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IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-12 DOI: 10.1111/jgs.17866
Connie S. Cole PhD, DNP, RN-GERO, NP-C, ACHPN, C. Robert Bennett PhD, CPNP-AC, Joan G. Carpenter PhD, CRNP, ACHPN, FPCN, Regina M. Fink PhD, APRN, CHPN, AOCN, FAAN, Amy Jackson BSN, Kathleen T. Unroe MD, MHA, MS, Cari R. Levy MD, PhD

Cover caption: Domains of screening for unmet palliative care needs in nursing home residents. See the related article by Cole et al., pages 2590–2594.

封面标题:筛查养老院居民未满足的姑息关怀需求的领域。参见科尔等人的相关文章,第 2590-2594 页。
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引用次数: 0
Alzheimer's disease and related dementia diagnoses among American Indian and Alaska Native adults aged ≥45 years, Indian Health Service System, 2016–2020 2016-2020年印第安人健康服务系统中年龄≥45岁的美国印第安人和阿拉斯加原住民成年人的阿尔茨海默病和相关痴呆症诊断。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-08 DOI: 10.1111/jgs.19058
Andria Apostolou PhD, MPH, Jordan L. Kennedy MSPH, Marissa K. Person MSPH, Eva M. J. Jackson MPH, Bruce Finke MD, Lisa C. McGuire PhD, Kevin A. Matthews PhD

Background

Alzheimer's disease is the most common type of dementia and is responsible for up to 80% of dementia diagnoses and is the sixth leading cause of death in the United States. An estimated 38,000 American Indian/Alaska Native (AI/AN) people aged ≥65 years were living with Alzheimer's disease and related dementias (ADRD) in 2020, a number expected to double by 2030 and quadruple by 2050. Administrative healthcare data from the Indian Health Service (IHS) were used to estimate ADRD among AI/AN populations.

Methods

Administrative IHS healthcare data from federal fiscal years 2016 to 2020 from the IHS National Data Warehouse were used to calculate the count and rate per 100,000 AI/AN adults aged ≥45 years with at least one ADRD diagnosis code on their medical record.

Results

This study identified 12,877 AI/AN adults aged ≥45 years with an ADRD diagnosis code, with an overall rate of 514 per 100,000. Of those, 1856 people were aged 45–64. Females were 1.2 times (95% confidence interval: 1.1–1.2) more likely than males to have a medical visit with an ADRD diagnosis code.

Conclusions

Many AI/AN people with ADRD rely on IHS, tribal, and urban Indian health programs. The high burden of ADRD in AI/AN populations aged 45–64 utilizing IHS health services highlights the need for implementation of ADRD risk reduction strategies and assessment and diagnosis of ADRD in younger AI/AN populations. This study provides a baseline to assess future progress for efforts addressing ADRD in AI/AN communities.

背景:阿尔茨海默病是最常见的痴呆症,占痴呆症诊断的 80%,是美国第六大死因。据估计,2020 年有 3.8 万名年龄超过 65 岁的美国印第安人/阿拉斯加原住民(AI/AN)患有阿尔茨海默病和相关痴呆症(ADRD),预计到 2030 年这一数字将翻一番,到 2050 年将翻两番。我们使用印第安人健康服务局(IHS)的医疗保健管理数据来估算阿拉斯加原住民/印第安人中的阿兹海默症和相关痴呆症患者人数:方法:使用 IHS 国家数据仓库(IHS National Data Warehouse)中 2016 至 2020 联邦财政年度的 IHS 医疗保健管理数据,计算每 10 万名年龄≥45 岁、医疗记录中至少有一个 ADRD 诊断代码的 AI/AN 成人的人数和比率:这项研究确定了 12,877 名年龄≥45 岁、有 ADRD 诊断代码的亚裔美国人/印第安人成年人,总比率为每 10 万人中有 514 人。其中,1856 人的年龄在 45-64 岁之间。女性使用 ADRD 诊断代码就诊的可能性是男性的 1.2 倍(95% 置信区间:1.1-1.2):许多患有 ADRD 的印第安原住民/雅利安人依赖于 IHS、部落和城市印第安人健康计划。使用 IHS 医疗服务的 45-64 岁美国印第安人/原住民人群的 ADRD 负担很高,这凸显了在年轻的美国印第安人/原住民人群中实施 ADRD 风险降低策略以及评估和诊断 ADRD 的必要性。这项研究提供了一个基线,可用于评估未来在解决阿拉斯加原住民/印第安人社区 ADRD 问题方面所取得的进展。
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引用次数: 0
The role of geriatricians in the atrial fibrillation management teams 老年病学专家在心房颤动管理团队中的作用。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-08 DOI: 10.1111/jgs.19132
Esra Ates Bulut MD, Mert Evlice MD, Ibrahim Halil Kurt MD, Ahmet Turan Isik MD
<p>The world's aging population is increasing, making it essential and complex to manage multimorbid older adults. According to United Nations statistics, people aged 65 years or older will rise from 761 million in 2021 to 1.6 billion in 2050. The number of people aged 80 years or older is growing even faster.<span><sup>1</sup></span> Due to the need to evaluate patients holistically and monitor them from a single source, geriatric medicine has gained importance all over the world. Geriatricians use an exclusive assessment method, the Comprehensive Geriatric Assessment (CGA), to evaluate not only systemic medical diseases and pharmacologic agents of the patients but also functionality, gait, mood, cognitive impairment, and nutritional status. This multidimensional holistic approach enables healthcare providers to identify medical and social problems and meet the sophisticated needs of older adults.</p><p>One of the major systemic medical conditions frequently encountered in older adults is atrial fibrillation (AF). In Europe, in 2010, around 9 million individuals older than 55 years had AF, and it is estimated to jump to 14 million by 2060.<span><sup>2</sup></span> AF prevalence gets higher with age, and it is an important issue in all specialties to prevent ischemic stroke because of a major cause of functionality and independence loss. AF screening, recognition, and management require multidisciplinary coordination. Therefore, AF has particular importance for geriatricians' clinical practice. Geriatricians also follow and implement the European Society of Cardiology guidelines into clinical practice as the most reliable source, updated in 2020.<span><sup>3</sup></span> Integrated management of patients was suggested in the guideline.</p><p>On the other hand, it should be kept in mind that some geriatric syndromes, such as falls, polypharmacy, malnutrition, and dementia, which may pose a risk in prescribing anticoagulant drugs, may make AF management more difficult in older adults. In addition, healthcare professionals should be aware that managing older patients with AF and one of those geriatric syndromes needs a special, holistic geriatric perspective. It is important to consider the risk of falls, chronic medical conditions (such as chronic liver or kidney disease), and the routine use of drugs to prevent unwanted drug–drug interactions or drug–disease interactions. It is also challenging to maintain the international normalized ratio (INR) therapeutic range in bed-bound patients on warfarin. Therefore, individual treatment and provision plans should be organized considering these situations. However, geriatricians have not been defined as a part of the integrated AF management team in fig. 11 in the 2020 AF guideline.<span><sup>3</sup></span> We believe geriatricians should be one of the top priorities in AF management. Additionally, it is important to raise awareness and specialization in the geriatric population among healthcare professio
全球老龄化人口不断增加,这使得对患有多种疾病的老年人进行管理变得十分必要和复杂。据联合国统计,65 岁或以上人口将从 2021 年的 7.61 亿增加到 2050 年的 16 亿。1 由于需要对患者进行全面评估和从单一来源进行监测,老年医学在全世界都得到了重视。老年医学专家使用一种独特的评估方法,即老年医学综合评估(CGA),不仅评估患者的系统性内科疾病和药物,还评估患者的功能、步态、情绪、认知障碍和营养状况。这种多维度的整体方法使医疗服务提供者能够识别医疗和社会问题,满足老年人的复杂需求。在欧洲,2010 年约有 900 万 55 岁以上的老年人患有心房颤动,预计到 2060 年将跃升至 1400 万。2 心房颤动的患病率随年龄增长而升高,是所有专科预防缺血性中风的重要问题,因为它是导致老年人丧失功能和独立性的主要原因。心房颤动的筛查、识别和管理需要多学科协调。因此,心房颤动对老年病学医生的临床实践尤为重要。老年病学医生在临床实践中也要遵循并执行欧洲心脏病学会的指南,因为它是最可靠的来源,并在 2020 年进行了更新。3 该指南建议对患者进行综合管理。另一方面,应注意的是,一些老年综合征,如跌倒、多药并用、营养不良和痴呆,可能会给抗凝药物的处方带来风险,这可能会使老年人的房颤管理更加困难。此外,医护人员应意识到,管理患有房颤和其中一种老年综合征的老年患者需要一种特殊的、全面的老年医学视角。重要的是要考虑跌倒风险、慢性疾病(如慢性肝病或肾病)以及常规用药,以防止不必要的药物间相互作用或药物与疾病间相互作用。对于卧床服用华法林的患者来说,维持国际正常化比值(INR)在治疗范围内也是一项挑战。因此,应根据这些情况制定个性化的治疗和供应计划。然而,在 2020 年心房颤动指南图 11 中,老年病学家并未被定义为心房颤动综合管理团队的一部分。此外,提高医护人员对老年病人群的认识和专业化水平也很重要。据报道,多学科综合护理方法(如除常规专科护理外的护士主导护理)与降低心血管疾病住院率和全因死亡率有关。4 将老年病学专家、老年心脏病专家、老年病学护士和老年药学专家纳入多学科心房颤动团队有助于患者坚持治疗和治疗随访,并有助于预防副作用。我们相信,这种方法将提高人们对心房颤动的认识,并提高心房颤动管理的质量。ME和IHK进行了文献检索并协助撰写了稿件。所有作者均参与并批准了最终稿件。作者无利益冲突需要声明。
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引用次数: 0
Progression of frailty and cardiovascular outcomes among Medicare beneficiaries 医疗保险受益人的虚弱程度和心血管疾病后果的进展。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 DOI: 10.1111/jgs.19116
Yusi Gong MD, Yang Song MSc, Jiaman Xu MPH, Huaying Dong MSc, Daniel B. Kramer MD, MPH, Ariela R. Orkaby MD, MPH, John A. Dodson MD, MPH, Jordan B. Strom MD, MSc

Background

Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression on cardiovascular outcomes remains uncertain.

Methods

To determine whether frailty progression is associated with adverse cardiovascular outcomes, independent of baseline frailty and age, we evaluated all Medicare Fee-for-Service beneficiaries ≥65 years at cohort inception with continuous enrollment from 2003 to 2015. Linear mixed effects models, adjusted for baseline frailty and age, were used to estimate change in a validated claims-based frailty index (CFI) over a 5-year period. Survival analysis was used to examine frailty progression and risk of adverse health outcomes.

Results

There were 8.9 million unique patients identified, mean age 77.3 ± 7.2 years, 58.7% female, 10.9% non-White race. In total, 60% had frailty progression and 40% frailty regression over median follow-up of 2.4 years. Compared to those with frailty regression, when adjusting for age and baseline CFI, those with frailty progression had a significantly greater risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.31–1.31), all-cause mortality (HR 1.34, 95% CI 1.34–1.34), acute myocardial infarction (HR 1.08, 95% CI 1.07–1.09), heart failure exacerbation (HR 1.30, 95% CI 1.29–1.30), ischemic stroke (HR 1.14, 95% CI 1.14–1.15). There was also a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer days alive at home (DAH) with more rapid progression compared to the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87–0.88, p < 0.001).

Conclusions

In this large, nationwide sample of older Medicare beneficiaries, frailty progression, independent of age and baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and ischemic stroke compared to those with frailty regression.

背景:虚弱与心血管不良后果相关,与年龄和合并症无关:虚弱与不良心血管预后相关,与年龄和合并症无关,但虚弱进展对心血管预后的独立影响仍不确定:为了确定虚弱进展是否与不良心血管预后相关,而与基线虚弱和年龄无关,我们评估了所有在队列开始时年龄≥65 岁的联邦医疗保险付费服务受益人,他们在 2003 年至 2015 年期间连续参加了队列。根据基线虚弱程度和年龄进行调整后,使用线性混合效应模型来估算 5 年间基于索赔的有效虚弱指数(CFI)的变化。使用生存分析来检验虚弱程度的进展和不良健康后果的风险:共识别出 890 万名患者,平均年龄为 77.3 ± 7.2 岁,58.7% 为女性,10.9% 为非白人。在 2.4 年的中位随访中,60% 的患者体弱程度加深,40% 的患者体弱程度减轻。在调整年龄和基线 CFI 后,与体弱衰退者相比,体弱衰退者发生重大心脑血管不良事件 (MACCE) 的风险明显更高(危险比 [HR] 1.31,95% 置信区间 [CI] 1.31-1.31)、全因死亡率(HR 1.34,95% CI 1.34-1.34)、急性心肌梗死(HR 1.08,95% CI 1.07-1.09)、心衰加重(HR 1.30,95% CI 1.29-1.30)、缺血性中风(HR 1.14,95% CI 1.14-1.15)。与进展最慢的组别相比,进展较快的组别发生各种结果的风险也呈梯度增加,而且进展较快的组别在家中存活的天数(DAH)也明显较少(270.4 ± 112.3 对 308.6 ± 93.0 天,比率比为 0.88,95% CI 0.87-0.88,P 结论:这是一项全国性的大型样本研究,研究结果表明,与进展最慢的组别相比,进展较快的组别发生各种结果的风险也呈梯度增加:在这一大型的全国性老年医疗保险受益人样本中,与体弱衰退的受益人相比,体弱衰退与年龄和基线体弱无关,与较少的 DAH 以及 MACCE、全因死亡率、心肌梗死、心力衰竭和缺血性中风的分级风险相关。
{"title":"Progression of frailty and cardiovascular outcomes among Medicare beneficiaries","authors":"Yusi Gong MD,&nbsp;Yang Song MSc,&nbsp;Jiaman Xu MPH,&nbsp;Huaying Dong MSc,&nbsp;Daniel B. Kramer MD, MPH,&nbsp;Ariela R. Orkaby MD, MPH,&nbsp;John A. Dodson MD, MPH,&nbsp;Jordan B. Strom MD, MSc","doi":"10.1111/jgs.19116","DOIUrl":"10.1111/jgs.19116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression on cardiovascular outcomes remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To determine whether frailty progression is associated with adverse cardiovascular outcomes, independent of baseline frailty and age, we evaluated all Medicare Fee-for-Service beneficiaries ≥65 years at cohort inception with continuous enrollment from 2003 to 2015. Linear mixed effects models, adjusted for baseline frailty and age, were used to estimate change in a validated claims-based frailty index (CFI) over a 5-year period. Survival analysis was used to examine frailty progression and risk of adverse health outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 8.9 million unique patients identified, mean age 77.3 ± 7.2 years, 58.7% female, 10.9% non-White race. In total, 60% had frailty progression and 40% frailty regression over median follow-up of 2.4 years. Compared to those with frailty regression, when adjusting for age and baseline CFI, those with frailty progression had a significantly greater risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.31–1.31), all-cause mortality (HR 1.34, 95% CI 1.34–1.34), acute myocardial infarction (HR 1.08, 95% CI 1.07–1.09), heart failure exacerbation (HR 1.30, 95% CI 1.29–1.30), ischemic stroke (HR 1.14, 95% CI 1.14–1.15). There was also a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer days alive at home (DAH) with more rapid progression compared to the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87–0.88, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this large, nationwide sample of older Medicare beneficiaries, frailty progression, independent of age and baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and ischemic stroke compared to those with frailty regression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141877013","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
Vaccine patterns among older adults with Guillain–Barré syndrome and matched comparators, 2006–2019 2006-2019 年患有格林-巴利综合征的老年人和匹配的比较者的疫苗接种模式。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 DOI: 10.1111/jgs.19110
Samantha R. Eiffert MPH, Alan C. Kinlaw PhD, MSPH, Betsy L. Sleath PhD, Carolyn T. Thorpe PhD, MPH, Rebecca Traub MD, Sudha R. Raman PhD, Til Stürmer MD, PhD

Background

Some vaccines have a small risk of triggering Guillain–Barré syndrome (GBS), an autoimmune disorder where nerve damage leads to paralysis. There is a CDC precaution for patients whose GBS was associated with an influenza or tetanus toxoid-containing vaccine (GBS occurring within 42 days following vaccination).

Methods

We described vaccine patterns before and after a GBS diagnosis with a matched cohort design in a 20% random sample of fee-for-service Medicare enrollees. We defined the index date as an ICD-9-CM or ICD-10-CM GBS diagnosis code in the primary position of an inpatient claim. We matched each GBS patient to five non-GBS comparators on sex, exact age, racial and ethnic category, state of residence and the month of preventive health visits during baseline; used weighting to balance covariates; and measured frequency of vaccines received per 100 people during year before and after the index date using the weighted mean cumulative count (wMCC).

Results

We identified 1567 patients with a GBS diagnosis with at least 1 year of prior continuous enrollment in Medicare A and B that matched to five comparators each. The wMCCs in the 1 year before the index date were similar for both groups, with a wMCC of 74 vaccines/100 people in the GBS group (95% CI 71, 77). Within 1 year after the index date, patients with GBS had received 26 vaccines/100 people (95% CI 23, 28), which was 41 fewer vaccines than matched non-GBS comparators (95% CI −44, −38). Among GBS patients, 11% were diagnosed with GBS within 42 days after a vaccine.

Conclusions

GBS diagnosis has a strong impact on reducing subsequent vaccination even though there is no warning or precaution about future vaccines for most patients diagnosed with GBS. These data suggest discordance between clinical practice and current vaccine recommendations.

背景:某些疫苗有引发吉兰-巴雷综合征(GBS)的小风险,这是一种自身免疫性疾病,神经损伤会导致瘫痪。美国疾病预防控制中心(CDC)对因接种流感疫苗或含破伤风类毒素疫苗而引发吉兰-巴雷综合征的患者制定了预防措施(接种后 42 天内发生吉兰-巴雷综合征):我们对 20% 的医疗保险付费服务参保者进行了随机抽样,通过匹配队列设计描述了 GBS 诊断前后的疫苗接种模式。我们将指数日期定义为住院索赔主要位置上的 ICD-9-CM 或 ICD-10-CM GBS 诊断代码。我们根据性别、确切年龄、种族和民族类别、居住州以及基线期间预防性健康检查的月份,将每位 GBS 患者与五位非 GBS 比较者进行匹配;使用加权法平衡协变量;并使用加权平均累积计数 (wMCC) 计算指数日期前后一年中每 100 人接种疫苗的频率:我们确定了 1567 名确诊为 GBS 的患者,他们之前至少连续参加了一年的 A 类和 B 类医疗保险,并分别与五个比较者匹配。两组患者在指数日期前 1 年内的疫苗接种率相似,GBS 组的疫苗接种率为 74 支/100 人(95% CI 71-77)。在指数日期后的 1 年内,GBS 患者每 100 人接种了 26 支疫苗(95% CI 23,28),比匹配的非 GBS 对照组少接种 41 支疫苗(95% CI -44,-38)。在 GBS 患者中,有 11% 在接种疫苗后 42 天内被确诊为 GBS:结论:GBS 诊断对减少后续疫苗接种有很大影响,尽管对大多数确诊为 GBS 的患者来说,未来的疫苗接种没有任何警告或预防措施。这些数据表明临床实践与当前疫苗接种建议之间存在不一致。
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引用次数: 0
Gaps in the coordination of care for people living with dementia 在协调对痴呆症患者的护理方面存在差距。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-07-29 DOI: 10.1111/jgs.19105
Lisa M. Kern MD, MPH, Catherine Riffin PhD, Veerawat Phongtankuel MD, MS, Joselyne E. Aucapina, Samprit Banerjee PhD, Joanna B. Ringel MPH, Jonathan N. Tobin PhD, Semhar Fisseha MPH, Helena Meiri RN, MA, Sigall K. Bell MD, Paul N. Casale MD, MPH

Background

One-third of people living with dementia (PLWD) have highly fragmented care (i.e., care spread across many ambulatory providers without a dominant provider). It is unclear whether PLWD with fragmented care and their caregivers perceive gaps in communication among the providers involved and whether any such gaps are perceived as benign inconveniences or as clinically meaningful, leading to adverse events. We sought to determine the frequency of perceived gaps in communication (coordination) among providers and the frequency of self-reported adverse events attributed to poor coordination.

Methods

We conducted a cross-sectional study in the context of a Medicare accountable care organization (ACO) in New York in 2022–2023. We included PLWD who were attributed to the ACO, had fragmented care in the past year by claims (reversed Bice-Boxerman Index ≥0.86), and were in a pragmatic clinical trial on care management. We used an existing survey instrument to determine perceptions of care coordination and perceptions of four adverse events (repeat tests, drug–drug interactions, emergency department visits, and hospital admissions). ACO care managers collected data by telephone, using clinical judgment to determine whether each survey respondent was the patient or a caregiver. We used descriptive statistics to summarize results.

Results

Of 167 eligible PLWD, surveys were completed for 97 (58.1%). Of those, 88 (90.7%) reported having >1 ambulatory visit and >1 ambulatory provider and were thus at risk for gaps in care coordination and included in the analysis. Of those, 23 respondents were patients (26.1%) and 64 were caregivers (72.7%), with one respondent's role missing. Overall, 57% of respondents reported a problem (or “gap”) in the coordination of care and, separately, 18% reported an adverse event that they attributed to poor care coordination.

Conclusion

Gaps in coordination of care for PLWD are reported to be very common and often perceived as hazardous.

背景:三分之一的痴呆症患者(PLWD)接受的是高度分散的护理(即护理分散在许多流动医疗服务提供者之间,而没有一个主要的医疗服务提供者)。目前尚不清楚接受分散护理的痴呆症患者及其护理人员是否认为相关医疗服务提供者之间存在沟通上的隔阂,也不清楚这些隔阂是被视为良性的不便,还是被视为有临床意义的隔阂,从而导致不良事件的发生。我们试图确定医疗服务提供者之间在沟通(协调)方面存在差距的频率,以及自我报告的因协调不力而导致的不良事件的频率:我们于 2022-2023 年在纽约的一家医疗保险责任护理组织 (ACO) 中开展了一项横断面研究。我们纳入了归属于 ACO 的 PLWD,这些 PLWD 在过去一年中报销的医疗费用分散(反向 Bice-Boxerman 指数≥0.86),并且参加了一项关于护理管理的实用临床试验。我们使用现有的调查工具来确定对护理协调的看法以及对四种不良事件(重复检查、药物相互作用、急诊就诊和入院)的看法。ACO 护理经理通过电话收集数据,利用临床判断来确定每位调查对象是患者还是护理人员。我们使用描述性统计来总结结果:在 167 名符合条件的 PLWD 中,97 人(58.1%)完成了调查。其中,88 人(90.7%)报告说,他们接受过 >1 次门诊就诊和 >1 次门诊医疗服务提供者提供的服务,因此有可能在护理协调方面存在差距,并被纳入分析范围。其中,23 位受访者是患者(26.1%),64 位受访者是护理人员(72.7%),还有一位受访者的角色缺失。总体而言,57% 的受访者报告了护理协调方面的问题(或 "差距"),另有 18% 的受访者报告了不良事件,并将其归咎于护理协调不力:结论:据报告,为 PLWD 提供的护理协调方面的差距非常普遍,而且通常被认为是危险的。
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引用次数: 0
Site-initiated adaptations in the implementation of an evidence-based inpatient walking program 在实施以证据为基础的住院病人步行计划过程中,由医院主动进行调整。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-07-29 DOI: 10.1111/jgs.19044
Jaime M. Hughes PhD, MPH, MSW, Ashley L. Choate MPH, Cassie Meyer BS, Caitlin B. Kappler MSW, Virginia Wang PhD, Kelli D. Allen PhD, Courtney H. Van Houtven PhD, S. Nicole Hastings MD, Leah L. Zullig PhD, MPH

Background

There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site-initiated adaptations to STRIDE, a hospital-based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States.

Methods

STRIDE was implemented at eight hospitals in a stepped-wedge cluster randomized trial. During the pre-implementation phase, sites were encouraged to adapt program characteristics to optimize implementation and align with their hospital's resources, needs, and culture. Recommended adaptations included those related to staffing models, marketing, and documentation. To assess the number and types of adaptations, multiple data sources were reviewed, including implementation support notes from site-level support calls and group-based learning collaborative sessions. Adaptations were classified based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), including attention to what was adapted, when, why, and by whom. We reviewed the number and types of adaptations across sites that did and did not sustain STRIDE, defined as continued program delivery during the post-implementation period.

Results

A total of 25 adaptations were reported and classified across seven of the eight sites. Adaptations were reported across five areas: program documentation (n = 13), patient eligibility criteria (n = 5), program enhancements (n = 3), staffing model (n = 2), and marketing and recruitment (n = 2). More than one-half of adaptations were planned. Adaptations were common in both sustaining and non-sustaining sites.

Conclusions

Adaptations were common within a program designed with flexible implementation in mind. Identifying common areas of planned and unplanned adaptations within a flexible program such as STRIDE may contribute to more efficient and effective national scaling. Future research should evaluate the relationship between adaptations and program implementation.

背景:越来越多的人认识到,在推广和普及有效项目的过程中,最大限度地提高项目与环境的契合度非常重要。然而,在基于医院的定向行走项目中,关于项目设置如何考虑当地情况并修改项目特征或实施活动以提高匹配度的信息非常有限。为了填补这一空白,我们研究了美国八家退伍军人事务机构对STRIDE(一项针对年长退伍军人的医院内行动项目)进行调整的情况:STRIDE在八家医院进行了阶梯式分组随机试验。在实施前阶段,我们鼓励医疗机构调整项目特点,以优化实施效果,并与医院的资源、需求和文化保持一致。建议的调整包括与人员配备模式、市场营销和文件相关的调整。为了评估调整的数量和类型,我们审查了多种数据来源,包括来自医疗点支持电话和小组学习合作会议的实施支持记录。我们根据 "报告调整和修改框架"(FRAME)对调整进行了分类,包括关注调整的内容、时间、原因和人员。我们审查了在实施和未实施 STRIDE(即在实施后期间继续实施计划)的地点之间进行调整的数量和类型:结果:八个项目点中的七个项目点共报告了 25 项调整,并进行了分类。报告的调整涉及五个方面:项目文件(13 项)、患者资格标准(5 项)、项目改进(3 项)、人员配置模式(2 项)以及营销和招聘(2 项)。超过一半的调整是有计划的。调整在持续性和非持续性地点都很常见:结论:在以灵活实施为目的的计划中,调整很常见。在像 STRIDE 这样的灵活计划中,确定计划内和计划外调整的共同领域可能有助于提高全国推广的效率和效果。未来的研究应评估调整与计划实施之间的关系。
{"title":"Site-initiated adaptations in the implementation of an evidence-based inpatient walking program","authors":"Jaime M. Hughes PhD, MPH, MSW,&nbsp;Ashley L. Choate MPH,&nbsp;Cassie Meyer BS,&nbsp;Caitlin B. Kappler MSW,&nbsp;Virginia Wang PhD,&nbsp;Kelli D. Allen PhD,&nbsp;Courtney H. Van Houtven PhD,&nbsp;S. Nicole Hastings MD,&nbsp;Leah L. Zullig PhD, MPH","doi":"10.1111/jgs.19044","DOIUrl":"10.1111/jgs.19044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site-initiated adaptations to STRIDE, a hospital-based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>STRIDE was implemented at eight hospitals in a stepped-wedge cluster randomized trial. During the pre-implementation phase, sites were encouraged to adapt program characteristics to optimize implementation and align with their hospital's resources, needs, and culture. Recommended adaptations included those related to staffing models, marketing, and documentation. To assess the number and types of adaptations, multiple data sources were reviewed, including implementation support notes from site-level support calls and group-based learning collaborative sessions. Adaptations were classified based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), including attention to what was adapted, when, why, and by whom. We reviewed the number and types of adaptations across sites that did and did not sustain STRIDE, defined as continued program delivery during the post-implementation period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 25 adaptations were reported and classified across seven of the eight sites. Adaptations were reported across five areas: program documentation (<i>n</i> = 13), patient eligibility criteria (<i>n</i> = 5), program enhancements (<i>n</i> = 3), staffing model (<i>n</i> = 2), and marketing and recruitment (<i>n</i> = 2). More than one-half of adaptations were planned. Adaptations were common in both sustaining and non-sustaining sites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adaptations were common within a program designed with flexible implementation in mind. Identifying common areas of planned and unplanned adaptations within a flexible program such as STRIDE may contribute to more efficient and effective national scaling. Future research should evaluate the relationship between adaptations and program implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790673","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
Nursing Home Compare star ratings before versus after a change in nursing home ownership 疗养院所有权变更前后的星级比较。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-07-29 DOI: 10.1111/jgs.19104
Kira L. Ryskina MD, MSHP, Emily Tu MS, Junning Liang MS, Seiyoun Kim PhD, Rachel M. Werner MD, PhD

Background

Efforts to increase transparency and accountability of nursing homes, and thus improve quality, now include information about changes in nursing home ownership. However, little is known about how change in ownership affects nursing home quality.

Methods

We conducted a retrospective cohort study of 15,471 U.S. nursing homes between January 2016 and December 2022, identifying all changes in ownership during that period. We used logistic regression to measure the association between nursing home characteristics and the odds of a change in ownership. A difference-in-differences model with multiple time periods was used to examine the impact of a change in ownership on the Medicare Nursing Home Compare 5-star ratings.

Results

One in five (23%) facilities changed ownership between 2016 and 2022. Nursing homes that were urban, for-profit, part of a chain, located in the South, had >50 beds, lower occupancy, higher percentage of stays covered by Medicaid, higher percentage of residents with non-white race, or a 1-star (poor) rating were more likely to undergo a change in ownership. There was a small statistically significant decrease in 5-star ratings after a change in ownership (−0.09 points on a 5-point scale; 95% CI −0.13 to −0.04; p < 0.001), driven primarily by a decrease in staffing ratings (−0.19 points; 95% CI −0.24 to −0.14; p < 0.001), and health inspections ratings (−0.07 points; 95% CI −0.11 to −0.03; p = 0.001). This was mitigated by an increase in quality measure ratings (0.15 points; 95% CI 0.10–0.20; p < 0.001).

Conclusion

Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.

背景:为了提高养老院的透明度和责任感,进而提高质量,现在养老院的所有权变更信息也被纳入其中。然而,人们对所有权变化如何影响养老院质量却知之甚少:我们对 2016 年 1 月至 2022 年 12 月期间的 15,471 家美国养老院进行了回顾性队列研究,确定了在此期间所有权的所有变化。我们使用逻辑回归法测算了养老院特征与所有权变更几率之间的关系。我们使用多时段差异模型来研究所有权变更对医疗保险疗养院比较五星评级的影响:每五家养老院中就有一家(23%)在 2016 年至 2022 年间变更了所有权。城市养老院、营利性养老院、连锁养老院、位于南方的养老院、床位数大于 50 张的养老院、入住率较低的养老院、享受医疗补助的住院比例较高的养老院、非白人居民比例较高的养老院,或评级为 1 星(差)的养老院更有可能发生所有权变更。所有权变更后,5 星评级在统计意义上有小幅下降(5 分制-0.09 分;95% CI -0.13 到 -0.04;P 结论):疗养院所有权变更后,疗养院比较评分略有下降,原因是人员配备和健康检查评分降低,而质量衡量评分的提高在一定程度上缓解了这一趋势。这些相互矛盾的趋势凸显了机构所有权变更透明度的必要性,以及更好地了解所有权变更对患者和家属的影响的必要性。
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引用次数: 0
The Medicare annual wellness visit: An opportunity to improve health system identification of hearing loss? 医疗保险年度健康检查:改善医疗系统识别听力损失的机会?
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-07-26 DOI: 10.1111/jgs.19111
Danielle S. Powell AuD, PhD, Mingche M. J. Wu MSPH, Stephanie Nothelle MD, Jamie M. Smith RN PhD, Kelly Gleason PN, PhD, Esther S. Oh MD, PhD, Hillary D. Lum MD, PhD, Nicholas S. Reed AuD, Jennifer L. Wolff PhD

Background

Hearing loss is prevalent and consequential but under-diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient-reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown.

Methods

We use 5 years of electronic medical record (EMR) data (2017–2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care.

Results

Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race.

Conclusion

Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams.

背景:听力损失是普遍存在的后果,但诊断和管理不足。医疗保险年度健康访视(AWV)健康风险评估会引起患者报告的听力问题,但这些信息是否会影响记录、诊断或转诊尚不得而知:我们使用了 13776 名老年初级保健患者样本的 5 年电子病历(EMR)数据(2017-2022 年)。我们确定了听力问题的首次(索引)AWV 指征,以及现有和后续的听力损失 EMR 诊断(就诊诊断或问题清单诊断)和听力转诊。对于 20% 的随机抽样 AWV 笔记(n = 474),我们比较了听力损失 EMR 诊断与以下记录:(1)听力问题;(2)听力损失/助听器使用;(3)听力保健转诊:在确定有听力问题的 3845 名(27.9%)老年人(平均年龄 79.1 岁,57% 为女性,75% 为白人)中,24% 记录了现有的听力诊断。在审查过的 474 名有听力问题的患者的临床记录中,有 90 人(19%)已有听力损失诊断。临床医生更有可能在已有(与没有)EMR 诊断的患者中记录听力问题或听力损失/助听器的使用情况(50.6% 对 35.9%,P = 0.01;68.9% 对 37.5%,P 结论:EMR 和助听器诊断中记录听力损失的可能性更大:有主观听力问题的老年人在 EMR 和 AWV 临床记录中对听力损失的记录有限。系统性地支持听力并将其纳入 EMR 和临床记录可提高护理团队对听力损失的关注度。
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引用次数: 0
“I make myself get busy”: Resilience and social connection among low-income older adults living in subsidized housing "我让自己变得忙碌居住在补贴住房中的低收入老年人的复原力和社会联系。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-07-25 DOI: 10.1111/jgs.19069
Marcela D. Blinka PhD, Suzanne M. Grieb PhD, MSPH, Tsai-Tong Lee MPH, Samantha Hogg MPH, Katherine L. Runge MA, Andre Nogueira PhD, Nicole Williams MS, Laura Prichett PhD, MHS, Carl A. Latkin PhD, Joseph J. Gallo MD, MPH, Cynthia M. Boyd MD, MPH, Thomas K. M. Cudjoe MD, MPH, MA

Background

Social isolation and loneliness are pervasive issues among older adults in the United States, carrying significant health risks. Low-income older adults are particularly vulnerable to these challenges compared with their higher-income counterparts due to their limited access to resources and social networks. Many low-income older adults live in subsidized housing, which has the potential to offer unique support tailored to their needs. The intersection of aging and the unique social circumstances faced by low-income older adults significantly influences how they navigate crises.

Methods

We conducted semi-structured interviews with 24 older adults aged 63–86 residing in subsidized housing communities in the United States. The data were collected from August 2021 to November 2022 and subsequently analyzed using a thematic constant comparison analysis approach.

Results

Many participants felt connected to their housing community. Participants reported that their lives changed substantially due to the pandemic: communal activities ceased leading to isolation and feelings of loneliness. Amid this challenge, participants were resourceful and found creative ways to manage. Many emphasized the crucial role of technology in maintaining emotional support despite physical separation.

Conclusions

Participants in subsidized housing shared their experiences before and during this unique crisis highlighting the challenges they face, as well as their resilience and adaptability when facing challenges. Our findings underscore the significance of community activation, demonstrating that activities motivated older adults to improve their well-being. Additionally, the role of technology in maintaining connections proved to be crucial.

背景:社会隔离和孤独是美国老年人中普遍存在的问题,具有重大的健康风险。与高收入老年人相比,低收入老年人由于获得资源和社交网络的机会有限,特别容易受到这些挑战的影响。许多低收入老年人居住在有补贴的住房中,这有可能为他们提供适合其需求的独特支持。老龄化与低收入老年人所面临的独特社会环境的交织,在很大程度上影响了他们应对危机的方式:我们对居住在美国补贴住房社区的 24 名 63-86 岁的老年人进行了半结构化访谈。数据收集时间为 2021 年 8 月至 2022 年 11 月,随后采用主题恒定比较分析方法对数据进行了分析:结果:许多参与者感到与他们的住房社区息息相关。参与者报告说,由于大流行病,他们的生活发生了很大变化:社区活动停止,导致孤立和孤独感。在这一挑战中,参与者足智多谋,找到了创造性的管理方法。许多人强调了技术在保持情感支持方面的重要作用,尽管他们实际上是分离的:住在补贴住房中的参与者分享了他们在这场独特的危机之前和危机期间的经历,强调了他们所面临的挑战,以及他们在面对挑战时的复原力和适应力。我们的研究结果强调了社区活动的重要性,表明活动能激励老年人改善他们的福祉。此外,技术在保持联系方面的作用也被证明是至关重要的。
{"title":"“I make myself get busy”: Resilience and social connection among low-income older adults living in subsidized housing","authors":"Marcela D. Blinka PhD,&nbsp;Suzanne M. Grieb PhD, MSPH,&nbsp;Tsai-Tong Lee MPH,&nbsp;Samantha Hogg MPH,&nbsp;Katherine L. Runge MA,&nbsp;Andre Nogueira PhD,&nbsp;Nicole Williams MS,&nbsp;Laura Prichett PhD, MHS,&nbsp;Carl A. Latkin PhD,&nbsp;Joseph J. Gallo MD, MPH,&nbsp;Cynthia M. Boyd MD, MPH,&nbsp;Thomas K. M. Cudjoe MD, MPH, MA","doi":"10.1111/jgs.19069","DOIUrl":"10.1111/jgs.19069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Social isolation and loneliness are pervasive issues among older adults in the United States, carrying significant health risks. Low-income older adults are particularly vulnerable to these challenges compared with their higher-income counterparts due to their limited access to resources and social networks. Many low-income older adults live in subsidized housing, which has the potential to offer unique support tailored to their needs. The intersection of aging and the unique social circumstances faced by low-income older adults significantly influences how they navigate crises.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews with 24 older adults aged 63–86 residing in subsidized housing communities in the United States. The data were collected from August 2021 to November 2022 and subsequently analyzed using a thematic constant comparison analysis approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Many participants felt connected to their housing community. Participants reported that their lives changed substantially due to the pandemic: communal activities ceased leading to isolation and feelings of loneliness. Amid this challenge, participants were resourceful and found creative ways to manage. Many emphasized the crucial role of technology in maintaining emotional support despite physical separation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Participants in subsidized housing shared their experiences before and during this unique crisis highlighting the challenges they face, as well as their resilience and adaptability when facing challenges. Our findings underscore the significance of community activation, demonstrating that activities motivated older adults to improve their well-being. Additionally, the role of technology in maintaining connections proved to be crucial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763646","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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Journal of the American Geriatrics Society
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