Journal of the American Medical Directors Association最新文献_第9页

Changing Patient Medical Complexity After Skilled Nursing Facility Payment Reform: An Interrupted Time Series Analysis 熟练护理机构支付改革后患者医疗复杂性的变化：中断时间序列分析。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2026-01-01 DOI: 10.1016/j.jamda.2025.106018

Rachel A. Prusynski DPT, PhD , Harsha Amaravadi MPH , Tracy M. Mroz PhD, OTR/L , Cait Brown MA, CCC-SLP , Debra Saliba MD, MPH , Natalie E. Leland PhD, OTR/L

Objectives

Medicare implemented a new skilled nursing facility (SNF) payment model, the Patient-Driven Payment Model (PDPM), in part to incentivize SNFs to admit more medically complex patients. However, it is unclear whether PDPM led to changes in case-mix in SNFs, and whether response to PDPM differed by SNF quality rating.

Design

Secondary analysis of January 2018 through February 2020 Medicare data.

Setting and Participants

A national cohort of fee-for-service Medicare beneficiaries who discharged from hospitals to SNFs. SNFs were classified as average/high quality if rated ≥3 stars and low quality if rated <3 stars.

Methods

Case-mix was defined using 4 measures of medical complexity relevant to PDPM incentives. Two measures captured diagnosis-specific reasons for SNF admission: medical management or uncomplicated total joint replacements. The third measure captured SNF admissions with dementia diagnoses. The final measure was the average complexity score based on the nontherapy ancillary (NTA) component of the PDPM model. Interrupted time series models with interaction terms for SNF quality (ie, low vs average/high quality) estimated how case-mix changed after PDPM implementation.

Results

Before PDPM, low-quality SNFs admitted more patients for medical management and with dementia, fewer patients for uncomplicated total joint replacements, and had higher NTA scores than average/high-quality SNFs. For all SNFs, PDPM was associated with increases in medical management admissions and a decline in total joint replacement admissions. Yet, effects were smaller in low-quality SNFs. For all SNFs, PDPM was associated with slight increases in NTA scores. PDPM was associated with fewer admissions for patients with dementia, especially in low-quality SNFs.

Conclusions and Implications

Results suggest that PDPM had its intended effect of shifting access to SNF care toward medically complex patients. However, low-quality SNFs were less responsive to PDPM in changing their case-mix. PDPM may also exacerbate challenges in SNF access for patients with dementia.

目的：医疗保险实施了一种新的熟练护理机构（SNF）支付模式，患者驱动的支付模式（PDPM），部分是为了激励SNF接收更多医疗复杂的患者。然而，目前尚不清楚PDPM是否会导致SNF病例组合的变化，以及对PDPM的反应是否因SNF质量评级而异。设计：对2018年1月至2020年2月的医疗保险数据进行二次分析。背景和参与者：从医院出院到snf的按服务收费的医疗保险受益人的全国队列。如果评分≥3星，snf被分为平均/高质量，如果评分为低质量。方法：使用与PDPM激励相关的4种医疗复杂性指标来定义病例组合。两项措施捕获了SNF入院的具体诊断原因：医疗管理或简单的全关节置换术。第三项措施捕获了SNF入院的痴呆症诊断。最后的测量是基于PDPM模型的非治疗辅助（NTA）成分的平均复杂性评分。具有SNF质量（即低质量与平均质量/高质量）相互作用项的中断时间序列模型估计了PDPM实施后病例组合的变化情况。结果：在PDPM之前，低质量SNFs接受医疗管理和痴呆的患者更多，进行无并发症全关节置换术的患者更少，并且NTA评分高于平均/高质量SNFs。对于所有snf， PDPM与医疗管理入院人数的增加和总关节置换术入院人数的下降有关。然而，低质量snf的影响较小。对于所有snf， PDPM与NTA评分轻微增加相关。PDPM与痴呆患者入院率降低有关，尤其是低质量snf患者。结论和意义：结果表明，PDPM具有将SNF护理转向医学复杂患者的预期效果。然而，低质量snf在改变其病例组合方面对PDPM的反应较差。PDPM也可能加剧痴呆症患者获得SNF的挑战。

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引用次数: 0

Reexamining Person-Centered Care Frameworks in Long-Term Care: A Cross-Cultural Perspective on Core Elements and Implementation Challenges 重新审视长期护理中以人为本的护理框架：核心要素和实施挑战的跨文化视角。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2026-01-01 DOI: 10.1016/j.jamda.2025.105908

Megan Davies PhD, Tonya J. Roberts PhD, RN, FGSA, Michael J. Lepore PhD, Jing Wang PhD, RN, FAAN, Hanzhang Xu PhD, RN, Patrick Alexander Wachholz MD, PhD, Barbara J. Bowers PhD, RN, FAAN, Franziska Zúñiga PhD, RN

引用次数: 0

Integrating Theory and Innovation in Pain Management for Long-Term Care 长期护理疼痛管理的理论与创新整合。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2026-01-01 DOI: 10.1016/j.jamda.2025.105953

Iman Nurjaman S.Kep., Ners., M.Kep., CWCCA., CSI

引用次数: 0

Clustering Analysis of Partial Tooth Loss Patterns and Their Association With Cardiovascular Health Using a Japanese Claims Database 利用日本索赔数据库对部分牙齿脱落模式及其与心血管健康的关联进行聚类分析。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-12-31 DOI: 10.1016/j.jamda.2025.106046

Takashi Miyano PhD , Taro Kusama DDS, PhD , Manami Hoshi-Harada DDS, PhD , Ken Osaka MD, PhD , Kenji Takeuchi DDS, PhD

Objective

Cardiovascular health (CVH), defined by the American Heart Association, aims to reduce cardiovascular disease (CVD) deaths and improve overall health. Poor oral health, including tooth loss, is increasingly linked to higher CVD risk. However, the effects of specific partial tooth loss patterns on CVH remain unclear. This study aimed to identify clinically relevant tooth loss patterns and evaluate their association with CVH in a large Japanese population.

Design

Retrospective cohort study.

Setting and Participants

Health insurance claims data were obtained from the JMDC database between 2016 and 2019. The study included 215,750 adults aged 40–75 years who had at least 20 remaining teeth and underwent both dental and general health examinations.

Methods

CVH scores were calculated based on 4 behavioral metrics [smoking status, body mass index (BMI), physical activity, and dietary habits] and 3 biological metrics (blood pressure, fasting glucose, and total cholesterol), following American Heart Association guidelines. K-median clustering was applied to identify patterns of partial tooth loss. Associations between tooth loss patterns and CVH scores were analyzed using fixed-effects models, including sex-stratified analyses.

Results

Six distinct partial tooth loss patterns were identified, including maxillary and mandibular molar loss, unilateral molar loss, and minor anterior tooth loss. Compared with individuals with all 28 teeth, those with partial tooth loss exhibited significantly lower CVH scores. The greatest reduction was observed in the maxillary molar loss group (β = −0.28; 95% CI, 0.34 to −0.22). Sex-stratified analyses showed that the associations were stronger in women than in men. Partial tooth loss was more strongly associated with behavioral metrics, particularly BMI and dietary habits, than with biological metrics.

Conclusions and Implications

Specific partial tooth loss patterns, especially molar loss, were associated with poorer CVH scores. These findings underscore the importance of preserving molar occlusion and integrating dental and cardiovascular prevention.

目的：心血管健康（CVH），由美国心脏协会定义，旨在减少心血管疾病（CVD）死亡和改善整体健康。口腔健康状况不佳，包括牙齿脱落，越来越多地与心血管疾病的高风险联系在一起。然而，特定的部分牙齿脱落模式对CVH的影响尚不清楚。本研究旨在确定临床相关的牙齿脱落模式，并评估其与大量日本人群CVH的关系。设计：回顾性队列研究。背景和参与者：2016年至2019年期间的健康保险索赔数据来自JMDC数据库。该研究包括215,750名年龄在40-75岁之间的成年人，他们至少有20颗牙齿，并接受了牙科和一般健康检查。方法：CVH评分基于4个行为指标（吸烟状况、体重指数、体力活动和饮食习惯）和3个生物学指标（血压、空腹血糖和总胆固醇），遵循美国心脏协会指南。k -中位数聚类应用于识别部分牙齿脱落的模式。使用固定效应模型分析牙齿脱落模式与CVH评分之间的关系，包括性别分层分析。结果：确定了六种不同的部分牙齿丢失模式，包括上颌和下颌臼齿丢失，单侧臼齿丢失和轻微前牙丢失。与所有28颗牙齿的个体相比，部分牙齿缺失者的CVH评分显着降低。上颌磨牙脱落组下降幅度最大（β = -0.28; 95% CI, 0.34 ~ -0.22）。性别分层分析表明，这种关联在女性中比在男性中更强。与生物学指标相比，部分牙齿脱落与行为指标（尤其是BMI和饮食习惯）的关系更为密切。结论和意义：特定的部分牙齿缺失模式，特别是磨牙缺失，与较差的CVH评分相关。这些发现强调了保留磨牙咬合和整合牙齿和心血管预防的重要性。

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引用次数: 0

Age-Adjusted Oral Temperature Thresholds for Rectal Fever Diagnosis in Hospitalized Older Adults 住院老年人直肠发热诊断的年龄调整口温阈值。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-12-30 DOI: 10.1016/j.jamda.2025.106044

Jean-Philippe Émond MD, MSc , Vincent Weng-Jy Cheung MSc , Apolline Brial MSc , Quoc Dinh Nguyen MD, MA, MPH, PhD

Objectives

Because older adults may present with atypical symptoms of infection, accurate thresholds for fever are critical for diagnosis and treatment. Accuracy of oral thresholds for rectal fever detection in older adults and those with frailty has not been well described in the hospital setting. The study's aim is to evaluate the diagnostic accuracy of oral fever threshold for predicting rectal fever and to propose age- and frailty-adjusted oral thresholds.

Design

Retrospective observational cohort study.

Setting and Participants

Adults aged 45 years and older hospitalized in a multicenter tertiary hospital center with rectal and oral temperatures measured.

Methods

We identified rectal and oral temperatures within a 60-minute interval. Fever was defined as rectal temperature ≥38.0 °C and oral ≥37.5 °C. A 34-deficit frailty index was constructed. Area under the curve (AUC), sensitivity, specificity, and confusion matrices for rectal fever prediction were calculated by age and frailty groups. Receiver operating characteristic curve analysis identified age- and frailty-adjusted oral thresholds using sensitivity of 45-54 and nonfrail groups as reference, respectively.

Results

Among 6814 participants with a mean age of 69 years (44% female), 8548 oral and rectal paired temperatures were included with 2100 (25%) paired discordances. The ≥85 years group had the lowest performance, with an AUC of 0.71 (95% CI: 0.67-0.74) and sensitivity of 0.60 (95% CI 0.55-0.65). Holding sensitivity equal across age groups, oral thresholds were 37.4 °C (95% CI 37.3-37.5 °C) for 45-54 years, 37.4 °C (95% CI 37.3-37.4 °C) for 55-64 years, 37.3 °C (95% CI 37.2-37.4 °C) for 65-74 years, 37.2 °C (95% CI 37.1-37.3 °C) for 75-84 years and 36.9 °C (95% CI 36.8-37.0 °C) for ≥85 years. AUC, sensitivity, specificity, and oral thresholds were similar between frailty groups.

Conclusions and Implications

Lower predictive performance for rectal fever prediction in older adults supports using an oral threshold of 37.2 °C in high-risk hospitalized adults aged ≥75 years. Adjusting oral thresholds in older adults may improve infection detection and management.

目的：由于老年人可能出现非典型感染症状，准确的发热阈值对诊断和治疗至关重要。口腔阈值的准确性直肠发热检测在老年人和那些虚弱的还没有很好地描述在医院设置。本研究的目的是评估口腔发热阈值预测直肠发热的诊断准确性，并提出年龄和虚弱调整的口腔阈值。设计：回顾性观察队列研究。环境和参与者：在多中心三级医院中心住院并测量直肠和口腔温度的45岁及以上的成年人。方法：我们在60分钟的间隔内确定直肠和口腔温度。发热定义为直肠温度≥38.0°C，口腔温度≥37.5°C。构建34赤字脆弱指数。曲线下面积（AUC）、敏感性、特异性和混淆矩阵对直肠发热预测的年龄和虚弱组进行计算。接受者工作特征曲线分析分别以45-54岁和非虚弱组的敏感性为参考，确定了年龄和虚弱调整的口腔阈值。结果：在6814名平均年龄为69岁（44%为女性）的参与者中，8548名口腔和直肠配对温度被纳入，2100名（25%）配对不一致。≥85岁组表现最差，AUC为0.71 (95% CI: 0.67-0.74)，敏感性为0.60 （95% CI: 0.55-0.65）。各年龄组的敏感性相同，45-54岁的口腔阈值为37.4°C (95% CI 37.3-37.5°C)， 55-64岁的口腔阈值为37.4°C (95% CI 37.3-37.4°C)， 65-74岁的口腔阈值为37.3°C (95% CI 37.2-37.4°C)， 75-84岁的口腔阈值为37.2°C (95% CI 37.1-37.3°C)，≥85岁的口腔阈值为36.9°C （95% CI 36.8-37.0°C）。AUC、敏感性、特异性和口腔阈值在虚弱组之间相似。结论和意义：老年人直肠发热预测性能较低，支持在≥75岁的高危住院成人中使用37.2°C的口腔阈值。调整老年人的口腔阈值可以改善感染的检测和管理。

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引用次数: 0

Factors Influencing Interprofessional Quality Improvement in Nursing Homes: A Systematic Review 影响养老院跨专业素质提升的因素：系统回顾。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-12-29 DOI: 10.1016/j.jamda.2025.106037

Rosanne M. Vosters MSc , Yvonne M.J. Goërtz PhD , Daisy J.A. Janssen PhD , Jan P.H. Hamers PhD , Katya Y.J. Sion PhD

Objectives

Previous studies have investigated quality improvement in the care for older people; however, there remains a need to identify the factors that influence interprofessional quality improvement. This study aims to study the facilitators and barriers for interprofessional quality improvement in the care for older people in nursing homes.

Design

Systematic literature review (PROSPERO registration number: CRD42024528522).

Setting and Participants

Interprofessional teams in the care for older people in nursing homes.

Methods

A systematic search of PubMed, CINAHL, PsycINFO, and Web of Science was performed. Peer-reviewed, original qualitative studies were included that reported on facilitators and/or barriers for quality improvement by teams of at least 2 different disciplines of care professionals in the long-term care for older people in nursing homes. Thematic synthesis was used to identify facilitators and barriers.

Results

Facilitators and barriers from 35 publications (40 quality improvement projects) were grouped into the following 8 themes: vision, culture, attitude, communication, collaboration, education, resources, and implementation. Within each theme, factors were divided into 5 different levels of influence: resident system, individual, team, organization, and external. The variety of themes and levels of influence shows the complexity of interprofessional quality improvement.

Conclusions and Implications

The literature shows that interprofessional quality improvement in nursing homes is a complex endeavor. Although the interprofessional team is responsible for quality improvement, the individuals within the team and the organization around the team have an active role in facilitating this process. In addition, quality improvement projects should more actively involve residents and their families.

目的：以往的研究调查了老年人护理质量的提高；但是，仍然需要确定影响跨专业质量改进的因素。本研究旨在探讨养老院长者护理跨专业品质提升的促进因素及障碍。设计：系统文献综述（PROSPERO注册号：CRD42024528522）。环境和参与者：在养老院照顾老年人的跨专业团队。方法：系统检索PubMed、CINAHL、PsycINFO、Web of Science。同行评议的，原始的定性研究，包括报告的促进和/或障碍的质量提高的团队至少2个不同学科的护理专业人员在养老院的老年人长期护理。专题综合用于确定促进因素和障碍。结果：来自35份出版物（40个质量改进项目）的促进因素和障碍分为以下8个主题：愿景、文化、态度、沟通、协作、教育、资源和实施。在每个主题中，因素分为5个不同的影响水平：居民系统、个人、团队、组织和外部。主题的多样性和影响程度显示了跨专业质量改进的复杂性。结论与启示：文献显示，疗养院的跨专业素质提升是一项复杂的努力。虽然跨专业团队负责质量改进，但团队中的个人和团队周围的组织在促进这一过程中起着积极的作用。此外，质量改善项目应更积极地让居民及其家庭参与进来。

{"title":"Factors Influencing Interprofessional Quality Improvement in Nursing Homes: A Systematic Review","authors":"Rosanne M. Vosters MSc , Yvonne M.J. Goërtz PhD , Daisy J.A. Janssen PhD , Jan P.H. Hamers PhD , Katya Y.J. Sion PhD","doi":"10.1016/j.jamda.2025.106037","DOIUrl":"10.1016/j.jamda.2025.106037","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies have investigated quality improvement in the care for older people; however, there remains a need to identify the factors that influence interprofessional quality improvement. This study aims to study the facilitators and barriers for interprofessional quality improvement in the care for older people in nursing homes.</div></div><div><h3>Design</h3><div>Systematic literature review (PROSPERO registration number: CRD42024528522).</div></div><div><h3>Setting and Participants</h3><div>Interprofessional teams in the care for older people in nursing homes.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, CINAHL, PsycINFO, and Web of Science was performed. Peer-reviewed, original qualitative studies were included that reported on facilitators and/or barriers for quality improvement by teams of at least 2 different disciplines of care professionals in the long-term care for older people in nursing homes. Thematic synthesis was used to identify facilitators and barriers.</div></div><div><h3>Results</h3><div>Facilitators and barriers from 35 publications (40 quality improvement projects) were grouped into the following 8 themes: vision, culture, attitude, communication, collaboration, education, resources, and implementation. Within each theme, factors were divided into 5 different levels of influence: resident system, individual, team, organization, and external. The variety of themes and levels of influence shows the complexity of interprofessional quality improvement.</div></div><div><h3>Conclusions and Implications</h3><div>The literature shows that interprofessional quality improvement in nursing homes is a complex endeavor. Although the interprofessional team is responsible for quality improvement, the individuals within the team and the organization around the team have an active role in facilitating this process. In addition, quality improvement projects should more actively involve residents and their families.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 2","pages":"Article 106037"},"PeriodicalIF":3.8,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sex Differences in Insomnia Symptoms and Sleep Duration as Risk Factors for Walking Speed Decline in Older Adults 失眠症状和睡眠时间的性别差异是老年人步行速度下降的危险因素。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-12-27 DOI: 10.1016/j.jamda.2025.106039

Leticia Coelho Silveira MSc , Roberta de Oliveira Máximo PhD , Mariane Marques Luiz PhD , Patrícia Silva Tofani PhD , Valdete Regina Guandalini PhD , Natália Cochar-Soares MSc , Sara Souza Lima MSc , Thais Barros Pereira da Silva MSc , Thales Batista de Souza MSc , Jassiely Priscila de Faria Santos MSc , Andrew Steptoe PhD , Cesar de Oliveira PhD , Tiago da Silva Alexandre PhD

Objectives

To examine the impact of insomnia symptoms and sleep duration on the progression of walking speed decline over time separately in men and women.

Design

Longitudinal study.

Setting and Participants

A sample of 3208 participants aged 60 years or older from the English Longitudinal Study of Ageing (ELSA), followed for 8 years.

Methods

Participants without mobility limitations (walking speed >0.8 m/s) at baseline were included. Insomnia symptoms were assessed using a questionnaire adapted from the Jenkins questionnaire. Sleep duration was categorized as short (≤6 hours), ideal (7 to <9 hours), or long (≥9 hours). The outcome measured was the decline in walking speed (m/s). Generalized linear mixed models stratified by sex were employed to estimate the rate of decline in walking speed based on insomnia symptoms and sleep duration, while adjusting for sociodemographic, behavioral, clinical, and anthropometric factors.

Results

No differences in walking speed were observed at baseline between men and women based on insomnia symptoms and sleep duration. After 8 years of follow-up, only men with long sleep duration (≥9 hours) experienced a greater decline in walking speed (−0.011 m/s per year; 95% CI, −0.021 to −0.001) compared with those with ideal sleep duration (−0.21 m/s over 8 years). Short sleep duration and insomnia symptoms were not associated with a decline in walking speed in either sex.

Conclusions and Implications

A long sleep duration (≥9 hours) is a risk factor for a decline in walking speed among men aged 60 years and older. Routine assessment of sleep duration in primary care provides a low-cost, scalable strategy to identify older adults at risk and guide early interventions aimed at maintaining mobility and independence, especially among older men.

目的：分别研究失眠症状和睡眠时间对男性和女性步行速度下降进展的影响。设计：纵向研究。环境和参与者：来自英国老龄化纵向研究（ELSA）的3208名60岁或以上的参与者，随访8年。方法：纳入基线时无行动能力限制（步行速度>0.8 m/s）的参与者。失眠症状的评估采用了一份改编自Jenkins问卷的问卷。睡眠时间分为短（≤6小时）、理想（7到7）。结果：基于失眠症状和睡眠时间，在基线时，男性和女性的步行速度没有差异。经过8年的随访，只有睡眠时间长（≥9小时）的男性与理想睡眠时间（8年-0.21米/秒）的男性相比，步行速度下降更大（-0.011米/秒/年；95% CI, -0.021至-0.001）。无论男女，短睡眠时间和失眠症状与步行速度的下降无关。结论和意义：长时间睡眠（≥9小时）是60岁及以上男性步行速度下降的危险因素。初级保健中对睡眠时间的常规评估提供了一种低成本、可扩展的策略，以识别处于风险中的老年人，并指导旨在维持活动能力和独立性的早期干预措施，特别是老年男性。

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引用次数: 0

Trauma-Informed Care—The Staff Matter Too 创伤知情护理——员工也很重要。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-12-26 DOI: 10.1016/j.jamda.2025.106034

Seyedehtanaz Saeidzadeh PhD, Yasin Barbakh MSc, Yinfei Duan PhD, Sube Banerjee MD, Peter G. Norton MD, Jim Silvius MD, Carole A. Estabrooks PhD

引用次数: 0

A Systematic Review and Meta-Analysis of the Effect of Virtual Reality on Cognitive Function and Instrumental Activities of Daily Living in Older Adults With Mild Cognitive Impairment 虚拟现实对轻度认知障碍老年人认知功能和日常生活工具活动影响的系统回顾和meta分析。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-12-26 DOI: 10.1016/j.jamda.2025.106024

Yi Tong Wang, Jia Qi Yang, Jie Li, Yong Hui He, Chuan Wu Lv, Meng Qi Chen, Li Na Wang MS, RN

Objectives

This study aimed to determine the effectiveness of virtual reality (VR) -based interventions on cognitive function and instrumental activities of daily living (IADL) in older adults with mild cognitive impairment (MCI). It also explored the influence of intervention frequency, duration, and total length on treatment outcomes.

Design

Systematic review and meta-analysis.

Setting and Participants

Participants with MCI received a VR-based intervention.

Methods

A systematic search was conducted in multiple electronic databases, including PubMed, Web of Science, Embase, Scopus, China National Knowledge Infrastructure Wanfang Database, VIP Database, and China Biology Medicine disc (CBM) from the earliest available dates stated in each database until March 2025 to identify relevant randomized controlled trials.

Results

VR intervention significantly improved global cognitive function [standardized mean difference (SMD), 0.64; 95% CI, 0.33–0.94], executive function as measured by the Trail Making Test (TMT)-A [mean difference (MD), −7.05; 95% CI, −10.88 to −3.22] and TMT-B (MD, −7.84; 95% CI, −13.38 to −2.30), attention (SMD, 1.37; 95% CI, 0.83–1.92), and memory (SMD, 0.66; 95% CI, 0.17–1.14) in older adults with MCI. However, no significant improvement was observed in IADLs (SMD, 1.01; 95% CI, −0.27 to 2.29). Subgroup analysis revealed that VR training with an intervention frequency of ≥3 times/week, length of intervention >8 weeks, and duration of intervention ≥18 hours yielded superior effect sizes.

Conclusions and Implications

This study shows that VR-based interventions effectively improve cognitive function in older adults with MCI. Interventions with higher frequency, longer duration, and extended total time show greater advantages. However, the facilitative effect on IADL requires further investigation. Future research should focus on extending follow-up periods to assess the clinical value and long-term benefits of VR interventions.

目的：本研究旨在确定虚拟现实（VR）认知训练对轻度认知障碍（MCI）老年人认知功能和日常生活工具活动（IADL）的有效性。研究还探讨了干预频率、持续时间和总时间对治疗结果的影响。设计：系统回顾和荟萃分析。环境和参与者：轻度认知障碍参与者接受基于虚拟现实的认知干预。方法：系统检索PubMed、Web of Science、Embase、Scopus、中国国家知识基础设施万方数据库、VIP数据库、中国生物医学光盘（CBM）等多个电子数据库，从各数据库最早可查日期开始至2025年3月，筛选相关随机对照试验。结果：VR干预显著改善了MCI老年人的整体认知功能（标准化平均差[SMD]， 0.64; 95% CI, 0.33-0.94），通过Trail Making Test （TMT）测量的执行功能（平均差[MD]， -7.05; 95% CI, -10.88至-3.22）和TMT- b (MD, -7.84; 95% CI, -13.38至-2.30)，注意力（SMD, 1.37; 95% CI, 0.83-1.92）和记忆（SMD, 0.66; 95% CI, 0.17-1.14）。然而，iadl无明显改善（SMD, 1.01; 95% CI, -0.27 ~ 2.29）。亚组分析显示，干预频率为>2次/周、干预时间为>8周、干预时间≥18小时的VR训练效果显著。结论和意义：本研究表明，基于vr的干预措施可以有效改善老年MCI患者的认知功能。频率越高、持续时间越长、总时间越长，干预效果越好。然而，对IADL的促进作用有待进一步研究。未来的研究应侧重于延长随访期，以评估虚拟现实干预的临床价值和长期效益。

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引用次数: 0

The Feasibility of Safe and Efficient Administration of COVID-19 Chemoprophylaxis to Nursing Home Residents 对养老院居民安全有效地实施COVID-19化学预防的可行性。

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2025-12-24 DOI: 10.1016/j.jamda.2025.106028

Amelia L. Milner MPH , Brigid Wilson PhD , Taissa A. Bej MS , Oteshia Hicks BA , Corinne Kowal BS , Jennifer Pruskowski PharmD, MS , Federico Perez MD, MS , Robin L.P. Jump MD, PhD

Objective

Chemoprophylaxis to mitigate the severity of COVID-19 outbreaks in nursing homes is not yet available. We assessed the feasibility of remdesivir, nirmatrelvir/ritonavir, and molnupiravir as potential chemoprophylaxis for nursing home residents.

Design

We conducted a national, cross-sectional study of residents of Department of Veterans Affairs (VA) Community Living Centers (CLCs) in 2021–2022.

Settings and Participants

Veterans living in 134 CLCs on 4 census dates: January 1, 2021, July 1, 2021, January 1, 2022, and July 1, 2022.

Methods

Estimated glomerular filtration rates (eGFRs) were used to determine the proportion of residents who would require dose adjustment for antiviral agents. Medications issued in the 14 days before the census date were assessed for potential drug-drug interactions (pDDIs) with remdesivir, nirmatrelvir/ritonavir, and molnupiravir. We determined the number of residents at risk for pDDI and characterized their possible severity and mitigating actions.

Results

Remdesivir and molnupiravir would not have required dose adjustments based on renal insufficiency, but 29% of CLC residents had eGFR values that would require adjustment for nirmatrelvir/ritonavir. The proportion of CLC residents at risk for pDDIs for remdesivir, nirmatrelvir/ritonavir, and molnupiravir was <1%, 91%, and 0%, respectively. Atorvastatin, tamsulosin, and amlodipine were the most frequently prescribed medications with a pDDI to nirmatrelvir/ritonavir. Therapy modification was required to address pDDIs among 61% of CLC residents; an additional 29% were taking ≥1 medication with an absolute contraindication to nirmatrelvir/ritonavir.

Conclusions and Implications

Given their tolerability among people with renal insufficiency and limited pDDIs, remdesivir and molnupiravir are both potential chemoprophylactic agents for COVID-19 outbreaks in nursing homes. Availability as oral capsules increases the feasibility for molnupiravir. Further work is needed to assess their efficacy to mitigate COVID-19 outbreaks in nursing homes.

目的：目前还没有缓解疗养院COVID-19疫情严重程度的化学预防措施。我们评估了remdesivir、nirmatrelvir/ritonavir和molnupiravir作为养老院居民潜在化学预防药物的可行性。设计：我们在2021-2022年对退伍军人事务部（VA）社区生活中心（CLCs）的居民进行了一项全国性的横断面研究。背景和参与者：在四个人口普查日期（2021年1月1日、2021年7月1日、2022年1月1日和2022年7月1日）居住在134个社区的退伍军人。方法：使用估计的肾小球滤过率（egfr）来确定需要调整抗病毒药物剂量的居民比例。在普查日期前14天内发放的药物被评估与remdesivir、nirmatrelvir/ritonavir和molnupiravir的潜在药物-药物相互作用（pddi）。我们确定了有pDDI风险的居民人数，并描述了他们可能的严重程度和缓解措施。结果：Remdesivir和molnupiravir不需要根据肾功能不全进行剂量调整，但29%的CLC患者的eGFR值需要调整nirmatrelvir/ritonavir。remdesivir、nirmatrelvir/ritonavir和molnupiravir在CLC居民中发生pddi风险的比例为：结论和意义：考虑到它们在肾功能不全和pddi有限的人群中的耐受性，remdesivir和molnupiravir都是养老院COVID-19爆发的潜在化学预防药物。口服胶囊的可用性增加了莫诺匹拉韦的可行性。需要进一步的工作来评估它们在缓解养老院COVID-19疫情方面的功效。

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引用次数: 0