Journal of the American Medical Directors Association最新文献

英文中文

The Impact of Unions on US Direct Care Workers in Long-Term Care Settings: A Systematic Review 工会对美国长期护理机构直接护理人员的影响：系统回顾。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-03 DOI: 10.1016/j.jamda.2024.105236

Objectives

To meet a growing demand for direct care workers (DCWs) in the United States, structural, organizational, and policy-related solutions are needed. Unionization of the workforce may be one such mechanism; however, its impact on outcomes remains poorly understood. To examine the impact of unionization on DCWs’ financial well-being and employment attitudes, as well as patient outcomes.

Design

A systematic search of AgeLine, CINAHL, PubMed, Scopus, and Web of Science from database inception through June 20, 2024. We included peer-reviewed empirical studies that used observational, quasi-experimental, and experimental designs.

Setting and Participants

Studies pertained to DCWs who provided care in the home and long-term care settings. We focused on studies that illustrated the financial outcomes of DCWs (wages, compensation, benefits), employment outcomes (job satisfaction, turnover), and health-related outcomes of DCWs and their patients.

Methods

Covidence was used to screen studies for inclusion criteria. Study characteristics were abstracted manually by prespecified domains. The Downs and Black tool was used for quality assessment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed.

Results

A total of 19 studies met inclusion criteria; they were predominantly observational (94%), with local (47%) and national (53%) samples. Three studies focused on compensation and all found that unionization was associated with higher wages and benefits among DCWs. Seven studies focused on employment, finding that unionization was associated with greater job satisfaction, quality, and retention, particularly among nursing home staff and home health aides. Unionized workplaces reported better care quality and safety, including fewer injuries and better equipment provision. Unionization's impact on patient outcomes showed mixed results, particularly among nursing home residents. Overall, the quality of the research studies varied, with limitations in methodology and sampling affecting reliability.

Conclusions and Implications

Unionization among DCWs was generally associated with higher wages, benefits, and job satisfaction, as well as reduced turnover; however, its impact on worker and patient outcomes varied across studies. The overall quality of the studies was fair to poor, highlighting the need for more rigorous research in this area.

目标：为满足美国对直接护理工作者（DCW）日益增长的需求，需要采取结构、组织和政策相关的解决方案。劳动力工会化可能就是这样一种机制；然而，人们对其对结果的影响仍然知之甚少。研究工会化对 DCWs 的财务状况、就业态度以及患者预后的影响：设计：对 AgeLine、CINAHL、PubMed、Scopus 和 Web of Science 进行系统检索，检索时间从数据库建立之初至 2024 年 6 月 20 日。我们纳入了采用观察性、准实验性和实验性设计的同行评审实证研究：研究涉及在家庭和长期护理环境中提供护理服务的家庭护理工作者。我们关注的研究重点是说明家庭护理员的经济成果（工资、补偿、福利）、就业成果（工作满意度、离职率）以及家庭护理员及其患者的健康相关成果：使用 Covidence 筛选符合纳入标准的研究。研究特征按预先确定的领域进行人工摘录。采用 Downs and Black 工具进行质量评估。结果：共有 19 项研究符合纳入标准：共有 19 项研究符合纳入标准；这些研究以观察性研究为主（94%），有地方样本（50%）和全国样本（50%）。三项研究的重点是报酬，所有研究都发现，加入工会与 DCW 工资和福利的提高有关。七项研究侧重于就业，发现工会与更高的工作满意度、质量和留任率相关，尤其是在养老院工作人员和家庭保健助理中。工会化的工作场所报告了更好的护理质量和安全，包括更少的伤害和更好的设备供应。工会化对患者疗效的影响结果不一，尤其是对养老院居民的影响。总体而言，研究的质量参差不齐，方法和抽样的局限性影响了研究的可靠性：DCW 工会化通常与较高的工资、福利和工作满意度以及较低的人员流动率相关；然而，工会化对工人和患者结果的影响在不同研究中各不相同。这些研究的总体质量一般或较差，这凸显了在这一领域进行更严格研究的必要性。

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引用次数: 0

Antidementia and Psychotropic Drug Use in Older People with Dementia in Australia: A National Data Linkage Study 澳大利亚老年痴呆症患者的抗痴呆药物和精神药物使用情况：全国数据链接研究》。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-03 DOI: 10.1016/j.jamda.2024.105237

Objectives

To estimate the national prevalence of antidementia and psychotropic medication use, and sociodemographic factors associated with their use, in Australians living with dementia.

Design

Retrospective cross-sectional study.

Setting and participants

Nationwide data linkage study using 2021 Census and Pharmaceutical Benefits Scheme (PBS) data. All people aged 65 or older with dementia (self-reported in the Census or dispensed an antidementia drug subsidized by the PBS) were included.

Methods

Medication use was defined as at least 1 dispensing during the 3-month period following the Census (August–October 2021). Prevalence of antidementia and psychotropic medication use, including antipsychotics, benzodiazepines and Z-drugs, antiepileptics, opioids, and psychostimulants, was calculated. Sociodemographic factors associated with medication use were explored using multivariable logistic regression models.

Results

Of the 177,809 older people living with dementia included, 58.6% were using at least 1 psychotropic medication. Antidepressants were the most commonly used psychotropics (41%), followed by opioids (20%) and antipsychotics (13%). Antidementia medications were used by a quarter of people with dementia (26%).

People with dementia living in the highest socioeconomic area were more likely to use antidementia medications [adjusted odds ratio (OR), 1.22; 95% CI, 1.17–1.28] and less likely to use psychotropics (OR, 0.91; 95% CI, 0.88–0.95) compared with people living in the lowest socioeconomic area. Conversely, those living in inner regional areas were more likely to use psychotropics (OR, 1.06; 95% CI, 1.03–1.10) and less likely to use antidementia medications (OR, 0.79; 95% CI, 0.77–0.82) compared with people living in metropolitan areas.

Conclusions and Implications

Psychotropics were commonly used in people with dementia in Australia. Disparities in access to health care due to socioeconomic status or remoteness may have influenced the use of antidementia and psychotropic medications. Further strategies to allow more equitable access to resources and medications are needed.

目标：估算澳大利亚全国痴呆症患者使用抗痴呆药物和精神药物的比例，以及与使用这些药物相关的社会人口因素：估计澳大利亚全国痴呆症患者使用抗痴呆药物和精神药物的情况，以及与使用这些药物相关的社会人口因素：设计：回顾性横断面研究：利用 2021 年人口普查和药品福利计划 (PBS) 数据进行全国范围的数据链接研究。所有年龄在 65 岁或以上的痴呆症患者（在人口普查中自我报告或配发了由 PBS 补贴的抗痴呆症药物）均被纳入研究范围：在人口普查后的 3 个月内（2021 年 8 月至 10 月）至少配药 1 次即为用药。计算抗痴呆药物和精神药物（包括抗精神病药物、苯二氮卓类药物和 Z 类药物、抗癫痫药物、阿片类药物和精神兴奋剂）的使用率。使用多变量逻辑回归模型探讨了与药物使用相关的社会人口学因素：结果：在纳入的 177 809 名老年痴呆症患者中，58.6% 至少使用一种精神药物。抗抑郁药是最常用的精神药物（41%），其次是阿片类药物（20%）和抗精神病药物（13%）。四分之一的痴呆症患者使用抗痴呆药物（26%）。与生活在社会经济水平最低地区的痴呆患者相比，生活在社会经济水平最高地区的痴呆患者更有可能使用抗痴呆药物（几率比 [OR]，1.22；95% CI，1.17-1.28），而使用精神药物的几率则较低（OR，0.91；95% CI，0.88-0.95）。相反，与生活在大都市地区的人相比，生活在内陆地区的人使用精神药物的可能性更大（OR，1.06；95% CI，1.03-1.10），而使用抗痴呆药物的可能性较小（OR，0.79；95% CI，0.77-0.82）：澳大利亚痴呆症患者普遍使用精神药物。由于社会经济地位或地理位置偏远，在获得医疗服务方面存在差异，这可能会影响抗痴呆药物和精神药物的使用。有必要制定进一步的策略，使人们能够更公平地获得资源和药物。

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引用次数: 0

Association of Polymorphic Cytochrome P450 Enzyme Pathways with Falls in Multimedicated Older Adults 多态细胞色素 P450 酶通路与服用多种药物的老年人跌倒的关系

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-03 DOI: 10.1016/j.jamda.2024.105235

Objectives

Dose exposure is considered relevant for drug-associated falls in older adults, pointing to an importance of drug metabolism. Aim was to analyze individual factors altering drug metabolism such as enzyme saturation by drug exposure and pharmacogenetics in the context of drug-associated falls.

Design

Prospective population-based study (ActiFE-Ulm study).

Setting and Participants

Community-dwelling older adults.

Methods

Focus was laid on the metabolism by polymorphic cytochrome P450 (CYP) enzymes CYP2C19, 2C9, and 2D6. Relevant variants of pharmacogenes were analyzed. Logistic binary regression analysis was used to calculate odds ratios (ORs) and 95% CIs for falls observed prospectively over a 1-year period with drug metabolism characteristics.

Results

In total, 1377 participants were included in the analysis. Although the phenotype predicted by the genotype was not, the use of drugs metabolized by CYP2C19 was associated with falls. Drugs not known as fall risk–increasing drugs (FRIDs; ie, non-FRIDs), but metabolized by CYP2C19, showed an OR of 1.46 (1.11-1.93) in adjusted analysis. Significant effect modification was observed for a reduced CYP2C19 activity phenotype with non-FRIDs metabolized by CYP2C19.

Conclusions and Implications

This study suggests an association between the occurrence of falls in older adults and the metabolic capacity of CYP2C19. Thus, an important step toward prevention of falls might be to personalize dosage and treatment length of the main drug classes known to be CYP2C19 substrates, such as many antidepressants, opioids, and sedatives, but also proton pump inhibitors in particular in poor and intermediate metabolizers.

目的：剂量暴露被认为与老年人药物相关性跌倒有关，这表明了药物代谢的重要性。目的：分析改变药物代谢的个体因素，如药物暴露的酶饱和度以及药物相关跌倒的药物遗传学：前瞻性人群研究（ActiFE-Ulm 研究）：环境和参与者：居住在社区的老年人：方法：重点研究多态细胞色素 P450（CYP）酶 CYP2C19、2C9 和 2D6 的代谢。对药物基因的相关变体进行了分析。采用逻辑二元回归分析法计算了在一年时间内前瞻性观察到的跌倒与药物代谢特征的几率比（OR）和 95% CI：共有 1377 名参与者参与了分析。虽然基因型预测的表型与跌倒无关，但使用经 CYP2C19 代谢的药物与跌倒有关。在调整分析中，不被称为增加跌倒风险的药物（FRIDs；即非FRIDs），但经CYP2C19代谢的药物的OR值为1.46（1.11-1.93）。CYP2C19活性降低表型与CYP2C19代谢的非FRIDs之间存在显著的效应修饰：这项研究表明，老年人跌倒的发生与 CYP2C19 的代谢能力有关。因此，预防跌倒的一个重要步骤可能是对已知为 CYP2C19 底物的主要药物类别，如许多抗抑郁药、阿片类药物和镇静剂，以及质子泵抑制剂，尤其是对代谢能力差和中等的代谢者，进行剂量和治疗时间的个性化调整。

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引用次数: 0

First Evidence on the Validity of the Complexity Index Derived from the Resident Assessment Instrument for Home Care in Home Care Patients 从居家护理居民评估工具中得出的居家护理患者复杂性指数有效性的初步证据。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-01 DOI: 10.1016/j.jamda.2024.105046

Objectives

Recently, a Complexity Index (CI), based on the multidimensional complexity model and derived from the Resident Assessment Instrument for Home Care (interRAI HC) was proposed as a decision-support tool to help frontline health care professionals in their clinical evaluation to identify and analyze complex situations. This study aims to test the CI: (1) concurrent validity with another measure of complexity (ie, the COMID), (2) convergent validity with related constructs assessed by interRAI HC scales (eg, depression), (3) divergent validity (comparison between CI-COMID and scales-COMID correlations), and (4) predictive validity on coordination meetings.

Design

A cross-sectional observational design was used for a secondary analysis of interRAI HC and COMID data collected in routine home care nursing practice (July-December 2021).

Setting and Participants

Participants were community-dwelling adults receiving home care, with full interRAI HC and COMID assessments (N = 3533).

Methods

Correlational analyses were conducted to test the concurrent validity of the CI (with the COMID) and the convergent and divergent validity of the CI (with interRAI HC_Switzerland scales, eg, Depression Rating Scale, Method for Assigning Priority Levels, and a Frailty Index). A receiver operating characteristic (ROC) analysis was conducted to test the discriminative ability of CI on specific professional team coordination meetings.

Results

Results showed that the CI correlated positively and strongly with the COMID (ρ = 0.691, P < .001, concurrent validity), positively with all the tested scales (P < .001, convergent validity), whereas the CI-COMID correlation was higher than the interRAI HC scales–COMID correlations (divergent validity). The ROC analysis showed the CI had a high area under the curve (AUC = 0.719, predictive validity).

Conclusions and Implications

The CI demonstrates good validity properties with a strong correlation with the COMID and a high predictive value for coordination meeting. It is distinct from the other interRAI HC scales and has its place among them to support the clinical analysis of complex situations.

目的：最近，一项基于多维复杂性模型并从家庭护理居民评估工具（interRAI HC）中衍生出来的复杂性指数（CI）被提出作为一种决策支持工具，以帮助一线医护人员在临床评估中识别和分析复杂情况。本研究旨在测试 CI：（1）与另一种复杂性测量（即 COMID）的并发有效性；（2）与 interRAI HC 量表评估的相关构念（如抑郁）的会聚有效性；（3）发散有效性（CI-COMID 与量表-COMID 相关性的比较）；以及（4）对协调会议的预测有效性：设计：采用横断面观察设计，对常规家庭护理实践（2021 年 7 月至 12 月）中收集的 interRAI HC 和 COMID 数据进行二次分析：参与者为接受家庭护理的社区成人，他们接受了完整的interRAI HC和COMID评估（N = 3533）：进行相关分析以检验 CI（与 COMID）的并发有效性以及 CI（与 InterRAI HCSwitzerland 量表，如抑郁评分量表、优先等级分配方法和虚弱指数）的收敛有效性和发散有效性。此外，还进行了接收者操作特征（ROC）分析，以检验 CI 对特定专业团队协调会议的判别能力：结果表明，CI 与 COMID 呈强正相关（ρ = 0.691，P < .001，并发效度），与所有测试量表呈正相关（P < .001，收敛效度），而 CI 与 COMID 的相关性则高于 RAI HC 量表间的相关性（发散效度）。ROC 分析显示，CI 的曲线下面积较高（AUC = 0.719，预测有效性）：CI具有良好的有效性，与COMID具有很强的相关性，对协调会议具有很高的预测价值。该量表有别于其他 interRAI HC 量表，在支持复杂情况的临床分析中占有一席之地。

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General Information 一般信息

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-01 DOI: 10.1016/S1525-8610(24)00668-6

引用次数: 0

Golden Opportunities: Commentary on “LGBTQ+ Inclusivity Training and Education” 黄金机遇关于 "LGBTQ+ 包容性培训和教育 "的评论

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-01 DOI: 10.1016/j.jamda.2024.105109

引用次数: 0

A Rose by Any Other Name 别名玫瑰

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-01 DOI: 10.1016/j.jamda.2024.105167

引用次数: 0

Promoting Effective Use of Technology to Support Post-Acute and Long-Term Care Facilities 促进技术的有效利用，为急性病后和长期护理机构提供支持

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-01 DOI: 10.1016/j.jamda.2024.105131

引用次数: 0

Directions & Connections 路线与连接

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-01 DOI: 10.1016/S1525-8610(24)00667-4

引用次数: 0

Improving Nursing Home Safety through Adoption of a Practical Resilient Health Care Approach 通过采用实用的弹性医疗保健方法改善疗养院安全。

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association

Pub Date : 2024-09-01 DOI: 10.1016/j.jamda.2024.03.124

Nursing homes struggle with safety issues, despite decades of intervention. This may, in part, stem from a reliance on a historical perspective that views safety as an intrinsic part of well-designed systems, with errors resulting from knowable, fixable causes. A new perspective (Resilient Health Care) assumes, instead, that in complex systems such as nursing homes, uncertainties and trade-offs occur in the course of everyday work. In this view, Resilient Health Care performance requires adapting to changes at different system levels to maintain high-quality care. An evidence-based program known as LOCK offers nursing homes a practical method for operationalizing a Resilient Health Care perspective. The LOCK program provides structures and processes that support frontline staff to successfully and safely navigate the complex interactions and factors that affect their daily provision of care.

尽管经过几十年的干预，疗养院仍在安全问题上挣扎。这可能部分源于对历史观点的依赖，即认为安全是精心设计的系统的固有组成部分，错误源于可知、可修复的原因。新的视角（弹性医疗保健）则认为，在养老院这样的复杂系统中，日常工作中会出现不确定性和权衡。根据这一观点，弹性医疗保健的绩效要求适应不同系统层面的变化，以保持高质量的护理服务。一项名为 "LOCK "的循证计划为养老院提供了一种实用的方法，可将弹性医疗保健的观点付诸实施。LOCK 计划提供结构和流程，支持一线员工成功、安全地应对影响日常护理工作的复杂互动和因素。

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