Journal of the American Medical Directors Association最新文献

{"title":"Polypharmacy and Mild Cognitive Impairment in Older Adults: A 3-year Study of DO-HEALTH","authors":"Caroline de Godoi Rezende Costa Molino PhD ,&nbsp;Konstantin Baumann MD ,&nbsp;Stephanie Gaengler PhD ,&nbsp;Tatjana Meyer-Heim MD ,&nbsp;Angélique Sadlon MD, PhD ,&nbsp;Gregor Freystaetter MD ,&nbsp;Reto W. Kressig MD ,&nbsp;Andreas Egli MD ,&nbsp;Heike A. Bischoff-Ferrari MD, DrPH","doi":"10.1016/j.jamda.2025.105586","DOIUrl":"10.1016/j.jamda.2025.105586","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between polypharmacy and mild cognitive impairment (MCI) at baseline and over 3 years in community-dwelling older adults.</div></div><div><h3>Design</h3><div>Observational analysis of the DO-HEALTH trial.</div></div><div><h3>Setting and Participants</h3><div>Community-dwelling adults aged ≥70 years with good cognitive function and without major diseases at baseline.</div></div><div><h3>Methods</h3><div>Main exposure was polypharmacy at baseline (≥5 medications). The outcome was MCI (Montreal Cognitive Assessment [MoCA] score &lt;26), assessed at baseline and years 1, 2, and 3. Logistic regression and generalized estimating equations (GEEs) for repeated binary outcomes were used for the cross-sectional and longitudinal analysis, respectively. Minimally adjusted models included age, sex, prior fall, study site, body mass index, and education. Fully adjusted models additionally adjusted for mental health and multimorbidity. GEE models also accounted for time and DO-HEALTH treatment effects. Sensitivity analysis used a stricter MCI definition (MoCA &lt; 24).</div></div><div><h3>Results</h3><div>A total of 2153 participants completed MoCA at baseline. Baseline MCI prevalence was higher in participants with polypharmacy compared with those with no polypharmacy (MCI &lt; 26: 53.5% vs 46.5%; MCI &lt; 24: 34.9% vs 17.2%). Polypharmacy was associated with greater MCI odds at baseline in the minimally adjusted models (MoCA &lt; 26: odds ratio [OR], 1.32; 95% CI, 1.05–1.66; MoCA &lt; 24: OR, 1.37; 95% CI, 1.06–1.79). Over 3 years, polypharmacy was associated with increased MCI odds in the minimally adjusted models (MoCA &lt; 26: OR, 1.28; 95% CI, 1.08–1.52; MoCA &lt; 24: OR, 1.33; 95% CI, 1.07–1.65). Notably, these associations were somewhat attenuated and nonsignificant after controlling for mental health and multimorbidity.</div></div><div><h3>Conclusion and Implications</h3><div>Our findings suggest that MCI is more prevalent in older adults with polypharmacy compared with those without polypharmacy. Although polypharmacy was associated with MCI at baseline and over 3 years, these associations were attenuated by mental health and multimorbidity, suggesting that mental health and multimorbidity contribute to both polypharmacy and MCI.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105586"},"PeriodicalIF":4.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811589","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}

{"title":"Barriers and Facilitators to Successful Outbreak Management of Viral Respiratory Tract Infections in Long-Term Care Facilities: A Qualitative Interview Study","authors":"Iris R. van der Horst Msc ,&nbsp;Daisy Kolk PhD ,&nbsp;Meriam Janssen PhD ,&nbsp;Sascha R. Bolt PhD ,&nbsp;Martin Smalbrugge PhD, MD ,&nbsp;Sarah Janus PhD ,&nbsp;Cees M.P.M. Hertog PhD, MD","doi":"10.1016/j.jamda.2025.105575","DOIUrl":"10.1016/j.jamda.2025.105575","url":null,"abstract":"<div><h3>Objectives</h3><div>Effective management of COVID-19 and influenza outbreaks in nursing homes (NHs) depends on preparation by the NH organization and the rightful execution of infection prevention and control (IPC) measures by NH staff. To be better prepared for future outbreaks and pandemics, we need a better understanding of barriers and facilitators to the execution of measures. This study aims to investigate which barriers and facilitators were perceived by Dutch NH staff during the execution of IPC measures to control outbreaks of COVID-19 and influenza in the COVID-19 pandemic end stage.</div></div><div><h3>Design</h3><div>Qualitative interview study.</div></div><div><h3>Setting</h3><div>Nursing homes where COVID-19 and/or influenza outbreaks (defined as at least 2 confirmed cases on an NH unit) occurred between February 2023 and April 2023.</div></div><div><h3>Methods</h3><div>We monitored 24 COVID-19 and influenza outbreaks in 14 Dutch NH organizations in the pandemic end stage. Purposive sampling was used to select a variety of outbreaks for more extensive monitoring, including qualitative interviews with NH staff involved in the management of the outbreak. During the interviews, participants reflected on the management of monitored outbreaks as well as previous outbreaks. Interview transcripts were thematically analyzed to identify determinants of IPC strategy execution.</div></div><div><h3>Results</h3><div>Determinants of IPC execution were clustered according to themes: motivations and attitudes; appropriateness of measures; guidance and cooperation of NH staff; communication; knowledge and skills; architectural features of the NH location; and availability of resources.</div></div><div><h3>Conclusions and Implications</h3><div>The current study provides in-depth insight into which determinants facilitated and impeded IPC execution during COVID-19 and influenza outbreaks pandemic end stage. These findings may help NHs to better prepare for the management of future outbreaks and pandemics, and provide insights into what determinants to consider for developing IPC strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105575"},"PeriodicalIF":4.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753290","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}

{"title":"Social Engagement is Associated with Location-based Digital Markers on a Dementia Care Unit","authors":"Leia C. Shum MASc ,&nbsp;Elham Khodabandehloo PhD ,&nbsp;Tamim Faruk MASc ,&nbsp;Twinkle Arora PhD ,&nbsp;Caitlin McArthur PhD ,&nbsp;Charlene H. Chu PhD ,&nbsp;Katherine S. McGilton PhD ,&nbsp;Alastair J. Flint MB ,&nbsp;Shehroz S. Khan PhD ,&nbsp;Andrea Iaboni MD, DPhil","doi":"10.1016/j.jamda.2025.105548","DOIUrl":"10.1016/j.jamda.2025.105548","url":null,"abstract":"<div><h3>Objective</h3><div>Social engagement is an important contributor to quality of life and the overall health of people with dementia. There is an opportunity to develop an objective measure of social engagement by capturing factors such as the number and duration of social contacts, time in social settings, and social network metrics. The aim of this study was to examine the longitudinal relationship between clinical assessment of social engagement and digital markers of social behavior and networks derived from a clinical real-time location system (RTLS).</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting and Participants</h3><div>Thirty-seven patients on a short-stay specialized dementia unit for behavioral and psychological symptoms of dementia (60-day average length of stay).</div></div><div><h3>Methods</h3><div>Location data were collected using a wrist-worn clinical RTLS. Features measuring social contact, time in social spaces, and social network analyses were extracted from the location data for each morning and evening shift. The association over time between average weekly features and weekly Revised Index of Social Engagement (RISE) assessment scores was investigated using univariate panel models.</div></div><div><h3>Results</h3><div>There was high variability within and between participants in the RTLS-derived digital markers of social behavior. Seven digital markers of social engagement were statistically associated with weekly RISE scores over time, including time spent in the dining hall, time without co-patient contact, number of contacts longer than 5 minutes in duration, and social network PageRank.</div></div><div><h3>Conclusions and Implications</h3><div>Location data collected in residential care environments can provide insights into patterns of social engagement in people with dementia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105548"},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670153","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}

{"title":"The Effects of Commercial Conversational Agents on Older Adults’ Mental Health: A Scoping Review","authors":"Jolene Zi Tong Teo BSN (Hons) ,&nbsp;Si Qi Yoong BSN (Hons) ,&nbsp;Yi Xuan Chan BSN (Hons) ,&nbsp;Ying Jiang PhD","doi":"10.1016/j.jamda.2025.105523","DOIUrl":"10.1016/j.jamda.2025.105523","url":null,"abstract":"<div><h3>Objectives</h3><div>With increasing life expectancy, more older adults are experiencing poor mental health because of the significant life transitions they face. Commercial conversational agents (CAs) are emerging devices that can potentially support older adults' mental well-being. However, limited literature has evaluated the influence of commercial CAs on older adults' mental health. This study aims to examine what is known about the effects of commercial CAs on older adults’ mental health and the associated features.</div></div><div><h3>Design</h3><div>This scoping review was conducted in accordance with Arksey and O'Malley's framework.</div></div><div><h3>Setting and Participants</h3><div>The review primarily focused on community-dwelling older adults aged 60 and above who used any commercial CAs.</div></div><div><h3>Methods</h3><div>Quantitative, qualitative, mixed-method peer-reviewed studies and dissertations were included. Eleven databases were searched for relevant articles published from January 1, 2010, until April 9, 2024. Data extracted included the author(s), year, country, objective, population details, eligibility criteria, study design, commercial CA type, and findings related to research questions. Inductive basic content analysis was used for data synthesis.</div></div><div><h3>Results</h3><div>Twenty-nine articles from 28 studies (n = 1017 older adults) were included. Five categories were synthesized: social wellness, emotional reactions, cognitive stimulation, autonomy, and depression. Common features impacting older adults' mental health were the CAs' conversational capacity and anthropomorphism, voice-activated functions, music, calling and other functions, and technological limitations. There were more positive than adverse effects on older adults’ mental health categories.</div></div><div><h3>Conclusion and Implications</h3><div>Commercial CAs can potentially mitigate mental health in older adults, but the evidence is still very preliminary. Their effects must be verified in randomized controlled trials using objective and validated tools and through mixed-method studies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105523"},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743120","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}

{"title":"Agreement of Medicare Part D and Minimum Data Set Reported Psychotropic Medication Use in Nursing Homes","authors":"Tianwen Huan MS ,&nbsp;Orna Intrator PhD ,&nbsp;Adam Simning MD, PhD ,&nbsp;Kenneth Boockvar MD ,&nbsp;David C. Grabowski PhD ,&nbsp;Shubing Cai PhD","doi":"10.1016/j.jamda.2025.105538","DOIUrl":"10.1016/j.jamda.2025.105538","url":null,"abstract":"<div><h3>Objectives</h3><div>Little evidence exists on the accuracy of the Minimum Data Set (MDS)–based medication items. We compared quarterly rates of antipsychotic, antidepressant, and hypnotic use between the MDS and Part D Prescription Drug Event file (PDE) in 2018.</div></div><div><h3>Design</h3><div>Cross-sectional comparison.</div></div><div><h3>Setting and Participants</h3><div>All US Medicare- or Medicaid-certified nursing homes were included. Long-stay nursing home residents enrolled in Medicare Part D who were aged ≥65 years with psychiatric disorders or dementia identified in the MDS data (N = 580,340) were included. Two subcohorts included the following: residents with psychiatric disorders and no Alzheimer's disease and related dementias (ADRD), and residents with ADRD.</div></div><div><h3>Methods</h3><div>Psychotropic medication use was assessed using the share of study participants who received the medication in the quarter identified by the MDS. We used Cohen kappa to assess agreement in the share of residents using psychotropic medications during the quarter and used PDE data as a reference to calculate validity parameters.</div></div><div><h3>Results</h3><div>The MDS-reported and PDE-reported antipsychotic (MDS vs PDE: 34.0% vs 34.3%) or antidepressant (MDS vs PDE: 73.4% vs 71.3%) users have high concordance as measured by the kappa value (antipsychotic: 0.9; antidepressant: 0.83). Sensitivity, specificity, positive predictive value, and negative predictive value of MDS data compared with PDE were 96.7%, 92.8%, 96.3%, and 93.6% for antipsychotic, and 84.5%, 96.7%, 91.1%, and 94.0% for antidepressant. Only 3.7% of study participants identified in the MDS data, vs 32.6% of PDE-based users (kappa value: 0.1), used hypnotics. By combining antianxiety medications with hypnotics, the rates of MDS hypnotic or antianxiety users increased to 35.0% (kappa value: 0.74). Sensitivity, specificity, positive predictive value, and negative predictive value were 89.5%, 85.6%, 92.8%, and 79.8%, respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Agreement between the MDS and PDE in antipsychotic and antidepressant use was high, suggesting that the MDS is a valid tool to measure antipsychotic and antidepressant use. Additional work is needed to understand the disagreements between MDS and PDE in hypnotic use.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105538"},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753289","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}

{"title":"Measuring Physical Activity in Hospital Settings: A Scoping Review of Randomized Controlled Trials","authors":"Christina L. Ekegren PhD ,&nbsp;Lane Meyer DPT ,&nbsp;Michele Callisaya PhD ,&nbsp;Maureen C. Ashe PhD ,&nbsp;Claire Baldwin PhD ,&nbsp;Sze-Ee Soh PhD ,&nbsp;Dawn C. Mackey PhD","doi":"10.1016/j.jamda.2025.105563","DOIUrl":"10.1016/j.jamda.2025.105563","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify physical activity and sedentary behavior outcomes, measurement tools and protocols used, and data integrity in randomized controlled trials (RCTs) of hospital-based movement interventions in middle-aged and older adults.</div></div><div><h3>Design</h3><div>Scoping review of RCTs.</div></div><div><h3>Setting and Participants</h3><div>Adults with a mean or median age ≥50 years admitted to an acute or subacute hospital.</div></div><div><h3>Methods</h3><div>Four databases were searched for RCTs published between 2000 and 2023 evaluating interventions and measuring outcomes related to movement behavior (physical activity and/or sedentary behavior) of adults during an acute or subacute inpatient admission. Data extracted included movement behavior outcomes, measurement tools/devices, measurement protocols, and the integrity of movement data. Data were reported and synthesized using frequencies/percentages and via narrative summaries.</div></div><div><h3>Results</h3><div>After screening (n = 18,018), 34 studies were included. Most studies were conducted in subacute rehabilitation (n = 13) and excluded participants with cognitive impairment (n = 27) and/or mobility impairment (n = 24). A total of 17 different movement behavior outcomes were measured, with step count measured in 22 studies. Most studies (n = 30) measured movement behaviors using a wearable device. There were 43 unique measurement devices/tools used across studies, with significant heterogeneity observed in protocols for their use.</div></div><div><h3>Conclusions and Implications</h3><div>Given the substantial heterogeneity of movement behavior outcomes, and measurement tools and protocols used, there is an urgent need to develop evidence-based guidelines for measuring movement behaviors in hospital-based trials. Without this, synthesis of clinical trial outcomes and subsequent implementation of effective interventions for improving hospital-based movement behaviors will remain lacking.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105563"},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700776","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}

{"title":"Commitment and Intention in Employee Turnover: An LTC Sector Study Using TCM and TTM Models","authors":"Robert F. Frediani PhD, MHA, LNHA ,&nbsp;Jake Luo PhD ,&nbsp;Janis T. Eells PhD ,&nbsp;Akke N. Talsma PhD, RN, FAAN ,&nbsp;Jennifer T. Fink PhD","doi":"10.1016/j.jamda.2025.105566","DOIUrl":"10.1016/j.jamda.2025.105566","url":null,"abstract":"<div><h3>Objectives</h3><div>Long-term care (LTC) providers are facing a persistent issue of employee turnover. Various sources cite turnover rates of 79% to 124% in 2024. We used the three-component model (TCM) of commitment and the transtheoretical model of change (TTM) to study the correlation between employee commitment and their intention to quit.</div></div><div><h3>Design</h3><div>A correlational statistical analysis of survey results.</div></div><div><h3>Setting and Participants</h3><div>We collected survey data from 327 employees from 14 LTC organizations across the state in the summer of 2023.</div></div><div><h3>Methods</h3><div>The researchers worked through a state association to invite their 500+ member organizations to participate in the survey. We used correlational statistics to examine the effects of malleable workplace factors and demographics (independent variables) on employee commitment. We then correlated employee commitment, as an independent variable, to the employee's intention to quit.</div></div><div><h3>Results</h3><div>From the 372 completed surveys, we showed significant correlations between workplace factors and employee commitment. Affective Commitment had the strongest negative correlation with the intention to quit (r = −0.446, <em>P</em> &lt; .01). Employees with higher pay, longer tenure, more working hours per week, and departmental consistency reported higher commitment and lower intention to quit. Employees in the Precontemplation and Maintenance/Termination stages of TTM had the lowest intention to quit, whereas those in Contemplation and Action stages showed a higher likelihood of leaving.</div></div><div><h3>Conclusions and Implications</h3><div>Workplace factors affect the employee's level and type of commitment, which then affects their intention to quit. In other words, commitment acts as a measurable and malleable moderator between workplace conditions and an employee's intention to quit. This study offers guidance to employers seeking to affect employee turnover. Further research into LTC facilities could include a more granular analysis of the bidirectional effects of changes in the workplace factors on commitment and employee turnover.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105566"},"PeriodicalIF":4.2,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730597","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}

{"title":"Post-Acute Care Staff Perspectives of Changes since the COVID-19 Pandemic","authors":"Maggie Syme PhD ,&nbsp;Darby M. Simon MS ,&nbsp;Sandra Shi MD ,&nbsp;Cari Levy MD ,&nbsp;Ana-Maria Vranceanu PhD ,&nbsp;Evan Plys PhD","doi":"10.1016/j.jamda.2025.105579","DOIUrl":"10.1016/j.jamda.2025.105579","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105579"},"PeriodicalIF":4.2,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753293","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}

{"title":"Treatments for Depression for Older Adults Living in Long-Term Care: A Systematic Review and Network Meta-Analysis","authors":"Kayla Atchison MSc ,&nbsp;Peter M. Hoang MD ,&nbsp;Daria Merrikh BSc ,&nbsp;Cindy Chang MD ,&nbsp;Jennifer A. Watt MD, PhD ,&nbsp;Mark Hofmeister MSc ,&nbsp;Zahra Goodarzi MD","doi":"10.1016/j.jamda.2024.105435","DOIUrl":"10.1016/j.jamda.2024.105435","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the comparative efficacy of interventions on depressive symptoms and disorders in older adults living in long-term care (LTC).</div></div><div><h3>Design</h3><div>Systematic review and network meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>Older adults living in LTC or equivalent settings.</div></div><div><h3>Methods</h3><div>We searched 6 electronic databases and gray literature sources to identify randomized controlled trials describing pharmacologic or nonpharmacologic interventions. Studies had to measure depression as an outcome in persons living in LTC. Study inclusion and study quality were assessed in duplicate. Population characteristics, descriptions of intervention and control treatments, and end-point depression outcomes for each treatment were extracted from included studies. A network meta-analysis using the standardized mean difference (SMD) of depression scores was completed using a random effects model.</div></div><div><h3>Results</h3><div>A total of 182 studies were included in the review. The network meta-analysis was completed with 147 studies and included 31 treatment conditions. Compared with usual care, horticulture therapy (SMD, −6.85; 95% Credibility Interval, −8.49 to −5.22) and cognitive behavioral therapy (SMD, −1.98; 95% Credibility Interval, −2.91 to −1.05) were the most efficacious treatments. Animal therapy, group reminiscence therapy, multicomponent nonpharmacologic treatments, exercise, and socialization interventions also significantly improved depressive symptoms compared with usual care.</div></div><div><h3>Conclusions and Implications</h3><div>Many nonpharmacologic treatments for depression in LTC have been studied and are found to be efficacious. The low-risk and cost-effective nature of many of the nonpharmacologic treatments makes them ideal for use in LTC. More studies of pharmacologic treatments are needed to inform prescribing for depression in the LTC population. The range of treatments available for depression may help clinicians select therapies individualized to resident needs.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105435"},"PeriodicalIF":4.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895739","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}

{"title":"Individuals with Cognitive Impairment Entering Long-Term Care: Characteristics and Cumulative Incidence of Dementia after Care Entry","authors":"Andrew P. Shoubridge PhD ,&nbsp;Maria C. Inacio PhD ,&nbsp;Tracy Air MBiostat ,&nbsp;Steven L. Taylor PhD ,&nbsp;Tesfahun C. Eshetie PhD ,&nbsp;Maria Crotty PhD ,&nbsp;Geraint B. Rogers PhD ,&nbsp;Stephanie L. Harrison PhD","doi":"10.1016/j.jamda.2025.105568","DOIUrl":"10.1016/j.jamda.2025.105568","url":null,"abstract":"<div><h3>Objectives</h3><div>To characterize individuals entering long-term care facilities (LTCFs) with evidence of cognitive impairment and without a diagnosis of dementia, and to ascertain the cumulative incidence of dementia after care entry.</div></div><div><h3>Design</h3><div>Retrospective cohort study using the Registry of Senior Australians (ROSA) National Historical Cohort.</div></div><div><h3>Setting and Participants</h3><div>Individuals aged 65 to 105 years who entered LTCFs between 2009 and 2018, received a cognitive evaluation, and had no recorded dementia diagnosis at the time of care entry.</div></div><div><h3>Methods</h3><div>Cognitive function was determined via the Psychogeriatric Assessment Scales–Cognitive Impairment Scales (PAS-CIS) and defined as none or minimal (PAS-CIS score 0 to &lt;4), mild (4 to &lt;10), or moderate to severe (10 to 21). The cumulative incidence of dementia, determined by aged care assessments, hospitalization, medication, or cause of death, was ascertained for the total cohort and by cognitive impairment status at care entry.</div></div><div><h3>Results</h3><div>In total, 90,122 individuals [median age 85 years; interquartile range (IQR) 81–89; 64.6% female] were studied, of whom 76.6% (n = 69,075) had cognitive impairment, including 51.4% (n = 46,350) with mild and 25.2% (n = 22,725) with moderate to severe impairment. Over a median follow-up of 1.5 years (IQR 0.6–2.9), the cumulative incidence of dementia was 26.8% [95% confidence interval (CI), 26.5–27.1]. Stratification by cognitive impairment status showed the cumulative incidence of dementia was 17.4% (95% CI, 16.8–17.9) for none or minimal, 27.3% (95% CI, 26.9–27.8) for mild, and 35.3% (95% CI, 34.7–36.0) for moderate to severe.</div></div><div><h3>Conclusions and Implications</h3><div>The cohort of people entering LTCFs with cognitive impairment had a high incidence of dementia diagnosis within 1.5 years after entry. Routine cognitive impairment assessments can inform dementia screening strategies by identifying individuals at higher risk of dementia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105568"},"PeriodicalIF":4.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730572","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}