Pub Date : 2024-09-23DOI: 10.1016/j.jamda.2024.105283
Jian Zhang MM , Ning Wang MD , Jiatian Li PhD, MD , Yilun Wang PhD, MD , Yongbing Xiao PhD, MD , Tingting Sha PhD
Objectives
Phase angle (PhA) declines with age and is a reliable marker for muscle function, making it a potential screening indicator for sarcopenia. However, studies examined the reliability and validity of PhA for detecting sarcopenia, yielding inconsistent results. This meta-analysis aimed to evaluate the accuracy and cutoff value of PhA for screening sarcopenia and examine the potential confounding factors.
Design
This is a meta-analysis.
Setting and Participants
PubMed, Embase, and Cochrane Library were searched up to September 18, 2023. Eighteen studies (6184 participants) were included reporting the diagnostic accuracy of PhA for screening sarcopenia.
Methods
Pooled accuracy [ie, the computed area under the curve value (AUC)] and cutoff value interval for screening sarcopenia were estimated using a random-effects model. Meta-regression analyses were conducted to identify sources of heterogeneity.
Results
The AUC value was 0.81. Pooled sensitivity and specificity were 80% and 70%. The calculated 95% CI of the cutoff value of PhA for screening sarcopenia falls between 4.54° and 5.25°. The results of meta-regression analyses showed that ethnicity, body mass index (BMI), health status, and diagnostic criteria were the main factors affecting the diagnostic accuracy for screening sarcopenia (with all P values < 0.01).
Conclusion and Implications
PhA may serve as a robust screening tool for sarcopenia, and the recommended cutoff interval falls between 4.54° and 5.25°. Ethnicity, BMI, health status, and diagnostic criteria can affect PhA's efficacy in sarcopenia screening.
{"title":"The Diagnostic Accuracy and Cutoff Value of Phase Angle for Screening Sarcopenia: A Systematic Review and Meta-Analysis","authors":"Jian Zhang MM , Ning Wang MD , Jiatian Li PhD, MD , Yilun Wang PhD, MD , Yongbing Xiao PhD, MD , Tingting Sha PhD","doi":"10.1016/j.jamda.2024.105283","DOIUrl":"10.1016/j.jamda.2024.105283","url":null,"abstract":"<div><h3>Objectives</h3><div>Phase angle (PhA) declines with age and is a reliable marker for muscle function, making it a potential screening indicator for sarcopenia. However, studies examined the reliability and validity of PhA for detecting sarcopenia, yielding inconsistent results. This meta-analysis aimed to evaluate the accuracy and cutoff value of PhA for screening sarcopenia and examine the potential confounding factors.</div></div><div><h3>Design</h3><div>This is a meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>PubMed, Embase, and Cochrane Library were searched up to September 18, 2023. Eighteen studies (6184 participants) were included reporting the diagnostic accuracy of PhA for screening sarcopenia.</div></div><div><h3>Methods</h3><div>Pooled accuracy [ie, the computed area under the curve value (AUC)] and cutoff value interval for screening sarcopenia were estimated using a random-effects model. Meta-regression analyses were conducted to identify sources of heterogeneity.</div></div><div><h3>Results</h3><div>The AUC value was 0.81. Pooled sensitivity and specificity were 80% and 70%. The calculated 95% CI of the cutoff value of PhA for screening sarcopenia falls between 4.54° and 5.25°. The results of meta-regression analyses showed that ethnicity, body mass index (BMI), health status, and diagnostic criteria were the main factors affecting the diagnostic accuracy for screening sarcopenia (with all <em>P</em> values < 0.01).</div></div><div><h3>Conclusion and Implications</h3><div>PhA may serve as a robust screening tool for sarcopenia, and the recommended cutoff interval falls between 4.54° and 5.25°. Ethnicity, BMI, health status, and diagnostic criteria can affect PhA's efficacy in sarcopenia screening.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105283"},"PeriodicalIF":4.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349057","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}
To examine (1) the prevalence of digital technology use, including information and communication technology devices, everyday technology use, and digital health technology use among community-dwelling older adults with or without homebound status and (2) the associations of digital technology use with homebound status.
Design
Cross-sectional study.
Setting and Participants
We used the 2022 National Health and Aging Trends Study (NHATS) data that included 5510 community-dwelling older adults.
Methods
Digital technology use was assessed using self-reported outcomes of the technological environment component of the NHATS, including information and communication technology devices, everyday technology use, and digital health technology use. Homebound status was measured with 4 mobility-related questions regarding the frequency, independence, and difficulties of leaving home. Survey-weighted, binomial logistic regression was used to examine the associations of 17 technological-related outcomes and homebound status.
Results
Overall, the prevalence of homebound older adults was 5.2% (95% CI, 4.4%–6.1%), representing an estimated 2,516,403 people. The prevalence of digital technology use outcomes varied according to homebound status. The prevalence of any technology used in homebound, semi-homebound, and non-homebound populations was 88.5%, 93.3%, and 98.5%, respectively. Compared with non-homebound older adults, semi-homebound older adults had lower odds of emailing (OR, 0.71; 95% CI, 0.53–0.94), using the internet for any other reason (OR, 0.70; 95% CI, 0.49–0.99), visiting medical providers (OR, 0.68; 95% CI, 0.48–0.95), and handling insurance (OR, 0.75; 95% CI, 0.56–0.99); homebound older adults had lower odds of using a phone (OR, 0.41; 95% CI, 0.28–0.59), using any everyday technology (OR, 0.58; 95% CI, 0.38–0.89), visiting medical providers (OR, 0.52; 95% CI, 0.35–0.76), and handling insurance (OR, 0.57; 95% CI, 0.38–0.86).
Conclusions and Implications
Non-homebound older adults are more likely to use digital technology than those who are semi-homebound or homebound. Public health care providers should prioritize efforts to enhance digital inclusion to ensure that all older adults can benefit from the advantages of digital technology.
{"title":"Digital Technology Use in US Community-Dwelling Seniors With and Without Homebound Status","authors":"Wenting Peng MMedsc , Gangjiao Zhu MSc , Zengyu Chen MSN , Tianxue Hou MSN , Yuqian Luo MMedSc , Lihua Huang MSN , Jianfeng Qiao MSN , Yamin Li PhD","doi":"10.1016/j.jamda.2024.105284","DOIUrl":"10.1016/j.jamda.2024.105284","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine (1) the prevalence of digital technology use, including information and communication technology devices, everyday technology use, and digital health technology use among community-dwelling older adults with or without homebound status and (2) the associations of digital technology use with homebound status.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>We used the 2022 National Health and Aging Trends Study (NHATS) data that included 5510 community-dwelling older adults.</div></div><div><h3>Methods</h3><div>Digital technology use was assessed using self-reported outcomes of the technological environment component of the NHATS, including information and communication technology devices, everyday technology use, and digital health technology use. Homebound status was measured with 4 mobility-related questions regarding the frequency, independence, and difficulties of leaving home. Survey-weighted, binomial logistic regression was used to examine the associations of 17 technological-related outcomes and homebound status.</div></div><div><h3>Results</h3><div>Overall, the prevalence of homebound older adults was 5.2% (95% CI, 4.4%–6.1%), representing an estimated 2,516,403 people. The prevalence of digital technology use outcomes varied according to homebound status. The prevalence of any technology used in homebound, semi-homebound, and non-homebound populations was 88.5%, 93.3%, and 98.5%, respectively. Compared with non-homebound older adults, semi-homebound older adults had lower odds of emailing (OR, 0.71; 95% CI, 0.53–0.94), using the internet for any other reason (OR, 0.70; 95% CI, 0.49–0.99), visiting medical providers (OR, 0.68; 95% CI, 0.48–0.95), and handling insurance (OR, 0.75; 95% CI, 0.56–0.99); homebound older adults had lower odds of using a phone (OR, 0.41; 95% CI, 0.28–0.59), using any everyday technology (OR, 0.58; 95% CI, 0.38–0.89), visiting medical providers (OR, 0.52; 95% CI, 0.35–0.76), and handling insurance (OR, 0.57; 95% CI, 0.38–0.86).</div></div><div><h3>Conclusions and Implications</h3><div>Non-homebound older adults are more likely to use digital technology than those who are semi-homebound or homebound. Public health care providers should prioritize efforts to enhance digital inclusion to ensure that all older adults can benefit from the advantages of digital technology.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105284"},"PeriodicalIF":4.2,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349037","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 : 2024-09-21DOI: 10.1016/j.jamda.2024.105281
Ann R. Falsey MD , Angela R. Branche MD , Michael Peasley BS , Mary Cole RN , Kim K. Petrone MD , Spencer Obrecht RN , Kari Steinmetz BS , Tanya Smith BS , Alexis Owen BS , Christopher S. Anderson PhD , Clyde Overby PhD , Derick R. Peterson PhD , Edward E. Walsh MD
Objectives
Phase 3 licensing trials for the recently approved respiratory syncytial virus (RSV) vaccines did not include many residents of long-term care facilities (LTCF). Our primary objective was to assess humoral immune responses in LTCF residents, aged 60 and older, to the RSV vaccines, and demonstrate noninferiority to antibody responses in community-dwelling (CD) adults who were representative of the phase 3 trial participants in whom the vaccines were highly efficacious.
Design
Prospective non-randomized intervention trial of RSV vaccines in LTCF residents.
Setting and Participants
Research clinic and 2 LTCFs. Adults aged ≥60 years old, free of immunosuppression and planning to receive an RSV vaccine were eligible.
Methods
LTCF and CD participants received either the GSK or Pfizer RSV vaccine in equal numbers. Blood was collected before and 30 days after vaccination. Total immunoglobulin (Ig)G to the prefusion F protein of RSV group A (FA) and B (FB), and neutralizing activity were measured, and geometric mean titer (GMT) and geometric mean fold rise (GMFR) calculated. Intercurrent respiratory illnesses were tracked.
Results
A total of 76 LTCF residents and 76 CD adults were enrolled. Day 30 blood was unavailable from 3 residents and 3 had RSV infection and vaccination was deferred, leaving data for 76 CD and 70 LTCF adults for analysis. Serum IgG GMFR prefusion FA (9.9 vs 12.5, P = .14), prefusion FB (8.7 vs 11.0, P = .17) were not statistically different in CD and LTCF cohorts, respectively, and also equivalent for GMFR in viral neutralization titers (12.8 vs. 15.5, P = .32). As measured by GMT or GMFR, RSV vaccine responses of LTCF residents met noninferiority criteria compared with the CD cohort.
Conclusions and Implications
This small immunobridging study demonstrates robust antibody responses to RSV vaccines in LTCF residents providing support for their use in this high-risk population.
目的：最近批准的呼吸道合胞病毒 (RSV) 疫苗的 3 期许可试验并未包括许多长期护理机构 (LTCF) 的居民。我们的主要目标是评估 60 岁及以上的长期护理机构居民对 RSV 疫苗的体液免疫反应，并证明其抗体反应不劣于社区居住（CD）成年人的抗体反应：设计：针对 LTCF 居民的 RSV 疫苗前瞻性非随机干预试验：研究诊所和 2 家 LTCF。年龄≥60 岁、无免疫抑制且计划接种 RSV 疫苗的成年人均符合条件：方法：LTCF 和 CD 参与者接受葛兰素史克或辉瑞 RSV 疫苗的人数相等。在接种前和接种后 30 天采集血液。测量 RSV A 组 (FA) 和 B 组 (FB) 预融合 F 蛋白的总免疫球蛋白 (Ig)G 和中和活性，并计算几何平均滴度 (GMT) 和几何平均折升 (GMFR)。对并发的呼吸道疾病进行了追踪：共有 76 名 LTCF 居民和 76 名 CD 成人参加了研究。有 3 名居民无法获得第 30 天的血液，3 名居民感染了 RSV，因此推迟了疫苗接种，因此只剩下 76 名 CD 成人和 70 名 LTCF 成人的数据可供分析。血清 IgG GMFR 预灌注 FA（9.9 vs 12.5，P = .14）和预灌注 FB（8.7 vs 11.0，P = .17）在 CD 和 LTCF 组群中分别没有统计学差异，病毒中和滴度 GMFR 也相同（12.8 vs 15.5，P = .32）。通过 GMT 或 GMFR 测定，与 CD 群体相比，LTCF 居民的 RSV 疫苗应答符合非劣效性标准：这项小型免疫桥接研究显示了 LTCF 居民对 RSV 疫苗的强大抗体反应，为在这一高风险人群中使用疫苗提供了支持。
{"title":"Short-Term Immunogenicity of Licensed Subunit RSV Vaccines in Residents of Long-Term Care Facilities (LTCF) Compared to Community-Dwelling Older Adults","authors":"Ann R. Falsey MD , Angela R. Branche MD , Michael Peasley BS , Mary Cole RN , Kim K. Petrone MD , Spencer Obrecht RN , Kari Steinmetz BS , Tanya Smith BS , Alexis Owen BS , Christopher S. Anderson PhD , Clyde Overby PhD , Derick R. Peterson PhD , Edward E. Walsh MD","doi":"10.1016/j.jamda.2024.105281","DOIUrl":"10.1016/j.jamda.2024.105281","url":null,"abstract":"<div><h3>Objectives</h3><div>Phase 3 licensing trials for the recently approved respiratory syncytial virus (RSV) vaccines did not include many residents of long-term care facilities (LTCF). Our primary objective was to assess humoral immune responses in LTCF residents, aged 60 and older, to the RSV vaccines, and demonstrate noninferiority to antibody responses in community-dwelling (CD) adults who were representative of the phase 3 trial participants in whom the vaccines were highly efficacious.</div></div><div><h3>Design</h3><div>Prospective non-randomized intervention trial of RSV vaccines in LTCF residents.</div></div><div><h3>Setting and Participants</h3><div>Research clinic and 2 LTCFs. Adults aged ≥60 years old, free of immunosuppression and planning to receive an RSV vaccine were eligible.</div></div><div><h3>Methods</h3><div>LTCF and CD participants received either the GSK or Pfizer RSV vaccine in equal numbers. Blood was collected before and 30 days after vaccination. Total immunoglobulin (Ig)G to the prefusion F protein of RSV group A (F<sub>A</sub>) and B (F<sub>B</sub>), and neutralizing activity were measured, and geometric mean titer (GMT) and geometric mean fold rise (GMFR) calculated. Intercurrent respiratory illnesses were tracked.</div></div><div><h3>Results</h3><div>A total of 76 LTCF residents and 76 CD adults were enrolled. Day 30 blood was unavailable from 3 residents and 3 had RSV infection and vaccination was deferred, leaving data for 76 CD and 70 LTCF adults for analysis. Serum IgG GMFR prefusion F<sub>A</sub> (9.9 vs 12.5, <em>P</em> = .14), prefusion F<sub>B</sub> (8.7 vs 11.0, <em>P</em> = .17) were not statistically different in CD and LTCF cohorts, respectively, and also equivalent for GMFR in viral neutralization titers (12.8 vs. 15.5, <em>P</em> = .32). As measured by GMT or GMFR, RSV vaccine responses of LTCF residents met noninferiority criteria compared with the CD cohort.</div></div><div><h3>Conclusions and Implications</h3><div>This small immunobridging study demonstrates robust antibody responses to RSV vaccines in LTCF residents providing support for their use in this high-risk population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105281"},"PeriodicalIF":4.2,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349055","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 : 2024-09-21DOI: 10.1016/j.jamda.2024.105274
Siyao Ma MD , Xiaoxu Guan PhD , Shawn L. Kang MSDS , Ailan Huang MD , Mengfei Yu PhD , Yi Zhou PhD
Objectives
To examine spatial access to sleep health care in the United States and investigate associations with demographic and socioeconomic characteristics, thereby identifying high-risk communities with limited spatial access to sleep health service.
Design
A cross-sectional population-based geospatial analysis.
Settings and Participants
Residents in US Census tracts across the 48 contiguous states, Alaska, and Hawaii.
Methods
The 2020 American Community Survey 5-year estimates, 2010 rural-urban commuting area codes, 2020 Area Deprivation Index, and sleep care provider locations from the National Provider Identifier file were used to assess the spatial access and related demographic/socioeconomic characteristics. Spatial access was measured by spatial access ratio using enhanced 2-step floating catchment area methods. The associations were investigated using logistic regression analysis and multivariate linear regression analysis.
Results
A total of 45.8 million residents experienced low spatial access to sleep health care. Spatial access decreased in rural and high Area Deprivation Index areas, and in areas characterized by higher population with uninsured status, vehicle unavailability, internet unavailability, cognitive difficulties, and hearing difficulties. With a 10% increase in the percentage of the racial minority (non-white) population, metropolitan census tracts experienced an increase in spatial access (3.268%), whereas micropolitan (−1.526%) and rural (−4.493%) areas experienced a decrease in spatial access. Similar findings were observed within the ethnic minority (Hispanic or Latino) population.
Conclusions and Implications
Disparities exist in spatial access to sleep health care across the United States, especially for disadvantaged individuals. Racial/ethnic minorities exhibit contrasting spatial access patterns in urban and rural areas, with those in rural areas facing more challenges in spatial access to sleep health care.
{"title":"Disparities in Spatial Access to Sleep Health Care in the United States: A Population-Based Geospatial Analysis","authors":"Siyao Ma MD , Xiaoxu Guan PhD , Shawn L. Kang MSDS , Ailan Huang MD , Mengfei Yu PhD , Yi Zhou PhD","doi":"10.1016/j.jamda.2024.105274","DOIUrl":"10.1016/j.jamda.2024.105274","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine spatial access to sleep health care in the United States and investigate associations with demographic and socioeconomic characteristics, thereby identifying high-risk communities with limited spatial access to sleep health service.</div></div><div><h3>Design</h3><div>A cross-sectional population-based geospatial analysis.</div></div><div><h3>Settings and Participants</h3><div>Residents in US Census tracts across the 48 contiguous states, Alaska, and Hawaii.</div></div><div><h3>Methods</h3><div>The 2020 American Community Survey 5-year estimates, 2010 rural-urban commuting area codes, 2020 Area Deprivation Index, and sleep care provider locations from the National Provider Identifier file were used to assess the spatial access and related demographic/socioeconomic characteristics. Spatial access was measured by spatial access ratio using enhanced 2-step floating catchment area methods. The associations were investigated using logistic regression analysis and multivariate linear regression analysis.</div></div><div><h3>Results</h3><div>A total of 45.8 million residents experienced low spatial access to sleep health care. Spatial access decreased in rural and high Area Deprivation Index areas, and in areas characterized by higher population with uninsured status, vehicle unavailability, internet unavailability, cognitive difficulties, and hearing difficulties. With a 10% increase in the percentage of the racial minority (non-white) population, metropolitan census tracts experienced an increase in spatial access (3.268%), whereas micropolitan (−1.526%) and rural (−4.493%) areas experienced a decrease in spatial access. Similar findings were observed within the ethnic minority (Hispanic or Latino) population.</div></div><div><h3>Conclusions and Implications</h3><div>Disparities exist in spatial access to sleep health care across the United States, especially for disadvantaged individuals. Racial/ethnic minorities exhibit contrasting spatial access patterns in urban and rural areas, with those in rural areas facing more challenges in spatial access to sleep health care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105274"},"PeriodicalIF":4.2,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349038","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 : 2024-09-20DOI: 10.1016/j.jamda.2024.105282
Tomoyuki Kawada MD, PhD
{"title":"Social Frailty and Cognitive Impairment in Older Adults","authors":"Tomoyuki Kawada MD, PhD","doi":"10.1016/j.jamda.2024.105282","DOIUrl":"10.1016/j.jamda.2024.105282","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 12","pages":"Article 105282"},"PeriodicalIF":4.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308018","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 : 2024-09-20DOI: 10.1016/j.jamda.2024.105270
Derek R. Manis PhD , David Kirkwood MSc , Wenshan Li PhD , Colleen Webber PhD , Stacey Fisher PhD , Peter Tanuseputro MD, MHSc , Jennifer A. Watt MD, PhD , Chantal Backman RN, PhD , Nathan M. Stall MD, PhD , Andrew P. Costa PhD
Objective
To examine transitions to an assisted living facility among community-dwelling older adults who received publicly funded home care services.
Design
Nested case-control study.
Setting and Participants
Linked, population-level health system administrative data were obtained from adults aged 65 years and older who received home care services in Ontario, Canada, from April 1, 2018, to December 31, 2019. New residents of assisted living were matched on age, sex, and initiation date of home care (± 7 days) to community-dwelling home care recipients in a 1:4 ratio.
Methods
Clinical and functional status, health service use, sociodemographic variables, and community-level characteristics were examined; conditional logistic regression was used to model associations with a transition to an assisted living facility.
Results
There were 2427 new residents of assisted living who were matched to 9708 home care recipients [mean (SD) age 85.5 (6.02) years, 72% female]. Most of the new residents were concentrated in urban communities and communities with higher income quintiles. New residents had an increased rate of physician-diagnosed dementia [adjusted hazard ratio (aHR), 1.28; 95% CI, 1.14–1.43], mood disorders (aHR, 1.17; 95% CI, 1.05–1.29), and cardiac arrhythmias (aHR, 1.19; 95% CI, 1.07–1.32). They also had higher rates of mild cognitive impairment (aHR, 1.43; 95% CI, 1.24–1.66), 2 or more falls (aHR, 1.29; 95% CI, 1.11–1.51), participation in activities of long-standing interest in the past 7 days (aHR, 1.29; 95% CI, 1.11–1.50), and a lower rate of a spouse or partner unpaid caregiver vs a child (aHR, 0.66; 95% CI, 0.56–0.79).
Conclusions and Implications
New residents of assisted living were mostly women, were cognitively impaired, had clinical comorbidities that could increase their risk of injuries, and had caregivers who were their children. These findings stress the importance of upscaling memory and dementia care in assisted living to address the needs of this population.
{"title":"Clinical and Sociodemographic Characteristics of New Residents of Assisted Living: A Nested Case-Control Study","authors":"Derek R. Manis PhD , David Kirkwood MSc , Wenshan Li PhD , Colleen Webber PhD , Stacey Fisher PhD , Peter Tanuseputro MD, MHSc , Jennifer A. Watt MD, PhD , Chantal Backman RN, PhD , Nathan M. Stall MD, PhD , Andrew P. Costa PhD","doi":"10.1016/j.jamda.2024.105270","DOIUrl":"10.1016/j.jamda.2024.105270","url":null,"abstract":"<div><h3>Objective</h3><div>To examine transitions to an assisted living facility among community-dwelling older adults who received publicly funded home care services.</div></div><div><h3>Design</h3><div>Nested case-control study.</div></div><div><h3>Setting and Participants</h3><div>Linked, population-level health system administrative data were obtained from adults aged 65 years and older who received home care services in Ontario, Canada, from April 1, 2018, to December 31, 2019. New residents of assisted living were matched on age, sex, and initiation date of home care (± 7 days) to community-dwelling home care recipients in a 1:4 ratio.</div></div><div><h3>Methods</h3><div>Clinical and functional status, health service use, sociodemographic variables, and community-level characteristics were examined; conditional logistic regression was used to model associations with a transition to an assisted living facility.</div></div><div><h3>Results</h3><div>There were 2427 new residents of assisted living who were matched to 9708 home care recipients [mean (SD) age 85.5 (6.02) years, 72% female]. Most of the new residents were concentrated in urban communities and communities with higher income quintiles. New residents had an increased rate of physician-diagnosed dementia [adjusted hazard ratio (aHR), 1.28; 95% CI, 1.14–1.43], mood disorders (aHR, 1.17; 95% CI, 1.05–1.29), and cardiac arrhythmias (aHR, 1.19; 95% CI, 1.07–1.32). They also had higher rates of mild cognitive impairment (aHR, 1.43; 95% CI, 1.24–1.66), 2 or more falls (aHR, 1.29; 95% CI, 1.11–1.51), participation in activities of long-standing interest in the past 7 days (aHR, 1.29; 95% CI, 1.11–1.50), and a lower rate of a spouse or partner unpaid caregiver vs a child (aHR, 0.66; 95% CI, 0.56–0.79).</div></div><div><h3>Conclusions and Implications</h3><div>New residents of assisted living were mostly women, were cognitively impaired, had clinical comorbidities that could increase their risk of injuries, and had caregivers who were their children. These findings stress the importance of upscaling memory and dementia care in assisted living to address the needs of this population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105270"},"PeriodicalIF":4.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308017","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 : 2024-09-19DOI: 10.1016/j.jamda.2024.105272
Stephanie L. Harrison PhD , Dylan Harries PhD , Yuyang Lin MPH , Gillian E. Caughey PhD , Caroline Miller PhD , Maria C. Inacio PhD
Objectives
A Star Rating system (1 to 5 stars) of long-term care facilities in Australia is based on 4 sub-categories: compliance, quality measures, residents’ experience, and staffing. The objectives were to examine associations between facility characteristics and the odds of receiving a 4- or 5-star rating, and changes in ratings between the earliest reporting period (October–December 2022) to the most recent (April–June 2023).
Design
Cross-sectional, ecological study, with an additional longitudinal component.
Setting
Long-term care facilities in Australia.
Methods
Associations between facility characteristics and the odds of receiving a 4- or 5-star rating were examined using a multiple logistic regression model. Average changes in overall star rating and each sub-category weighted by fractional contribution to overall star rating were estimated.
Results
Of 2476 facilities, 53.7% received a 4- or 5-star rating, 44.1% a 3-star rating, and 2.1% a 1- or 2-star rating in the April–June 2023 reporting period. Facility characteristics associated with higher odds of 4- or 5-star ratings included small (≤60 residents) and medium-size (61–100 residents) (odds ratios, 3.16; 95% CI, 2.51–3.98 and 1.72; 95% CI, 1.38–2.13, respectively), and Queensland location compared with New South Wales (2.42; 95% CI, 1.87–3.14). Facilities in socioeconomically disadvantaged areas (0.45; 95% CI, 0.33–0.62) and for-profit (0.12; 95% CI, 0.07–0.22) or not-for-profit facilities (0.16; 95% CI, 0.09–0.29) compared with government-operated were associated with lower odds of 4- or 5-star ratings. Between the 2 reporting periods, 25.1% of facilities' star ratings increased and 10.2% decreased (average change 0.156). Residents’ experience, compliance, and staffing had the largest weighted average sub-category rating changes (0.051, 0.042, and 0.042, respectively).
Conclusions
Smaller size, government ownership, and location in socioeconomically advantaged areas were associated with higher odds of 4- or 5-star ratings in long-term care facilities. Average star ratings increased over time but increases and decreases in overall and sub-category ratings were observed.
{"title":"Star Ratings in Long-Term Care Facilities in Australia: Facility Characteristics Associated with High Ratings and Changes in Ratings Over Time","authors":"Stephanie L. Harrison PhD , Dylan Harries PhD , Yuyang Lin MPH , Gillian E. Caughey PhD , Caroline Miller PhD , Maria C. Inacio PhD","doi":"10.1016/j.jamda.2024.105272","DOIUrl":"10.1016/j.jamda.2024.105272","url":null,"abstract":"<div><h3>Objectives</h3><div>A Star Rating system (1 to 5 stars) of long-term care facilities in Australia is based on 4 sub-categories: compliance, quality measures, residents’ experience, and staffing. The objectives were to examine associations between facility characteristics and the odds of receiving a 4- or 5-star rating, and changes in ratings between the earliest reporting period (October–December 2022) to the most recent (April–June 2023).</div></div><div><h3>Design</h3><div>Cross-sectional, ecological study, with an additional longitudinal component.</div></div><div><h3>Setting</h3><div>Long-term care facilities in Australia.</div></div><div><h3>Methods</h3><div>Associations between facility characteristics and the odds of receiving a 4- or 5-star rating were examined using a multiple logistic regression model. Average changes in overall star rating and each sub-category weighted by fractional contribution to overall star rating were estimated.</div></div><div><h3>Results</h3><div>Of 2476 facilities, 53.7% received a 4- or 5-star rating, 44.1% a 3-star rating, and 2.1% a 1- or 2-star rating in the April–June 2023 reporting period. Facility characteristics associated with higher odds of 4- or 5-star ratings included small (≤60 residents) and medium-size (61–100 residents) (odds ratios, 3.16; 95% CI, 2.51–3.98 and 1.72; 95% CI, 1.38–2.13, respectively), and Queensland location compared with New South Wales (2.42; 95% CI, 1.87–3.14). Facilities in socioeconomically disadvantaged areas (0.45; 95% CI, 0.33–0.62) and for-profit (0.12; 95% CI, 0.07–0.22) or not-for-profit facilities (0.16; 95% CI, 0.09–0.29) compared with government-operated were associated with lower odds of 4- or 5-star ratings. Between the 2 reporting periods, 25.1% of facilities' star ratings increased and 10.2% decreased (average change 0.156). Residents’ experience, compliance, and staffing had the largest weighted average sub-category rating changes (0.051, 0.042, and 0.042, respectively).</div></div><div><h3>Conclusions</h3><div>Smaller size, government ownership, and location in socioeconomically advantaged areas were associated with higher odds of 4- or 5-star ratings in long-term care facilities. Average star ratings increased over time but increases and decreases in overall and sub-category ratings were observed.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105272"},"PeriodicalIF":4.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289810","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 : 2024-09-19DOI: 10.1016/j.jamda.2024.105273
Xinxin Cai PhD , Yingyang Zhang PhD , Cheng Shi PhD , Gloria H.Y. Wong PhD , Hao Luo PhD , Huali Wang MD
Objectives
Nonpharmacologic interventions are recommended to improve outcomes in dementia. Little is known about their prescription in practice, especially in non-Western populations. We investigated individual- and institution-level characteristics associated with nonpharmacologic interventions prescription in China.
Design
A multicenter observational study.
Setting and Participants
This study used cross-sectional data from 889 community-dwelling outpatients living with dementia aged ≥45 years from a multicenter registry of 28 memory clinics in China.
Methods
Prescription records of nonpharmacologic interventions, carer and clinic characteristics, and reasons for declining interventions were collected. Multilevel logistic regression was used to identify factors associated with the prescription.
Results
Nonpharmacologic interventions were prescribed in 323 people (36.3%) with mild cognitive impairment or dementia. Cognitive activities and carer training/support were the most prescribed interventions. Multilevel logistic regression showed that 73% of the variance in prescription was attributed to institutional characteristics of the memory clinic. Greater caregiving gain [odds ratio (OR), 1.05; 95% CI, 1.02-1.09], lower burden (OR, 0.97; 95% CI, 0.95-1.00), worse carer-perceived dyad relationship (OR, 0.83; 95% CI, 0.70-0.99), and family history of dementia (OR, 2.08; 95% CI, 1.19-3.65) were individual-level factors associated with prescription. Among 440 people considered having a need but received no prescription, declined by user/carer was the main reason for not prescribing (70.7%). Skepticism about effectiveness by physicians/carers and carers being unable or lacking resources to use the interventions were the common reasons given.
Conclusions and Implications
A relatively low prescription rate of nonpharmacologic interventions is related to both individual- and institution-level factors. Carer support and education, instrumental support, and prescription guidelines across specialties and sites are possible strategies to improve access to nonpharmacologic interventions in dementia care.
{"title":"Prescription of Nonpharmacologic Interventions in Memory Clinics: Data from the Clinical Pathway for Alzheimer's Disease in China (CPAD) Study","authors":"Xinxin Cai PhD , Yingyang Zhang PhD , Cheng Shi PhD , Gloria H.Y. Wong PhD , Hao Luo PhD , Huali Wang MD","doi":"10.1016/j.jamda.2024.105273","DOIUrl":"10.1016/j.jamda.2024.105273","url":null,"abstract":"<div><h3>Objectives</h3><div>Nonpharmacologic interventions are recommended to improve outcomes in dementia. Little is known about their prescription in practice, especially in non-Western populations. We investigated individual- and institution-level characteristics associated with nonpharmacologic interventions prescription in China.</div></div><div><h3>Design</h3><div>A multicenter observational study.</div></div><div><h3>Setting and Participants</h3><div>This study used cross-sectional data from 889 community-dwelling outpatients living with dementia aged ≥45 years from a multicenter registry of 28 memory clinics in China.</div></div><div><h3>Methods</h3><div>Prescription records of nonpharmacologic interventions, carer and clinic characteristics, and reasons for declining interventions were collected. Multilevel logistic regression was used to identify factors associated with the prescription.</div></div><div><h3>Results</h3><div>Nonpharmacologic interventions were prescribed in 323 people (36.3%) with mild cognitive impairment or dementia. Cognitive activities and carer training/support were the most prescribed interventions. Multilevel logistic regression showed that 73% of the variance in prescription was attributed to institutional characteristics of the memory clinic. Greater caregiving gain [odds ratio (OR), 1.05; 95% CI, 1.02-1.09], lower burden (OR, 0.97; 95% CI, 0.95-1.00), worse carer-perceived dyad relationship (OR, 0.83; 95% CI, 0.70-0.99), and family history of dementia (OR, 2.08; 95% CI, 1.19-3.65) were individual-level factors associated with prescription. Among 440 people considered having a need but received no prescription, declined by user/carer was the main reason for not prescribing (70.7%). Skepticism about effectiveness by physicians/carers and carers being unable or lacking resources to use the interventions were the common reasons given.</div></div><div><h3>Conclusions and Implications</h3><div>A relatively low prescription rate of nonpharmacologic interventions is related to both individual- and institution-level factors. Carer support and education, instrumental support, and prescription guidelines across specialties and sites are possible strategies to improve access to nonpharmacologic interventions in dementia care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 12","pages":"Article 105273"},"PeriodicalIF":4.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289807","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 : 2024-09-19DOI: 10.1016/j.jamda.2024.105275
Shaojie Li MS , Guanghui Cui MBBS , Xiaochen Zhang MBBS , Shengkai Zhang MBBS , Yongtian Yin MS
Objectives
Frailty is a common geriatric syndrome in older adults; however, its relationship with digital factors is underexplored. This study aimed to examine the association between digital skills, eHealth literacy, and frailty to provide insights for developing frailty interventions in the digital age.
Design
Cross-sectional study.
Setting and Participants
Data were collected from a cross-sectional survey of older adults aged ≥60 years in China.
Methods
We used a digital skills questionnaire, the eHealth Literacy Scale, and the Tilburg Frailty Indicator to measure digital skill, eHealth literacy, and frailty, respectively. Linear regression and logistic models were established to explore the association between digital skill, eHealth literacy, and frailty. Finally, we used a structural equation model and the Karlson-Holm-Breen method to test the mediation.
Results
A total of 2144 older adults were included in this study. The rates of adequate digital skill, adequate eHealth literacy, and frailty were 4.1%, 11.9%, and 38.3%, respectively. Digital skill (β = −0.108; 95% CI, −0.151 to –0.065) and eHealth literacy (β = −0.153; 95% CI, −0.195 to –0.112) were negatively associated with frailty score (P < .05), and adequate digital skill (odds ratio, 0.367; 95% CI, 0.170-0.793) and adequate eHealth literacy (odds ratio, 0.455; 95% CI, 0.298-0.694) were associated with a lower prevalence of frailty. eHealth literacy had a mediating effect on the association between digital skills and frailty.
Conclusions and Implications
Better digital skill and eHealth literacy are associated with a lower prevalence of frailty among older adults. The association between digital skill and frailty was found to be completely mediated by eHealth literacy.
{"title":"Associations between Digital Skill, eHealth Literacy, and Frailty among Older Adults: Evidence from China","authors":"Shaojie Li MS , Guanghui Cui MBBS , Xiaochen Zhang MBBS , Shengkai Zhang MBBS , Yongtian Yin MS","doi":"10.1016/j.jamda.2024.105275","DOIUrl":"10.1016/j.jamda.2024.105275","url":null,"abstract":"<div><h3>Objectives</h3><div>Frailty is a common geriatric syndrome in older adults; however, its relationship with digital factors is underexplored. This study aimed to examine the association between digital skills, eHealth literacy, and frailty to provide insights for developing frailty interventions in the digital age.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Data were collected from a cross-sectional survey of older adults aged ≥60 years in China.</div></div><div><h3>Methods</h3><div>We used a digital skills questionnaire, the eHealth Literacy Scale, and the Tilburg Frailty Indicator to measure digital skill, eHealth literacy, and frailty, respectively. Linear regression and logistic models were established to explore the association between digital skill, eHealth literacy, and frailty. Finally, we used a structural equation model and the Karlson-Holm-Breen method to test the mediation.</div></div><div><h3>Results</h3><div>A total of 2144 older adults were included in this study. The rates of adequate digital skill, adequate eHealth literacy, and frailty were 4.1%, 11.9%, and 38.3%, respectively. Digital skill (β = −0.108; 95% CI, −0.151 to –0.065) and eHealth literacy (β = −0.153; 95% CI, −0.195 to –0.112) were negatively associated with frailty score (<em>P</em> < .05), and adequate digital skill (odds ratio, 0.367; 95% CI, 0.170-0.793) and adequate eHealth literacy (odds ratio, 0.455; 95% CI, 0.298-0.694) were associated with a lower prevalence of frailty. eHealth literacy had a mediating effect on the association between digital skills and frailty.</div></div><div><h3>Conclusions and Implications</h3><div>Better digital skill and eHealth literacy are associated with a lower prevalence of frailty among older adults. The association between digital skill and frailty was found to be completely mediated by eHealth literacy.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105275"},"PeriodicalIF":4.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289887","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}
To examine the feasibility and effects of a 12-week exercise intervention on physical performance, muscular strength, and circulating myokines in frail individuals living in nursing homes.
Design
A cluster randomized, 2-period, 2-intervention crossover trial.
Setting and Participants
Frail residents of 9 nursing homes were randomly assigned to either 12 weeks of concurrent exercise training (n = 5, 29 participants) or usual care (n = 4, 17 participants). The concurrent exercise training consisted of resistance and aerobic exercises (3 days/week). The usual care consisted of everyday routine and standard care. After a 4-week washout period, participants crossed to the other intervention.
Methods
The feasibility outcomes included recruitment rate, dropout rate and reasons, harms during the trial, adherence to exercise, and implementation cost. The primary endpoint was the change in physical performance measured by the Short Physical Performance Battery (SPPB). The secondary endpoints were changes in muscular strength (eg, handgrip strength, isokinetic knee extension, and flexion strength) and serum myokines concentration (myostatin and decorin).
Results
From the 46 participants enrolled (aged 70–99 years, 67.4% female), 34 completed the trial (26.1% dropout rate), the median adherence was 93.75%, and no adverse events occurred during the exercise sessions. The concurrent exercise training provided significant benefits over usual care on SPPB (B = 2.18; 95% CI, 1.35–3.00; P < .001), handgrip strength (B = 2.15; 95% CI, 1.00–3.30; P < .001), myostatin concentrations (B = −7.07; 95% CI, −13.48 to −0.66; P = .031) and myostatin-decorin ratio (B = −95.54; 95% CI, −158.30 to −32.78, P = .004). No significant between-group differences were found for the remaining secondary endpoints.
Conclusions and Implications
This concurrent exercise training is feasible, well-tolerated, and effective in improving physical performance, handgrip strength, myostatin, and myostatin-decorin ratio concentrations in frail older adults residing in nursing homes. These data reinforce the relevance of integrating exercise interventions in long-term care settings.
{"title":"Feasibility and Effectiveness of a 12-Week Concurrent Exercise Training on Physical Performance, Muscular Strength, and Myokines in Frail Individuals Living in Nursing Homes: A Cluster Randomized Crossover Trial","authors":"Duarte Barros MSc , Anabela Silva-Fernandes PhD , Sandra Martins MSc , Susana Guerreiro PhD , José Magalhães PhD , Joana Carvalho PhD , Elisa A. Marques PhD","doi":"10.1016/j.jamda.2024.105271","DOIUrl":"10.1016/j.jamda.2024.105271","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the feasibility and effects of a 12-week exercise intervention on physical performance, muscular strength, and circulating myokines in frail individuals living in nursing homes.</div></div><div><h3>Design</h3><div>A cluster randomized, 2-period, 2-intervention crossover trial.</div></div><div><h3>Setting and Participants</h3><div>Frail residents of 9 nursing homes were randomly assigned to either 12 weeks of concurrent exercise training (n = 5, 29 participants) or usual care (n = 4, 17 participants). The concurrent exercise training consisted of resistance and aerobic exercises (3 days/week). The usual care consisted of everyday routine and standard care. After a 4-week washout period, participants crossed to the other intervention.</div></div><div><h3>Methods</h3><div>The feasibility outcomes included recruitment rate, dropout rate and reasons, harms during the trial, adherence to exercise, and implementation cost. The primary endpoint was the change in physical performance measured by the Short Physical Performance Battery (SPPB). The secondary endpoints were changes in muscular strength (eg, handgrip strength, isokinetic knee extension, and flexion strength) and serum myokines concentration (myostatin and decorin).</div></div><div><h3>Results</h3><div>From the 46 participants enrolled (aged 70–99 years, 67.4% female), 34 completed the trial (26.1% dropout rate), the median adherence was 93.75%, and no adverse events occurred during the exercise sessions. The concurrent exercise training provided significant benefits over usual care on SPPB (B = 2.18; 95% CI, 1.35–3.00; <em>P</em> < .001), handgrip strength (B = 2.15; 95% CI, 1.00–3.30; <em>P</em> < .001), myostatin concentrations (B = −7.07; 95% CI, −13.48 to −0.66; <em>P</em> = .031) and myostatin-decorin ratio (B = −95.54; 95% CI, −158.30 to −32.78, <em>P</em> = .004). No significant between-group differences were found for the remaining secondary endpoints.</div></div><div><h3>Conclusions and Implications</h3><div>This concurrent exercise training is feasible, well-tolerated, and effective in improving physical performance, handgrip strength, myostatin, and myostatin-decorin ratio concentrations in frail older adults residing in nursing homes. These data reinforce the relevance of integrating exercise interventions in long-term care settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105271"},"PeriodicalIF":4.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289892","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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