Blair P Golden, David Sonnentag, Farah A Kaiksow, Andrea Gilmore-Bykovskyi, Manish N Shah, Sharon K Inouye, Eduard E Vasilevskis
{"title":"A retrospective cohort study of hospital discharge instructions following delirium episodes.","authors":"Blair P Golden, David Sonnentag, Farah A Kaiksow, Andrea Gilmore-Bykovskyi, Manish N Shah, Sharon K Inouye, Eduard E Vasilevskis","doi":"10.1111/jgs.19146","DOIUrl":"10.1111/jgs.19146","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"My first clinic patient taught me to be a geriatrician long before I became one.","authors":"Mfon E Umoh","doi":"10.1111/jgs.19144","DOIUrl":"https://doi.org/10.1111/jgs.19144","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Youngjae Lee, Neil B Alexander, Lisa Pompeii, Linda V Nyquist, Michael L Madigan
Background: Most falls among community-dwelling older adults are due to a loss of balance (LOB) after tripping or slipping. Unfortunately, limited insight is available on the detailed circumstances and context of these LOBs. Moreover, commonly used methods to collect this information is susceptible to limitations of memory recall. The goal of this pilot observational study was to explore the circumstances and context of self-reported LOBs captured by wrist-worn voice recorders among community-dwelling older adults.
Methods: In this pilot observational cohort study, 30 community-dwelling adults with a mean (SD) age of 71.8 (4.4) years were asked to wear a voice recorder on their wrist daily for 3 weeks. Following any naturally-occurring LOB, participants were asked to record their verbal responses to six questions regarding the circumstances and context of each LOB abbreviated with the mnemonic 4WHO: When, Where, What, Why, How, and Outcome.
Results: Participants wore the voice recorder 10.9 (0.6) hours per day for 20.7 (0.5) days. One hundred seventy-five voice recordings were collected, with 122 meeting our definition of a LOB. Each participant reported 0-23 LOBs over the 3 weeks or 1.4 (2.1) per participant per week. Across all participants, LOBs were most commonly reported 3 p.m. or later (42%), inside the home (39%), while walking (33%), resulting from a trip (54%), and having induced a stepping response to regain balance (48%). No LOBs resulted in a fall.
Conclusions: Among community-dwelling older adults, wrist-worn voice recorders capture the circumstances and context of LOBs thereby facilitating the documentation of detail of LOBs and potentially falls, without reliance on later recall.
{"title":"Wrist-worn voice recorders capture the circumstances and context of losses of balance among community-dwelling older adults.","authors":"Youngjae Lee, Neil B Alexander, Lisa Pompeii, Linda V Nyquist, Michael L Madigan","doi":"10.1111/jgs.19148","DOIUrl":"https://doi.org/10.1111/jgs.19148","url":null,"abstract":"<p><strong>Background: </strong>Most falls among community-dwelling older adults are due to a loss of balance (LOB) after tripping or slipping. Unfortunately, limited insight is available on the detailed circumstances and context of these LOBs. Moreover, commonly used methods to collect this information is susceptible to limitations of memory recall. The goal of this pilot observational study was to explore the circumstances and context of self-reported LOBs captured by wrist-worn voice recorders among community-dwelling older adults.</p><p><strong>Methods: </strong>In this pilot observational cohort study, 30 community-dwelling adults with a mean (SD) age of 71.8 (4.4) years were asked to wear a voice recorder on their wrist daily for 3 weeks. Following any naturally-occurring LOB, participants were asked to record their verbal responses to six questions regarding the circumstances and context of each LOB abbreviated with the mnemonic 4WHO: When, Where, What, Why, How, and Outcome.</p><p><strong>Results: </strong>Participants wore the voice recorder 10.9 (0.6) hours per day for 20.7 (0.5) days. One hundred seventy-five voice recordings were collected, with 122 meeting our definition of a LOB. Each participant reported 0-23 LOBs over the 3 weeks or 1.4 (2.1) per participant per week. Across all participants, LOBs were most commonly reported 3 p.m. or later (42%), inside the home (39%), while walking (33%), resulting from a trip (54%), and having induced a stepping response to regain balance (48%). No LOBs resulted in a fall.</p><p><strong>Conclusions: </strong>Among community-dwelling older adults, wrist-worn voice recorders capture the circumstances and context of LOBs thereby facilitating the documentation of detail of LOBs and potentially falls, without reliance on later recall.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sunny C Lin, Jie Zheng, Arnold Epstein, E John Orav, Michael Barnett, David C Grabowski, Karen E Joynt Maddox
Background: Although many healthcare settings have since returned to pre-pandemic levels of operation, long-term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre-pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid.
Methods: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over-dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non-dually enrolled residents.
Results: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre-pandemic years for all examined subgroups. For example, compared with 2018-2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher.
Conclusions: In 2022, emergency department and hospital utilization rates among long-term residents were lower than pre-pandemic levels and mortality rates were higher than pre-pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents.
{"title":"The extended impact of the COVID-19 pandemic on long-term care residents in Medicare with frailty or dual Medicaid enrollment.","authors":"Sunny C Lin, Jie Zheng, Arnold Epstein, E John Orav, Michael Barnett, David C Grabowski, Karen E Joynt Maddox","doi":"10.1111/jgs.19131","DOIUrl":"https://doi.org/10.1111/jgs.19131","url":null,"abstract":"<p><strong>Background: </strong>Although many healthcare settings have since returned to pre-pandemic levels of operation, long-term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre-pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid.</p><p><strong>Methods: </strong>Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over-dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non-dually enrolled residents.</p><p><strong>Results: </strong>Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre-pandemic years for all examined subgroups. For example, compared with 2018-2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher.</p><p><strong>Conclusions: </strong>In 2022, emergency department and hospital utilization rates among long-term residents were lower than pre-pandemic levels and mortality rates were higher than pre-pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James W Mold, Frank H Lawler, Xiaolan Liao, David E Bard
Background: Both age-associated hearing loss (AAHL) and peripheral neuropathy (PN) are common in older patients, and both are associated with impaired balance, falls, and premature mortality. The objectives of this study were to document the prevalence and severity of AAHL in older primary care patients, and to explore associations between AAHL, PN, balance, falls, and mortality.
Methods: We analyzed information obtained in 1999 from 793 primary care patients recruited from practices participating in the Oklahoma Longitudinal Assessment of the Health Outcomes of Mature Adults (OKLAHOMA) Studies. Available data included demographic and health information, history of falls and hospitalizations, audiometry, balance testing, examination of the peripheral nerves, 50 foot timed gait, and dates of death up to 22 calendar years and 8106 person-years of follow-up. Proportionate hazards (PH) and structural equation modeling (SEM) were used to examine associations between AAHL, PN, balance, gait time, and mortality.
Results: 501 of the 793 participants (63%) had AAHL. Another 156 (20%) had low frequency and 32 (4%) had unilateral deficits. Those with moderate or severe AAHL and the 255 (32%) with PN had impaired balance (p < 0.0001), increased gait time (p = 0.0001), and reduced survival time (p < 0.0001). In the PH model, both AAHL and PN were associated with earlier mortality (H.Rs. [95% C.I.]: 1.36 [1.13-1.64] and 1.32 [1.10-1.59] respectively). The combination of moderate or severe AAHL and PN, present in 24% of participants, predicted earlier mortality than predicted by either deficit alone (O.R. [95% C.I.I] 1.55 [1.25-1.92]). In the SEM models, the impacts of both moderate or severe AAHL and PN on survival were mediated, in part, through loss of balance.
Conclusions: Hearing loss and PN, both common in older patients, appear to be independently and additively associated with premature mortality. Those associations may be mediated in part by impaired balance. The Mechanisms are likely multiple and complex.
{"title":"Associations between hearing loss, peripheral neuropathy, balance, and survival in older primary care patients.","authors":"James W Mold, Frank H Lawler, Xiaolan Liao, David E Bard","doi":"10.1111/jgs.19142","DOIUrl":"https://doi.org/10.1111/jgs.19142","url":null,"abstract":"<p><strong>Background: </strong>Both age-associated hearing loss (AAHL) and peripheral neuropathy (PN) are common in older patients, and both are associated with impaired balance, falls, and premature mortality. The objectives of this study were to document the prevalence and severity of AAHL in older primary care patients, and to explore associations between AAHL, PN, balance, falls, and mortality.</p><p><strong>Methods: </strong>We analyzed information obtained in 1999 from 793 primary care patients recruited from practices participating in the Oklahoma Longitudinal Assessment of the Health Outcomes of Mature Adults (OKLAHOMA) Studies. Available data included demographic and health information, history of falls and hospitalizations, audiometry, balance testing, examination of the peripheral nerves, 50 foot timed gait, and dates of death up to 22 calendar years and 8106 person-years of follow-up. Proportionate hazards (PH) and structural equation modeling (SEM) were used to examine associations between AAHL, PN, balance, gait time, and mortality.</p><p><strong>Results: </strong>501 of the 793 participants (63%) had AAHL. Another 156 (20%) had low frequency and 32 (4%) had unilateral deficits. Those with moderate or severe AAHL and the 255 (32%) with PN had impaired balance (p < 0.0001), increased gait time (p = 0.0001), and reduced survival time (p < 0.0001). In the PH model, both AAHL and PN were associated with earlier mortality (H.Rs. [95% C.I.]: 1.36 [1.13-1.64] and 1.32 [1.10-1.59] respectively). The combination of moderate or severe AAHL and PN, present in 24% of participants, predicted earlier mortality than predicted by either deficit alone (O.R. [95% C.I.I] 1.55 [1.25-1.92]). In the SEM models, the impacts of both moderate or severe AAHL and PN on survival were mediated, in part, through loss of balance.</p><p><strong>Conclusions: </strong>Hearing loss and PN, both common in older patients, appear to be independently and additively associated with premature mortality. Those associations may be mediated in part by impaired balance. The Mechanisms are likely multiple and complex.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nancy L Schoenborn, Susan M Hannum, Sarah E Gollust, Rebekah H Nagler, Mara A Schonberg, Craig E Pollack, Cynthia M Boyd, Qian-Li Xue, Mary Catherine Beach
Background: Public health campaigns have often used persuasive techniques to promote healthy behaviors but the use of persuasion by doctors is controversial. We sought to examine older women's perspectives.
Methods: We conducted semi-structured interviews with 20 community-dwelling older women from the Baltimore metropolitan area. We asked whether participants thought it was ethically appropriate for doctors to try to persuade patients and explored their rationales. We probed about commonly used persuasive techniques and two example decisional contexts-stopping mammograms and moving out of one's house after multiple falls. We used qualitative thematic analysis to code the transcripts and summarized results into major themes.
Results: We found mixed views on the ethical appropriateness of persuasion (theme 1); supporters of persuasion were motivated by the potential benefit to patients' health, whereas opponents thought patients should be the ultimate decision-makers. Perspectives depended on the persuasive technique (theme 2), where emotional appeals elicited the most negative reactions while use of facts and patient stories were viewed more positively. Perspectives also varied by the decisional context (theme 3), where higher severity and certainty of harm influenced participants to be more accepting of persuasion. Participants suggested alternative communication approaches to persuasion (theme 4) that emphasized respect for patients.
Conclusions: Our findings suggest that the type of persuasive technique and the decisional context are important considerations in the ethical debate around the use of persuasion. Limiting the use of persuasion to high-stakes decisions and using facts and patient stories rather than emotional appeals are likely more acceptable.
背景:公共卫生运动经常使用说服技术来促进健康行为,但医生使用说服技术却存在争议。我们试图研究老年妇女的观点:我们对来自巴尔的摩大都会地区的 20 名居住在社区的老年妇女进行了半结构化访谈。我们询问参与者是否认为医生试图说服病人在道德上是适当的,并探讨了她们的理由。我们探究了常用的说服技巧和两个决策情境实例--停止乳房 X 光检查和多次跌倒后搬出自己的房子。我们使用定性主题分析法对记录誊本进行编码,并将结果归纳为主要的主题:我们发现,对于劝说的道德适当性(主题 1),人们看法不一;支持劝说者的动机是劝说对患者健康的潜在益处,而反对者则认为患者应该是最终的决策者。观点取决于说服技巧(主题 2),情感诉求引起的反应最为负面,而使用事实和患者故事则更受好评。观点也因决策环境而异(主题 3),危害的严重性和确定性越高,参与者对说服的接受度就越高。参与者建议采用其他沟通方式进行说服(主题 4),强调对患者的尊重:我们的研究结果表明,劝说技巧的类型和决策背景是围绕劝说使用的伦理辩论中的重要考虑因素。将劝说的使用限制在高风险决策中,使用事实和患者故事而非情感诉求可能更容易被接受。
{"title":"Older women's perspectives on the ethics of persuasion in doctor-patient communication.","authors":"Nancy L Schoenborn, Susan M Hannum, Sarah E Gollust, Rebekah H Nagler, Mara A Schonberg, Craig E Pollack, Cynthia M Boyd, Qian-Li Xue, Mary Catherine Beach","doi":"10.1111/jgs.19121","DOIUrl":"https://doi.org/10.1111/jgs.19121","url":null,"abstract":"<p><strong>Background: </strong>Public health campaigns have often used persuasive techniques to promote healthy behaviors but the use of persuasion by doctors is controversial. We sought to examine older women's perspectives.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 20 community-dwelling older women from the Baltimore metropolitan area. We asked whether participants thought it was ethically appropriate for doctors to try to persuade patients and explored their rationales. We probed about commonly used persuasive techniques and two example decisional contexts-stopping mammograms and moving out of one's house after multiple falls. We used qualitative thematic analysis to code the transcripts and summarized results into major themes.</p><p><strong>Results: </strong>We found mixed views on the ethical appropriateness of persuasion (theme 1); supporters of persuasion were motivated by the potential benefit to patients' health, whereas opponents thought patients should be the ultimate decision-makers. Perspectives depended on the persuasive technique (theme 2), where emotional appeals elicited the most negative reactions while use of facts and patient stories were viewed more positively. Perspectives also varied by the decisional context (theme 3), where higher severity and certainty of harm influenced participants to be more accepting of persuasion. Participants suggested alternative communication approaches to persuasion (theme 4) that emphasized respect for patients.</p><p><strong>Conclusions: </strong>Our findings suggest that the type of persuasive technique and the decisional context are important considerations in the ethical debate around the use of persuasion. Limiting the use of persuasion to high-stakes decisions and using facts and patient stories rather than emotional appeals are likely more acceptable.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine L Auriemma, Maayra I Butt, Julia McMillan, Jasmine A Silvestri, Carolyn Chow, Melanie Bahti, Tamar Klaiman, Kristin Harkins, Jason Karlawish, Scott D Halpern
Background: Promoting options for aging in place (AIP) has broad appeal to policymakers and professionals providing services to persons living with dementia (PWD). However, the benefits or burdens of AIP likely vary among individuals and families. We sought to describe factors influencing decision-making to age in place versus seek a higher level of residential care for PWD.
Methods: A qualitative study was undertaken as part of a larger mixed-methods study utilizing semi-structured interviews with PWD, family care partners, and dementia clinicians. Interview transcripts were analyzed using qualitative content analysis with constant comparison. Sample size was determined by thematic saturation within subgroups.
Results: We conducted 74 interviews among 14 PWD, 36 care partners, and 24 clinicians. Preferences for AIP were driven by (1) desire to preserve independence, (2) a sense that the "best care" is delivered by loved ones and in a familiar environment, (3) distrust and fear of care facilities, and (4) caregiver guilt. PWD and care partners frequently considered moving from home as a "last resort" and wanted to avoid planning for future care needs. Many decisions to move were reactive and triggered by patient safety events, physical dependency, or the loss of caregiver. Proactive decision-making was facilitated by (1) prior experience witnessing the challenges of caring for a person with advanced dementia in the home; and (2) having substantial financial resources such that participants could seek major home adaptations or avoid "lower quality" institutions.
Conclusions: Decisions regarding care setting for PWD frequently do not feel like a choice and are made under imperfect conditions. Programs using AIP as an outcome measure should recognize the various patient-centered and non-patient-centered factors that influence such choices, and interventions should be designed to promote more informed and equitable decision-making for care setting in dementia.
{"title":"\"What choice do we have?\" Reactive and proactive decision-making for aging in place with dementia.","authors":"Catherine L Auriemma, Maayra I Butt, Julia McMillan, Jasmine A Silvestri, Carolyn Chow, Melanie Bahti, Tamar Klaiman, Kristin Harkins, Jason Karlawish, Scott D Halpern","doi":"10.1111/jgs.19140","DOIUrl":"https://doi.org/10.1111/jgs.19140","url":null,"abstract":"<p><strong>Background: </strong>Promoting options for aging in place (AIP) has broad appeal to policymakers and professionals providing services to persons living with dementia (PWD). However, the benefits or burdens of AIP likely vary among individuals and families. We sought to describe factors influencing decision-making to age in place versus seek a higher level of residential care for PWD.</p><p><strong>Methods: </strong>A qualitative study was undertaken as part of a larger mixed-methods study utilizing semi-structured interviews with PWD, family care partners, and dementia clinicians. Interview transcripts were analyzed using qualitative content analysis with constant comparison. Sample size was determined by thematic saturation within subgroups.</p><p><strong>Results: </strong>We conducted 74 interviews among 14 PWD, 36 care partners, and 24 clinicians. Preferences for AIP were driven by (1) desire to preserve independence, (2) a sense that the \"best care\" is delivered by loved ones and in a familiar environment, (3) distrust and fear of care facilities, and (4) caregiver guilt. PWD and care partners frequently considered moving from home as a \"last resort\" and wanted to avoid planning for future care needs. Many decisions to move were reactive and triggered by patient safety events, physical dependency, or the loss of caregiver. Proactive decision-making was facilitated by (1) prior experience witnessing the challenges of caring for a person with advanced dementia in the home; and (2) having substantial financial resources such that participants could seek major home adaptations or avoid \"lower quality\" institutions.</p><p><strong>Conclusions: </strong>Decisions regarding care setting for PWD frequently do not feel like a choice and are made under imperfect conditions. Programs using AIP as an outcome measure should recognize the various patient-centered and non-patient-centered factors that influence such choices, and interventions should be designed to promote more informed and equitable decision-making for care setting in dementia.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert S Dicks, Jimmy Choi, Christine Waszynski, Beth Taylor, Javeed Sukhera, Jesse Charpentier, David M O'Sullivan, Godfrey D Pearlson
{"title":"Association between race and ethnicity and delirium incidence in acute care.","authors":"Robert S Dicks, Jimmy Choi, Christine Waszynski, Beth Taylor, Javeed Sukhera, Jesse Charpentier, David M O'Sullivan, Godfrey D Pearlson","doi":"10.1111/jgs.19134","DOIUrl":"https://doi.org/10.1111/jgs.19134","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surviving aging-An assets-based approach.","authors":"Brianna E Morgan, Harriet Mather, Daniel David","doi":"10.1111/jgs.19126","DOIUrl":"https://doi.org/10.1111/jgs.19126","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Courtney H Van Houtven, Karen M Stechuchak, Paul A Dennis, Kasey Decosimo, Chelsea L Whitfield, Nina R Sperber, S Nicole Hastings, Megan Shepherd-Banigan, Brystana G Kaufman, Valerie A Smith
Background: Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home-days in the emergency department (ED), inpatient (IP) care, and post-acute care (PAC)-to understand how care recipient days not at home correspond to family caregiver QoL.
Methods: Secondary data were linked to care recipient utilization data. Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted "days not at home" variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden).
Results: In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%-3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (-0.1%). An IP day had a slight protective effect (-0.2 to -0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. PAC had a slight protective effect for caregiver burden (-0.1%). Cumulative days in all settings combined generally was not associated with caregiver QoL.
Conclusion: Whereas total care recipient time away from home had some negative spillovers to family caregivers, the countervailing effects of unique settings on caregiver QoL may mask net QoL effects. This finding limits the utility of a single care recipient home time measure as a valid caregiver-centered measure. Considering cumulative care recipient time in individual settings separately may be needed to reveal the true net effects on caregiver QoL.
背景:在医疗机构的时间与患者生活质量(QoL)的下降有关,但对家庭护理者生活质量的影响尚不清楚。我们评估了护理对象不在家的天数--在急诊科(ED)、住院(IP)护理和急性期后护理(PAC)的天数--以了解护理对象不在家的天数与家庭护理者 QoL 的对应关系:方法:将二级数据与接受护理者的使用数据联系起来。我们使用弹性网机器学习模型来评估在每种环境中使用一天护理服务对二元 QoL 结果的影响。我们还比较了综合加权和非加权 "不在家天数 "变量。我们使用 6 个月和 18 个月这两个时间段来预测三种照顾者 QoL 指标(自评健康、抑郁症状和主观负担):结果:在 6 个月的时间框架内,单日使用急诊室与所有三个评估结果的 QoL 较差可能性增加有关(范围:1.4%-3.2%)。一天的 PAC 与护理负担(0.2%)和抑郁症状(0.1%)的增加有一定程度的相关性,但对自评健康有轻微的保护作用(-0.1%)。IP 日也有轻微的保护作用(-0.2% 到 -0.1%)。在 18 个月时,ED 和 IP 与照顾者负担和抑郁症状的关系相似,但较为平淡。PAC 对照顾者的负担有轻微的保护作用(-0.1%)。在所有环境中的累计天数一般与护理者的 QoL 无关:虽然接受照护者离开家庭的总时间对家庭照护者有一些负面溢出效应,但独特环境对照护者 QoL 的反作用可能会掩盖 QoL 的净效应。这一发现限制了单一的受照护者在家时间测量作为以照护者为中心的有效测量方法的实用性。要揭示对照顾者 QoL 的真正净影响,可能需要单独考虑个别环境中照顾者的累计时间。
{"title":"Is more care recipient time at home also a family caregiver-centered quality of life measure?","authors":"Courtney H Van Houtven, Karen M Stechuchak, Paul A Dennis, Kasey Decosimo, Chelsea L Whitfield, Nina R Sperber, S Nicole Hastings, Megan Shepherd-Banigan, Brystana G Kaufman, Valerie A Smith","doi":"10.1111/jgs.19115","DOIUrl":"https://doi.org/10.1111/jgs.19115","url":null,"abstract":"<p><strong>Background: </strong>Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home-days in the emergency department (ED), inpatient (IP) care, and post-acute care (PAC)-to understand how care recipient days not at home correspond to family caregiver QoL.</p><p><strong>Methods: </strong>Secondary data were linked to care recipient utilization data. Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted \"days not at home\" variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden).</p><p><strong>Results: </strong>In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%-3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (-0.1%). An IP day had a slight protective effect (-0.2 to -0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. PAC had a slight protective effect for caregiver burden (-0.1%). Cumulative days in all settings combined generally was not associated with caregiver QoL.</p><p><strong>Conclusion: </strong>Whereas total care recipient time away from home had some negative spillovers to family caregivers, the countervailing effects of unique settings on caregiver QoL may mask net QoL effects. This finding limits the utility of a single care recipient home time measure as a valid caregiver-centered measure. Considering cumulative care recipient time in individual settings separately may be needed to reveal the true net effects on caregiver QoL.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}