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Optimizing inpatient rehabilitation use in older adults with trauma: A collaborative geriatric trauma approach 优化老年创伤患者的住院康复治疗:老年创伤协作方法。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-26 DOI: 10.1111/jgs.19285
Garrett Trang BS, Maeliss Gelas BS, Kristina Balangue MD, Natasha Keric MD, Nimit Agarwal MD, AGSF
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引用次数: 0
Deprescribing considerations for central nervous system-active polypharmacy in patients with dementia 痴呆症患者中枢神经系统活性多药的去处方考虑因素。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-26 DOI: 10.1111/jgs.19294
Anna Hung PharmD, PhD, MS, Matthew E. Growdon MD, MPH
<p>Older adults with dementia are much more likely than those without dementia to experience polypharmacy, defined as taking at least five medications. Approximately 72% of older adults with dementia, versus only 44% of those without dementia, experience polypharmacy.<span><sup>1</sup></span> Although multiple medications may be prescribed to treat multiple chronic conditions, polypharmacy in older adults is associated with increased risks of adverse drug events,<span><sup>2</sup></span> cognitive and physical impairment,<span><sup>3</sup></span> frailty, falls, and mortality.<span><sup>4</sup></span> For older adults with dementia, the most common contributors to polypharmacy include cardiovascular medications and medications acting on the central nervous system.<span><sup>1</sup></span> An estimated 73% of adults aged 65 and over with dementia use at least one cardiovascular medication, and an estimated 85% use at least one medication acting on the central nervous system.<span><sup>1, 5</sup></span> Yet another risk beyond polypharmacy alone is the concomitant use of three or more medications all acting on the central nervous system, termed central nervous system-active polypharmacy. These medications typically include: antiepileptics, antidepressants, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics (i.e., z-drugs), opioids, and skeletal muscle relaxants.<span><sup>6</sup></span> The concomitant use of these medications is associated with increased risks of falls,<span><sup>7</sup></span> cognitive decline,<span><sup>8</sup></span> emergency room visits, and hospitalizations.<span><sup>9, 10</sup></span> The 2023 Beers Criteria recommend against central nervous system-active polypharmacy.<span><sup>6</sup></span></p><p>Older adults with dementia are more likely to experience central nervous system-active polypharmacy because many of the medications can be used to manage neuropsychiatric symptoms, such as agitation, aggression, sleep disorders, mood disorders, and psychotic symptoms, related to the underlying dementia. This is concerning because antipsychotics, benzodiazepines, and z-drugs are specifically advised against in persons with dementia.<span><sup>6</sup></span> In 2005, the Food and Drug Administration added a black box warning for atypical antipsychotics for persons with dementia due to increased mortality risks, and in 2008, the black box warning was expanded to all antipsychotics (including typical antipsychotics). Nonetheless, in community-dwelling older adults living with dementia in the United States, 14% in 2018 concomitantly used at least three medications acting on the central nervous system for at least 30 overlapping days.<span><sup>11</sup></span></p><p>In this month's issue, Dr. Vordenberg and colleagues sought to understand how the 14% came to be, by analyzing 2019 prescription claims data from a cohort of community-dwelling Medicare beneficiaries aged 65 and above with Alzhei
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引用次数: 0
Characterizing patient portal use of people with cognitive impairment and potentially inappropriate medications 了解认知障碍患者门户网站的使用特点以及潜在的用药不当。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-23 DOI: 10.1111/jgs.19284
Ariel R. Green MD, PhD, MPH, Daniel Martin MA, Andrew Jessen MS, Mingche M. J. Wu MPH, Andrea E. Daddato PhD, MS, Rosalphie Quiles Rosado PhD, Kelly T. Gleason PhD, RN, Aleksandra Wec BA, Jennifer L. Wolff PhD, Casey O. Taylor PhD, Elizabeth A. Bayliss MD, MSPH

Background

People with cognitive impairment commonly use central nervous system-active potentially inappropriate medications (CNS-PIM), increasing risk of adverse outcomes. Patient portals may be a promising tool for facilitating medication-related conversations. Little is known about portal use by this population related to medications.

Objective

To target portal interventions, we sought to identify individuals with cognitive impairment and CNS-PIM exposure who discussed medications through the portal and to determine how frequently their messages described possible adverse effects.

Methods

We used electronic health record (EHR) data from an academic health system in Maryland (Site 1) from 2017 to 2022 and pharmacy and EHR data from an integrated health system in Colorado (Site 2) in 2022 to identify people with cognitive impairment and CNS-PIM exposure who communicated about medications through the portal. At Site 1, message threads were manually categorized based on content. At Site 2, messages were categorized using natural language processing (NLP).

Results

The Site 1 cohort included 5543 patients aged ≥65 with cognitive impairment and ≥2 outpatient visits from 2017 to 2022. Over half (n = 3072; 55%) had CNS-PIM prescriptions. Most with CNS-PIM prescriptions had portal use (n = 1987; 65%); 1320 (66%) of those patients sent messages during possible CNS-PIM exposure. Coding of a 5% random sample of message threads revealed that 3% mentioned CNS-PIM and possible adverse effects, while 8% mentioned possible adverse effects without referencing CNS-PIM. At Site 2, 4270 people had cognitive impairment and CNS-PIM exposure in 2022; of these, 1984 (46%) had portal use and 1768 (41%) sent medication-related messages during CNS-PIM exposure. NLP identified 663 (8%) messages that mentioned CNS-PIM and possible adverse effects, while 726 (41%) mentioned possible adverse effects without referencing CNS-PIM.

Conclusions

People with cognitive impairment and care partners frequently send portal messages about medications and possible adverse effects. Identifying such messages can help target deprescribing interventions.

背景:认知障碍患者通常使用中枢神经系统活性药物(CNS-PIM),这增加了不良后果的风险。患者门户网站可能是促进用药相关对话的有效工具。但人们对这一人群使用门户网站进行药物治疗的情况知之甚少:为了有针对性地采取门户网站干预措施,我们试图找出那些通过门户网站讨论药物的认知障碍患者和 CNS-PIM 暴露者,并确定他们在信息中描述可能的不良反应的频率:我们使用了马里兰州一家学术医疗系统(站点 1)2017 年至 2022 年的电子健康记录(EHR)数据,以及科罗拉多州一家综合医疗系统(站点 2)2022 年的药房和 EHR 数据,以识别通过门户网站交流药物的认知障碍患者和 CNS-PIM 暴露者。在站点 1,根据内容对消息线程进行人工分类。在网站 2,使用自然语言处理(NLP)对信息进行分类:网站 1 的队列包括 5543 名年龄≥65 岁、有认知障碍且在 2017 年至 2022 年期间门诊就诊次数≥2 次的患者。半数以上(n = 3072;55%)开具了 CNS-PIM 处方。大多数具有 CNS-PIM 处方的患者使用过门户网站(n = 1987;65%);其中 1320 名(66%)患者在可能接触 CNS-PIM 期间发送了信息。对 5% 的随机信息样本进行编码后发现,3% 的信息提及 CNS-PIM 和可能的不良反应,8% 的信息提及可能的不良反应,但未提及 CNS-PIM。在站点 2,有 4270 人在 2022 年出现认知障碍并接触过 CNS-PIM;其中,1984 人(46%)使用过门户网站,1768 人(41%)在接触 CNS-PIM 期间发送过与药物相关的信息。NLP发现663条(8%)信息提到了CNS-PIM和可能的不良反应,726条(41%)信息提到了可能的不良反应,但没有提到CNS-PIM:结论:认知障碍患者和护理伙伴经常通过门户网站发送有关药物和可能不良反应的信息。识别这些信息有助于有针对性地采取处方干预措施。
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引用次数: 0
Changes in leisure activity, all-cause mortality, and functional disability in older Japanese adults: The JAGES cohort study 日本老年人休闲活动、全因死亡率和功能性残疾的变化:JAGES 队列研究。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-22 DOI: 10.1111/jgs.19264
Sayo Masuko DDS, Yusuke Matsuyama PhD, Shiho Kino PhD, Katsunori Kondo PhD, Jun Aida PhD

Background/Objectives

Leisure activities provide various health benefits for older adults. However, few studies have examined changes in leisure activities and health. This study aimed to determine the association among changes in leisure activities, subsequent all-cause mortality, and functional disability.

Methods

Using a longitudinal, prospective cohort design, we analyzed data from the Japan Gerontological Evaluation Study (JAGES) in 2010 and 2013 merged with government data on death and long-term care needs by 2020. Changes in leisure activity were defined as four-category exposure based on a question about leisure activities: those with leisure activities in both 2010 and 2013, those who started leisure activities in 2013, those without leisure activities in both 2010 and 2013 (reference group), and those who stopped leisure activities in 2013. All-cause mortality and functional disability were defined as onset during the 6-year follow-up from the 2013 survey. We applied the inverse probability of censoring and treatment-weighted methods for analyses using Cox proportional hazards models, where missingness was addressed using multiple imputation.

Results

The study included 38,125 participants with a mean age of 72.8 ± 5.5 years at baseline, and 46.9% were male. Among those without leisure activities between 2010 and 2013 and those who started leisure activities in 2013, mortality rates by 2020 were 28.6% and 21.1%, and functional disability rates were 24.6% and 18.1%, respectively; and in analyses with the inverse probability of censoring and treatment-weighted methods, the hazard ratio for mortality was 0.82 (95% confidence interval (CI), 0.75–0.90) and 0.89 (95% CI, 0.79–1.01) for functional disability, respectively.

Conclusion

Initiation of leisure activities among the older adults was associated with a lower risk of mortality and functional disability over the subsequent 6 years compared to older adults who did not report initiating any leisure activities.

背景/目的:休闲活动对老年人的健康有各种益处。然而,很少有研究探讨休闲活动的变化与健康之间的关系。本研究旨在确定休闲活动的变化、随后的全因死亡率和功能性残疾之间的关联:我们采用纵向、前瞻性队列设计,分析了日本老年学评估研究(JAGES)2010 年和 2013 年的数据,并将这些数据与政府提供的 2020 年死亡和长期护理需求数据进行了合并。休闲活动的变化被定义为基于休闲活动问题的四类暴露:2010 年和 2013 年均有休闲活动者、2013 年开始休闲活动者、2010 年和 2013 年均无休闲活动者(参照组)以及 2013 年停止休闲活动者。全因死亡率和功能性残疾的定义是在 2013 年调查后的 6 年随访期间发病。我们采用逆概率删减法和治疗加权法,使用 Cox 比例危险模型进行分析,并使用多重估算法解决缺失问题:研究共纳入 38 125 名参与者,基线平均年龄为 72.8 ± 5.5 岁,46.9% 为男性。在2010年至2013年期间没有参加休闲活动的人和2013年开始参加休闲活动的人中,到2020年的死亡率分别为28.6%和21.1%,功能性残疾率分别为24.6%和18.1%;在采用逆概率删减法和治疗加权法进行的分析中,死亡率的危险比分别为0.82(95%置信区间(CI),0.75-0.90),功能性残疾的危险比分别为0.89(95% CI,0.79-1.01):结论:与未报告开始休闲活动的老年人相比,开始休闲活动的老年人在随后的 6 年中死亡和功能性残疾的风险较低。
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引用次数: 0
Barriers and enablers of deprescribing in older adults: Trainee's perspectives 老年人取消处方的障碍和促进因素:受训人员的观点。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-22 DOI: 10.1111/jgs.19281
S. Nachammai Vidhya MBBS, MMED, MRCP, Reshma Aziz Merchant MBChB, FRCP, FRCP, FAMS
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引用次数: 0
Shared decision-making about autologous stem cell transplantation: A qualitative study of older patients and physicians 自体干细胞移植的共同决策:一项针对老年患者和医生的定性研究。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-22 DOI: 10.1111/jgs.19276
Qian Liu PhD, Jianfang Li MB, Lixiu Wang MSN, Chuyue Shan BA, Li Wang BSN, Dan Ye BSN, Dan Luo PhD, Huijing Zou PhD, Bing Xiang Yang PhD, Xiao Qin Wang PhD, Jingjing Zhang BSN, Fuling Zhou MD

Background

The decision-making process between autologous hematopoietic stem cell transplant (autoHSCT) and less-intensive treatments necessitates shared decision-making between older patients with hematological malignancies and healthcare providers. However, there is limited knowledge from both perspectives. This qualitative study aimed to comprehensively understand the experiences of shared decision-making regarding autoHSCT among older patients with hematological malignancies and physicians.

Methods

Older patients and physicians were recruited from the hematology department at one of the affiliated general hospitals of Wuhan University. They participated in semi-structured, in-depth face-to-face individual interviews from August 2022 to March 2023. The interviews explored their experiences with shared decision-making about autoHSCT. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method.

Results

Thirteen older patients and eight physicians were recruited. Two themes were identified: (1) Factors influencing AutoHSCT recommendations and decision-making: Seven factors were categorized into three groups: physician-driven factors (pretransplant assessments, experience-based judgment, and communication approaches), patient-driven factors (perceived benefits and risks, financial challenges, and family involvement), and mutual trust between patients and physicians, which is a bidirectional factor relying on both physicians' trust and the active participation of patients in the decision-making process. (2) Treatment planning and outcome expectations: Regardless of treatment choices, patients focused on engaging in self-management and prioritizing quality of life, and maintaining hope for positive outcomes.

Conclusions

The shared decision-making process for autoHSCT between older patients with hematological malignancies and physicians is shaped by physician-driven factors, patient-driven factors, and mutual trust. These findings provide a foundation for developing patient-centered care strategies, including decision aids and enhanced communication training for physicians, aimed at improving outcomes for older patients facing complex treatment choices. Future research should explore how these factors interact over time, through longitudinal studies, to assess their long-term impact on patient outcomes and quality of life.

背景:在自体造血干细胞移植(autologous hematopoietic stem cell transplant,autoHSCT)和低强度治疗之间的决策过程,需要老年血液恶性肿瘤患者和医疗服务提供者共同决策。然而,从这两个角度获得的知识都很有限。这项定性研究旨在全面了解老年血液恶性肿瘤患者和医生在共同决策自体HSCT方面的经验:方法:从武汉大学附属某综合医院血液科招募老年患者和医生。他们在 2022 年 8 月至 2023 年 3 月期间参加了半结构化、面对面的深入访谈。访谈探讨了他们对自体肝细胞移植共同决策的经验。访谈内容逐字记录,并采用科莱兹现象学方法进行分析:共招募了 13 名老年患者和 8 名医生。确定了两个主题:(1) 影响 AutoHSCT 建议和决策的因素:七个因素被分为三组:医生驱动因素(移植前评估、基于经验的判断和沟通方法)、患者驱动因素(感知到的益处和风险、经济挑战和家庭参与)以及患者和医生之间的相互信任,这是一个双向因素,既依赖于医生的信任,也依赖于患者在决策过程中的积极参与。(2) 治疗计划和结果预期:无论选择哪种治疗方法,患者都注重参与自我管理和优先考虑生活质量,并对积极的治疗结果保持希望:老年血液恶性肿瘤患者与医生之间的自体血细胞移植共同决策过程受医生驱动因素、患者驱动因素和相互信任的影响。这些发现为制定以患者为中心的护理策略奠定了基础,包括决策辅助工具和加强医生沟通培训,旨在改善面临复杂治疗选择的老年患者的治疗效果。未来的研究应通过纵向研究探讨这些因素如何随着时间的推移而相互作用,以评估它们对患者治疗效果和生活质量的长期影响。
{"title":"Shared decision-making about autologous stem cell transplantation: A qualitative study of older patients and physicians","authors":"Qian Liu PhD,&nbsp;Jianfang Li MB,&nbsp;Lixiu Wang MSN,&nbsp;Chuyue Shan BA,&nbsp;Li Wang BSN,&nbsp;Dan Ye BSN,&nbsp;Dan Luo PhD,&nbsp;Huijing Zou PhD,&nbsp;Bing Xiang Yang PhD,&nbsp;Xiao Qin Wang PhD,&nbsp;Jingjing Zhang BSN,&nbsp;Fuling Zhou MD","doi":"10.1111/jgs.19276","DOIUrl":"10.1111/jgs.19276","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The decision-making process between autologous hematopoietic stem cell transplant (autoHSCT) and less-intensive treatments necessitates shared decision-making between older patients with hematological malignancies and healthcare providers. However, there is limited knowledge from both perspectives. This qualitative study aimed to comprehensively understand the experiences of shared decision-making regarding autoHSCT among older patients with hematological malignancies and physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Older patients and physicians were recruited from the hematology department at one of the affiliated general hospitals of Wuhan University. They participated in semi-structured, in-depth face-to-face individual interviews from August 2022 to March 2023. The interviews explored their experiences with shared decision-making about autoHSCT. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen older patients and eight physicians were recruited. Two themes were identified: (1) Factors influencing AutoHSCT recommendations and decision-making: Seven factors were categorized into three groups: physician-driven factors (pretransplant assessments, experience-based judgment, and communication approaches), patient-driven factors (perceived benefits and risks, financial challenges, and family involvement), and mutual trust between patients and physicians, which is a bidirectional factor relying on both physicians' trust and the active participation of patients in the decision-making process. (2) Treatment planning and outcome expectations: Regardless of treatment choices, patients focused on engaging in self-management and prioritizing quality of life, and maintaining hope for positive outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The shared decision-making process for autoHSCT between older patients with hematological malignancies and physicians is shaped by physician-driven factors, patient-driven factors, and mutual trust. These findings provide a foundation for developing patient-centered care strategies, including decision aids and enhanced communication training for physicians, aimed at improving outcomes for older patients facing complex treatment choices. Future research should explore how these factors interact over time, through longitudinal studies, to assess their long-term impact on patient outcomes and quality of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"458-469"},"PeriodicalIF":4.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690155","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
Adaptation, calibration, and validation of a cognitive assessment battery for telephone and video administration 改编、校准和验证用于电话和视频管理的认知评估电池。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-21 DOI: 10.1111/jgs.19275
Yonah Joffe MS, Julianna Liu BS, Franchesca Arias PhD, Douglas Tommet MS, Tamara G. Fong MD, PhD, Eva M. Schmitt PhD, Thomas Travison PhD, Zachary J. Kunicki PhD, MS, MPH, Sharon K. Inouye MD, MPH, Richard N. Jones ScD

Background

Events such as global pandemics can force rapid adoption of new modes of assessment. We describe the evaluation of a modified neuropsychological assessment for web and telephone administration.

Methods

Telephone and video conferencing-based neuropsychological assessment procedures were developed and implemented within an ongoing observational study, the Successful Aging following Elective Surgery II (SAGES) study (N = 420 persons). Repeated cognitive assessments were used (N = 2008 observations). Analyses using latent variable psychometric methods were used to compare the measurement modes, and a nested validation sub-study (N = 100 persons) was used to test for measurement equivalence. We used item response theory methods to calibrate data collected by different assessment modes. Measurement equivalence was assessed with Bland–Altman plots and regression analysis.

Results

Only small differences were detected between in-person and video modes of assessment. The largest difference among factor loadings was shared for the Boston Naming Test and Visual Search and attention test, but the effects were very small (Cohen's q = 0.06) and not statistically significant (95% confidence interval on q, −0.06, +0.18). In terms of item difficulty differences between in-person and video, the Digit Span Backwards test was less difficult by video with a small-to-moderate effect size (Cohen's d of −0.28, 95% CI, −0.54, −0.01). The contrast of in-person and telephone assessment was larger, with telephone assessment being less difficult than in-person (largest shift in item difficulty for digit span backwards, d = −1.12 95% CI −1.35, −0.90). Calibrated scores from telephone and videoconference demonstrated good agreement (r = 0.72, 95% CI 0.61, 0.80), and the differences could be corrected with latent variable measurement models.

Conclusions

Videoconference based neuropsychological assessment can be as precise as in-person. Calibration of ability estimates using latent variable measurement models can address measurement differences and generate scores without evidence of systematic bias.

背景:全球大流行病等事件会迫使人们迅速采用新的评估模式。我们描述了对网络和电话管理的改良神经心理学评估的评估:方法:在一项正在进行的观察性研究 "选择性手术后的成功衰老 II(SAGES)研究"(N = 420 人)中,开发并实施了基于电话和视频会议的神经心理评估程序。采用重复认知评估(N = 2008 次观察)。使用潜变量心理测量方法进行分析,以比较测量模式,并使用嵌套验证子研究(N = 100 人)来检验测量等效性。我们使用项目反应理论方法对不同评估模式收集的数据进行校准。测量等效性通过布兰-阿尔特曼图和回归分析进行评估:结果:在面对面评估模式和视频评估模式之间只发现了很小的差异。波士顿命名测试和视觉搜索与注意力测试的因子负荷差异最大,但影响非常小(Cohen's q = 0.06),且无统计学意义(q 的 95% 置信区间为 -0.06, +0.18)。就面对面测试和视频测试的项目难度差异而言,视频测试的数字跨度向后测试难度较低,且具有小到中等的效应大小(Cohen's d 为 -0.28,95% 置信区间为 -0.54,-0.01)。面对面评估和电话评估的反差较大,电话评估的难度低于面对面评估(数字跨度倒数的项目难度变化最大,d = -1.12 95% CI -1.35, -0.90)。电话和视频会议的校准分数显示出良好的一致性(r = 0.72,95% CI 0.61,0.80),差异可通过潜在变量测量模型进行修正:结论:基于视频会议的神经心理学评估与面对面评估一样精确。结论:基于视频会议的神经心理评估可以像面对面评估一样精确,使用潜在变量测量模型校正能力估计值可以解决测量差异问题,并生成没有系统性偏差证据的分数。
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引用次数: 0
Impact of in-hospital cardiac rehabilitation on hospital-associated disability after transcatheter aortic valve implantation 院内心脏康复对经导管主动脉瓣植入术后住院相关残疾的影响。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-21 DOI: 10.1111/jgs.19265
Satoshi Katano PhD, Yuji Kono PhD, Toshiyuki Yano MD, PhD, Koshiro Kanaoka MD, PhD, Akinori Sawamura MD, PhD, Tetsufumi Motokawa MD, PhD, Yoshihiro Miyamoto MD, PhD, Yusuke Ohya MD, PhD, Shin-ichiro Miura MD, PhD, Nagaharu Fukuma MD, PhD, Shigeru Makita MD, PhD, Hideo Izawa MD, PhD

Background

Hospital-associated disability (HAD), a decline in the ability to perform activities of daily living (ADL) during hospitalization, is a modifiable target in integrated care for older adults. The aim of this study was to determine the impact of inpatient cardiac rehabilitation (CR) on the development of HAD in older patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

Methods

Older patients undergoing TAVI were extracted from the Japanese nationwide database (JROAD-DPC) from April 2014 to March 2021 and were divided into patients receiving inpatient CR (CR group) and a non-CR group. HAD was defined as a decrease in the Barthel Index (BI) score ≥5 points at discharge compared with the score at admission.

Results

Of 19,789 eligible patients, 17,066 (86%) underwent inpatient CR. The overall prevalence of HAD was 9.6%, with a lower incidence in the CR group than in the non-CR group (8.8% vs. 14.2%, p < 0.001). Random forest analysis revealed key features associated with HAD risk including BI score at admission, inpatient CR participation, age, body mass index (BMI), and chronic kidney disease. The results of multivariate logistic regression analysis showed that participation in inpatient CR was associated with a lower odds ratio (OR) of HAD (OR, 0.62; 95% confidence interval, 0.54–0.70), with similar results in inverse probability of treatment weighting-adjusted logistic regression analyses (OR, 0.82; 95% confidence interval, 0.77–0.88). Analyses in subgroups of interest showed heterogeneity in the effects of inpatient CR with possible loss in patients with a BMI of <18.5 kg/m2 or a BI score of less than 60 points at admission.

Conclusions

The data suggest a beneficial effect of inpatient CR participation on the prevention of HAD in older patients undergoing TAVI, but the effect may be limited in lean patients with disability for ADL before TAVI.

背景:医院相关残疾(HAD)是指住院期间日常生活能力(ADL)的下降,是老年人综合护理的一个可调节目标。本研究旨在确定住院心脏康复(CR)对接受经导管主动脉瓣植入术(TAVI)的主动脉瓣狭窄老年患者 HAD 发展的影响:从日本全国数据库(JROAD-DPC)中提取2014年4月至2021年3月期间接受TAVI手术的老年患者,并将其分为接受住院CR的患者(CR组)和非CR组。HAD的定义是出院时巴特尔指数(Barthel Index,BI)与入院时相比下降≥5分:在 19,789 名符合条件的患者中,17,066 人(86%)接受了住院 CR 治疗。HAD的总发生率为9.6%,CR组的发生率低于非CR组(8.8% vs. 14.2%,P 2):这些数据表明,住院患者参与CR对预防接受TAVI的老年患者的HAD有好处,但对于TAVI前有ADL残疾的瘦弱患者来说,效果可能有限。
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引用次数: 0
Termination of dual-special needs plan “look-alikes” and subsequent insurance enrollment 终止双重特殊需求计划的 "相似计划 "和随后的保险注册。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-21 DOI: 10.1111/jgs.19272
Meehir N. Dixit BA, David J. Meyers PhD, MPH, Amal N. Trivedi MD, MPH
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引用次数: 0
The tip of the iceberg: A call to improve medical director presence, time, and training in US nursing facilities 冰山一角:呼吁改善美国护理机构中医务主任的存在、时间和培训。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-20 DOI: 10.1111/jgs.19270
Denise Zwahlen MD, Jay Luxenberg MD
<p>The 1974 federal requirement that skilled nursing facilities provide a physician medical director was partly a response to an investigation of a 1970 salmonella outbreak in a nursing facility.<span><sup>1</sup></span> In 1987, the Omnibus Budget Reconciliation Act (OBRA) expanded the requirements to include a medical director in residential as well as skilled portions of nursing facilities. Forty-two CFR 483.70(g) Medical director and Appendix PP of the <i>State Operations Manual</i> for F-Tag 841 Responsibilities of Medical Director outline the expectations for medical direction in nursing homes. The federal regulations state that the medical director is responsible for implementing resident care policies and coordinating medical care in the facility. Reporting of medical direction hours is now required through the federal Staffing Data Submission Payroll-Based Journal (PBJ) system.<span><sup>2</sup></span></p><p>Goldwein et al.<span><sup>3</sup></span> provide excellent service through their descriptive study, which looks at the PBJ data on medical director hours. Their finding that more than a third of US nursing facilities report zero medical director time represents a wake-up call for enforcement of the federal mandate for medical direction. Surprisingly, they report that surveyors rarely cite deficiencies related to medical direction. This article should trigger a reevaluation of how CMS and state surveyors use the available PBJ data as part of the survey process.</p><p>Goldwein et al.<span><sup>3</sup></span> use mean medical director minutes per day (MPD) to compare among different facility sizes. They then evaluated the facility's MPD by ownership type and found that government-owned facilities had significantly more medical director time. There was little difference between nonprofit and for-profit facilities. The analysis found considerable state-to-state variation with the majority of facilities in four states reporting no medical direction time at all. This raises serious questions about the adequate enforcement of reporting requirements including the CMS PBJ Policy mandate that the reported medical director data be auditable and verifiable.<span><sup>2</sup></span> Goldwein et al.<span><sup>3</sup></span> recognize this problem by identifying the primary limitation of their study, which is the accuracy of the medical direction data. These findings of variability and significant numbers of facilities reporting no hours could reflect an alarming failure to have meaningful medical direction, inaccurate documentation of time, or a combination of the two. It is imperative that state surveyors and CMS step up and enforce current reporting regulations to improve the quality of this data.</p><p>The CMS “Nursing Home Compare” website (https://www.medicare.gov/nursinghomecompare) is a resource available for consumers to readily access pertinent information about competing nursing facilities to make an informed decision about which nursing
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Journal of the American Geriatrics Society
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