sup> 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}
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.
{"title":"Medication Use in People Aged 90 Years and Older: A Nationwide Study","authors":"Lukshe Kanagaratnam MD, PhD , Laura Semenzato MSc , Edouard-Pierre Baudouin MD , Joël Ankri MD, PhD , Alain Weill MD, PhD , 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}
Pub Date : 2025-01-23DOI: 10.1016/j.jamda.2024.105462
Noah C. Ramsey BPharm(Hons), Gregory M. Peterson PhD, Corinne Mirkazemi PhD, Mohammed S. Salahudeen PhD
Objectives
To investigate the rate of, and factors affecting, acceptance of pharmacists’ recommendations by medical prescribers following medication reviews conducted in non-hospitalized older adults.
Design
A systematic review and meta-analysis with meta-regression.
Setting and Participants
Older adults (mean aged ≥55 years) residing in the community or in aged care facilities (ie, non-hospitalized) who had received an individualized medication review by a pharmacist.
Methods
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 databases (MEDLINE, Embase, and Web of Science) from 2000 until May 2024, and included studies that reported the acceptance rates of pharmacists’ recommendations by prescribers, either by recommendation type (eg, initiation, cessation, dose change) or the reason for the recommendation (eg, drug-related problem identified). JBI tools were used to assess the methodological quality, and a meta-analysis with meta-regression was performed.
Results
There were 21 studies included in the review: 13 studies in the community setting, and 8 in aged care facilities. The acceptance rates of the pharmacists’ recommendations ranged from 42% to 93%, and the implementation rates ranged from 27% to 88%. The setting where the pharmacist conducted the review was found to be a significant determinant in the acceptance of recommendations in the meta-regression model (P = .021), with the highest acceptance and implementation rates reported when pharmacists were integrated into general medical practices (79%; 95% CI, 52%–97%).
Conclusions and Implications
The acceptance of pharmacists’ recommendations following the conduct of medication reviews was highly variable. Multiple factors appear to influence acceptance rates, particularly the setting where the pharmacist conducted the review and the level of collaboration between the pharmacist and prescriber. Future research should explore targeted strategies to improve collaboration and communication between pharmacists and prescribers, such as the integration of pharmacists into general medical practices and aged care facilities.
{"title":"Factors Influencing Medical Prescribers' Acceptance of Pharmacists’ Recommendations in Non-hospitalized Older Adults: A Systematic Review and Meta-Analysis","authors":"Noah C. Ramsey BPharm(Hons), Gregory M. Peterson PhD, Corinne Mirkazemi PhD, Mohammed S. Salahudeen PhD","doi":"10.1016/j.jamda.2024.105462","DOIUrl":"10.1016/j.jamda.2024.105462","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the rate of, and factors affecting, acceptance of pharmacists’ recommendations by medical prescribers following medication reviews conducted in non-hospitalized older adults.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis with meta-regression.</div></div><div><h3>Setting and Participants</h3><div>Older adults (mean aged ≥55 years) residing in the community or in aged care facilities (ie, non-hospitalized) who had received an individualized medication review by a pharmacist.</div></div><div><h3>Methods</h3><div>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 databases (MEDLINE, Embase, and Web of Science) from 2000 until May 2024, and included studies that reported the acceptance rates of pharmacists’ recommendations by prescribers, either by recommendation type (eg, initiation, cessation, dose change) or the reason for the recommendation (eg, drug-related problem identified). JBI tools were used to assess the methodological quality, and a meta-analysis with meta-regression was performed.</div></div><div><h3>Results</h3><div>There were 21 studies included in the review: 13 studies in the community setting, and 8 in aged care facilities. The acceptance rates of the pharmacists’ recommendations ranged from 42% to 93%, and the implementation rates ranged from 27% to 88%. The setting where the pharmacist conducted the review was found to be a significant determinant in the acceptance of recommendations in the meta-regression model (<em>P</em> = .021), with the highest acceptance and implementation rates reported when pharmacists were integrated into general medical practices (79%; 95% CI, 52%–97%).</div></div><div><h3>Conclusions and Implications</h3><div>The acceptance of pharmacists’ recommendations following the conduct of medication reviews was highly variable. Multiple factors appear to influence acceptance rates, particularly the setting where the pharmacist conducted the review and the level of collaboration between the pharmacist and prescriber. Future research should explore targeted strategies to improve collaboration and communication between pharmacists and prescribers, such as the integration of pharmacists into general medical practices and aged care facilities.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105462"},"PeriodicalIF":4.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.jamda.2024.105424
Rangika L. Fernando MD , Maria C. Inacio PhD , Janet K. Sluggett PhD , Stephanie A. Ward BMed, MPH , Elizabeth Beattie PhD , Jyoti Khadka PhD , Gillian E. Caughey PhD , Australian Consortium for Aged Care Quality Measurement Toolbox (ACAC-QMET) Research Collaborators
Objective
To identify quality and safety indicators routinely used to monitor, evaluate, and improve care transitions for older adults globally.
Design
A scoping literature review.
Setting and Participants
This review identified indicators used internationally to monitor and evaluate the quality and safety of care transitions by older adults. Care transitions were defined as the transfer of health care at least once between care settings.
Methods
A search of academic and gray literature identified indicators that were publicly available, used routinely at the population level, and reported on since 2012. Indicators were summarized by care domain (ie, hospitalization, consumer experience, access/waiting times, communication, follow-up, and medication-related), type (structure, process, outcome), quality dimension (patient centeredness, timeliness, effectiveness, efficiency, safety, and equity), data collection approach, reporting strategies, and care settings involved.
Results
The review identified 361 quality indicators from 89 programs across 12 countries. Care domains included hospitalization (n = 112; 31.0%), consumer experience (n = 82; 22.7%), access/waiting times (n = 63; 17.5%), communication (n = 40; 11.1%), follow-up (n = 40; 11.1%), and medication-related (n = 24; 6.6%). Indicators measured outcomes (n = 227; 62.9%) or processes (n = 134; 37.1%) and represented the dimensions of patient centeredness (n = 155, 42.9%), timeliness (n = 91; 25.2%), and effectiveness (n = 87; 24.1%), efficiency (n = 18; 5.0%) and safety (n = 10; 2.8%). Most indicators were constructed from survey (n = 160; 44.3%) or administrative data (n = 138; 38.2%); 69% (n = 249) were publicly reported and 80% (n = 287) measured transitions related to acute settings.
Conclusions and Implications
Eighty-nine international programs routinely monitor the quality and safety of care transitions, and focus on the domains of hospitalization, access and waiting times, and communication. Considering the vulnerability of older adults as they transition across settings and providers, it is important to ensure holistic measurement of the quality of these care transitions to identify sub-optimal transitions, inform quality improvement, and ultimately improve outcomes for older adults.
{"title":"Quality and Safety Indicators for Care Transitions by Older Adults: A Scoping Review","authors":"Rangika L. Fernando MD , Maria C. Inacio PhD , Janet K. Sluggett PhD , Stephanie A. Ward BMed, MPH , Elizabeth Beattie PhD , Jyoti Khadka PhD , Gillian E. Caughey PhD , Australian Consortium for Aged Care Quality Measurement Toolbox (ACAC-QMET) Research Collaborators","doi":"10.1016/j.jamda.2024.105424","DOIUrl":"10.1016/j.jamda.2024.105424","url":null,"abstract":"<div><h3>Objective</h3><div>To identify quality and safety indicators routinely used to monitor, evaluate, and improve care transitions for older adults globally.</div></div><div><h3>Design</h3><div>A scoping literature review.</div></div><div><h3>Setting and Participants</h3><div>This review identified indicators used internationally to monitor and evaluate the quality and safety of care transitions by older adults. Care transitions were defined as the transfer of health care at least once between care settings.</div></div><div><h3>Methods</h3><div>A search of academic and gray literature identified indicators that were publicly available, used routinely at the population level, and reported on since 2012. Indicators were summarized by care domain (ie, hospitalization, consumer experience, access/waiting times, communication, follow-up, and medication-related), type (structure, process, outcome), quality dimension (patient centeredness, timeliness, effectiveness, efficiency, safety, and equity), data collection approach, reporting strategies, and care settings involved.</div></div><div><h3>Results</h3><div>The review identified 361 quality indicators from 89 programs across 12 countries. Care domains included hospitalization (n = 112; 31.0%), consumer experience (n = 82; 22.7%), access/waiting times (n = 63; 17.5%), communication (n = 40; 11.1%), follow-up (n = 40; 11.1%), and medication-related (n = 24; 6.6%). Indicators measured outcomes (n = 227; 62.9%) or processes (n = 134; 37.1%) and represented the dimensions of patient centeredness (n = 155, 42.9%), timeliness (n = 91; 25.2%), and effectiveness (n = 87; 24.1%), efficiency (n = 18; 5.0%) and safety (n = 10; 2.8%). Most indicators were constructed from survey (n = 160; 44.3%) or administrative data (n = 138; 38.2%); 69% (n = 249) were publicly reported and 80% (n = 287) measured transitions related to acute settings.</div></div><div><h3>Conclusions and Implications</h3><div>Eighty-nine international programs routinely monitor the quality and safety of care transitions, and focus on the domains of hospitalization, access and waiting times, and communication. Considering the vulnerability of older adults as they transition across settings and providers, it is important to ensure holistic measurement of the quality of these care transitions to identify sub-optimal transitions, inform quality improvement, and ultimately improve outcomes for older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105424"},"PeriodicalIF":4.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.jamda.2024.105457
Tosin Yinka Akintunde PhD, Joel T. Minion PhD, Kathleen Hegadoren PhD, Sube Banerjee MD, Carole A. Estabrooks PhD
{"title":"Experiences of Care Aides Caring for Residents with a History of Psychological Trauma in Long-Term Care Homes (Nursing Homes)—Early Findings","authors":"Tosin Yinka Akintunde PhD, Joel T. Minion PhD, Kathleen Hegadoren PhD, Sube Banerjee MD, Carole A. Estabrooks PhD","doi":"10.1016/j.jamda.2024.105457","DOIUrl":"10.1016/j.jamda.2024.105457","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105457"},"PeriodicalIF":4.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.jamda.2024.105461
Shengyu Luo MS , Weiqing Chen PhD , Jinghua Li PhD , Vivian Yawei Guo PhD
Objectives
Multimorbidity poses significant challenges to the well-being of middle-aged and older adults, but its impact on end-of-life experiences remains relatively underexplored and inconsistent. This study aims to investigate the association between the number of chronic conditions and 6 end-of-life outcomes across 28 countries.
Design
Longitudinal analyses.
Setting and Participants
Data were drawn from 6625 participants in the Survey of Health, Ageing, and Retirement in Europe (SHARE).
Methods
Information on 12 chronic non-communicable conditions was self-reported by participants in core interviews and categorized into 4 groups: 0, 1, 2, and ≥3 chronic conditions. Six end-of-life outcomes were reported by proxy respondents during end-of-life interviews after participants’ deaths. These outcomes included the place of death, duration of hospital stays in the last year of life, hospice or palliative care utilization, and symptoms such as pain, breathlessness, and anxiety or sadness in the last month of life. Mixed-effects logistic regression models were conducted to examine the association between the number of chronic conditions and end-of-life outcomes.
Results
Among the included participants, having 3 or more chronic conditions was positively associated with dying in a hospital [odds ratio (OR), 1.31; 95% CI, 1.15–1.49)], staying in hospitals for 3 months or more during the last year of life (OR, 1.36; 95% CI, 1.04–1.78), and experiencing symptoms such as pain (OR, 1.67; 95% CI, 1.34–2.08), breathlessness (OR, 1.32; 95% CI, 1.08–1.60), and anxiety or sadness (OR, 1.43; 95% CI, 1.12–1.83) in the last month of life after adjusting for covariates. In addition, each additional chronic condition was associated with 6% to 12% increases in the odds of these end-of-life outcomes, except for hospice or palliative care utilization.
Conclusions and Implications
Our findings underscore the significant impact of multimorbidity on end-of-life experiences and highlight the importance of coordinated care strategies to address the complex needs of patients with multimorbidity and alleviate their symptom burden.
{"title":"Association between Multimorbidity and End-of-Life Outcomes among Middle-Aged and Older Adults: Evidence from 28 Countries","authors":"Shengyu Luo MS , Weiqing Chen PhD , Jinghua Li PhD , Vivian Yawei Guo PhD","doi":"10.1016/j.jamda.2024.105461","DOIUrl":"10.1016/j.jamda.2024.105461","url":null,"abstract":"<div><h3>Objectives</h3><div>Multimorbidity poses significant challenges to the well-being of middle-aged and older adults, but its impact on end-of-life experiences remains relatively underexplored and inconsistent. This study aims to investigate the association between the number of chronic conditions and 6 end-of-life outcomes across 28 countries.</div></div><div><h3>Design</h3><div>Longitudinal analyses.</div></div><div><h3>Setting and Participants</h3><div>Data were drawn from 6625 participants in the Survey of Health, Ageing, and Retirement in Europe (SHARE).</div></div><div><h3>Methods</h3><div>Information on 12 chronic non-communicable conditions was self-reported by participants in core interviews and categorized into 4 groups: 0, 1, 2, and ≥3 chronic conditions. Six end-of-life outcomes were reported by proxy respondents during end-of-life interviews after participants’ deaths. These outcomes included the place of death, duration of hospital stays in the last year of life, hospice or palliative care utilization, and symptoms such as pain, breathlessness, and anxiety or sadness in the last month of life. Mixed-effects logistic regression models were conducted to examine the association between the number of chronic conditions and end-of-life outcomes.</div></div><div><h3>Results</h3><div>Among the included participants, having 3 or more chronic conditions was positively associated with dying in a hospital [odds ratio (OR), 1.31; 95% CI, 1.15–1.49)], staying in hospitals for 3 months or more during the last year of life (OR, 1.36; 95% CI, 1.04–1.78), and experiencing symptoms such as pain (OR, 1.67; 95% CI, 1.34–2.08), breathlessness (OR, 1.32; 95% CI, 1.08–1.60), and anxiety or sadness (OR, 1.43; 95% CI, 1.12–1.83) in the last month of life after adjusting for covariates. In addition, each additional chronic condition was associated with 6% to 12% increases in the odds of these end-of-life outcomes, except for hospice or palliative care utilization.</div></div><div><h3>Conclusions and Implications</h3><div>Our findings underscore the significant impact of multimorbidity on end-of-life experiences and highlight the importance of coordinated care strategies to address the complex needs of patients with multimorbidity and alleviate their symptom burden.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105461"},"PeriodicalIF":4.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1016/j.jamda.2024.105454
Kelly Cotton PhD , Joe Verghese MBBS
Objectives
Early research reported that older adults who stopped walking when they began a conversation were more likely to fall in the future. As a systematic measure of dual-task performance, Verghese and colleagues developed the Walking While Talking (WWT) test, in which a person walks at a normal pace while reciting alternate letters of the alphabet. The present paper highlights key findings from the 2 decades of research using the WWT test.
Design
Narrative review.
Settings and Participants
People who completed the WWT test in clinical and research settings.
Methods
A literature review was conducted for studies using the WWT test from 2002 until April 2024.
Results
Several studies reported that the WWT test is an easy-to-administer assessment with high face and concurrent validity and good reliability in different populations. Most studies were conducted in older adults; however, the WWT test has also been used in other clinical groups, such as adults with multiple sclerosis. Many studies investigated the cognitive and motor correlates of WWT, finding that performance on the WWT test is consistently associated with balance, executive function, and memory. Several studies have linked the neural underpinnings of WWT performance to the prefrontal cortex and motor regions. Further, the WWT test has been used to predict important outcomes such as dementia or future falls and a limited number of studies have used WWT performance as an outcome of clinical interventions, with mixed results.
Conclusions and Implications
Several important directions for future research concerning the WWT test remain, such as an expansion of its clinical applications and a better understanding of the longitudinal trajectory of WWT performance. However, the WWT test is an easy-to-administer, reliable, and sensitive measure of dual-task performance and is useful in many clinical and research settings.
{"title":"Two Decades of the Walking While Talking Test: A Narrative Review","authors":"Kelly Cotton PhD , Joe Verghese MBBS","doi":"10.1016/j.jamda.2024.105454","DOIUrl":"10.1016/j.jamda.2024.105454","url":null,"abstract":"<div><h3>Objectives</h3><div>Early research reported that older adults who stopped walking when they began a conversation were more likely to fall in the future. As a systematic measure of dual-task performance, Verghese and colleagues developed the Walking While Talking (WWT) test, in which a person walks at a normal pace while reciting alternate letters of the alphabet. The present paper highlights key findings from the 2 decades of research using the WWT test.</div></div><div><h3>Design</h3><div>Narrative review.</div></div><div><h3>Settings and Participants</h3><div>People who completed the WWT test in clinical and research settings.</div></div><div><h3>Methods</h3><div>A literature review was conducted for studies using the WWT test from 2002 until April 2024.</div></div><div><h3>Results</h3><div>Several studies reported that the WWT test is an easy-to-administer assessment with high face and concurrent validity and good reliability in different populations. Most studies were conducted in older adults; however, the WWT test has also been used in other clinical groups, such as adults with multiple sclerosis. Many studies investigated the cognitive and motor correlates of WWT, finding that performance on the WWT test is consistently associated with balance, executive function, and memory. Several studies have linked the neural underpinnings of WWT performance to the prefrontal cortex and motor regions. Further, the WWT test has been used to predict important outcomes such as dementia or future falls and a limited number of studies have used WWT performance as an outcome of clinical interventions, with mixed results.</div></div><div><h3>Conclusions and Implications</h3><div>Several important directions for future research concerning the WWT test remain, such as an expansion of its clinical applications and a better understanding of the longitudinal trajectory of WWT performance. However, the WWT test is an easy-to-administer, reliable, and sensitive measure of dual-task performance and is useful in many clinical and research settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105454"},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1016/j.jamda.2024.105460
Muhamad Z. Ally MSc, Jessica Casey MScOT, Rachel Devitt BHSc(OT), MHSc, Julia Filinski MScPT, Roger Marple, Ron Beleno, Zeest Kadri MSc, Zahra Hussain MSc, Aaron Jones PhD, Sharon E. Straus MD, MSc, Sharon Marr MD, MED, Zahra Goodarzi MD, MSc, Jennifer A. Watt MD, PhD
{"title":"Rehabilitation Outcomes and Experiences of People Living With Dementia: A Mixed-Methods Study","authors":"Muhamad Z. Ally MSc, Jessica Casey MScOT, Rachel Devitt BHSc(OT), MHSc, Julia Filinski MScPT, Roger Marple, Ron Beleno, Zeest Kadri MSc, Zahra Hussain MSc, Aaron Jones PhD, Sharon E. Straus MD, MSc, Sharon Marr MD, MED, Zahra Goodarzi MD, MSc, Jennifer A. Watt MD, PhD","doi":"10.1016/j.jamda.2024.105460","DOIUrl":"10.1016/j.jamda.2024.105460","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105460"},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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