Journal of the American Medical Directors Association最新文献

{"title":"Predictive Accuracy of the 3-m Backward Walk Test for Fall Risk in Older Adults","authors":"Ali Kapan PhD ,&nbsp;Milos Ristic MSc ,&nbsp;Richard Felsinger MD ,&nbsp;Andreas Konrad PhD ,&nbsp;Thomas Waldhoer PhD","doi":"10.1016/j.jamda.2025.105580","DOIUrl":"10.1016/j.jamda.2025.105580","url":null,"abstract":"<div><h3>Objectives</h3><div>Falls are a leading cause of injury in older adults, and accurate tools to predict fall risk are essential. This study evaluates the predictive accuracy of the 3-m Backward Walk Test (3 MBWT) for fall risk, comparing it with the Short Physical Performance Battery (SPPB), 10-m walk test (10 MWT), and fall-related questionnaires.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>The study was conducted in 2 nursing homes in Vienna, Austria. A total of 217 participants (65.9% female, median age, 80 years) were included.</div></div><div><h3>Methods</h3><div>Fall history was recorded retrospectively over 12 months and prospectively over 4 months using interviews and a Cogvis 3D sensor system. Predictive accuracy was assessed with receiver operating characteristic curves and area under the curve (AUC) analyses, whereas Poisson regression was used to analyze fall incidence.</div></div><div><h3>Results</h3><div>Among participants, 86 (39.6%) reported a fall within the previous 12 months. For retrospective falls, the SPPB (AUC, 0.76), 3 MBWT (AUC, 0.75), and 10 MWT (AUC, 0.73) showed similar predictive accuracy. For prospective falls, the SPPB (AUC, 0.75) and 3 MBWT (AUC, 0.74) remained similarly accurate, whereas the 10 MWT had lower predictive power (AUC, 0.67). For the 3 MBWT, cutoff points were ≥9.31 seconds for retrospective falls (32% higher incidence; 95% CI, 1.05–1.95) and ≥8.15 seconds for prospective falls (27% higher incidence; 95% CI, 1.02–1.66). Each additional second in 3 MBWT performance increased fall incidence (retrospective, 7%; prospective, 5%). SPPB cutoffs of &lt;7.02 and &lt;8.00 were associated with 49% (95% CI, 1.06–2.21) and 30% (95% CI, 1.02–1.74) higher fall incidence, respectively.</div></div><div><h3>Conclusions and Implications</h3><div>The 3 MBWT shows comparable accuracy with the SPPB and moderately better performance than the 10 MWT for prospective falls. Its efficiency, predictive value, and time savings make it a practical and viable tool for clinical fall risk assessment in older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105580"},"PeriodicalIF":4.2,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788468","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":"Risk Factors for Falls in Community-Dwelling Older Adults: An Umbrella Review","authors":"Stephanie Saunders MScPT,&nbsp;Cassandra D'Amore PhD,&nbsp;Quikui Hao MD,&nbsp;Nabil Abd El-Moneim MScPT,&nbsp;Julie Richardson PhD, PT,&nbsp;Ayse Kuspinar PhD, PT,&nbsp;Marla Beauchamp PhD, PT","doi":"10.1016/j.jamda.2025.105765","DOIUrl":"10.1016/j.jamda.2025.105765","url":null,"abstract":"<div><h3>Objectives</h3><div>Falls are a key public health concern, resulting in disability and increased mortality risk. An extensive body of literature has examined risk factors for falls; however, results vary across different studies and populations. We aimed to synthesize systematic reviews of fall risk factors in community-dwelling older adults.</div></div><div><h3>Design</h3><div>A systematic review of systematic reviews. Searches were executed in 6 databases (MEDLINE, Embase, CINAHL, Cochrane Library, PsychINFO, and AgeLine) from inception until June 13, 2023.</div></div><div><h3>Setting and Participants</h3><div>Eligible studies included systematic reviews of prospective cohort studies that included a population of community-dwelling older adults (≥60 years of age) and reported fall risk factors.</div></div><div><h3>Methods</h3><div>Three reviewers screened 8173 records. Summary data were extracted, and the units of analyses were the relationships between risk factors and falls. Descriptive results are reported in counts and frequencies.</div></div><div><h3>Results</h3><div>Fifty-seven reviews were included examining 29 risk factors. Mobility-related measures (balance, gait, physical function, physical activity, dual task ability, strength, and range of motion) accounted for 40% of all relationships. Clinical tests of balance and physical function, cognition, specifically executive function (76% significant) and processing speed (100%), medications (58%), frailty (100%), and chronic conditions (83%) were all consistent predictors of falls. There was a paucity of evidence for psychosocial, environmental, and sociodemographic factors. Most reviews (54%) were rated as low risk of bias.</div></div><div><h3>Conclusions and Implications</h3><div>Mobility-related risk factors for falls are well established and can be addressed through interventions. Findings highlight the limited examination of psychosocial, sociodemographic, and environmental risk factors for falls, indicating areas for future research.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105765"},"PeriodicalIF":4.2,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618716","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":"Association Between Multidimensional Frailty and Postoperative Outcomes in Older Patients With Hip Fracture: A Scoping Review","authors":"Yifei Li RN ,&nbsp;Xiao Sun PhD, RN","doi":"10.1016/j.jamda.2025.105769","DOIUrl":"10.1016/j.jamda.2025.105769","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;Hip fractures represent a common injury resulting from falls among older adults, significantly impairing their mobility and independence in daily activities, and substantially increasing mortality risk. Recent research has demonstrated that frailty is closely associated with postoperative adverse outcomes in older patients with hip fracture. However, most existing studies focus predominantly on single-dimensional frailty assessments, which lack comprehensive insight into the integrated impact of multidimensional frailty on postoperative outcomes. Thus, this review systematically summarizes the associations between multidimensional frailty and postoperative adverse outcomes, and examines the current application and effectiveness of multidimensional frailty assessment tools in older patients with hip fracture.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A scoping review that focuses on the association between multidimensional frailty and postoperative adverse outcomes among older patients with hip fracture.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting and Participants&lt;/h3&gt;&lt;div&gt;Original studies related to multidimensional frailty in older patients with hip fracture.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A comprehensive literature search was performed using databases, including PubMed, Embase, Cochrane, Web of Science, CINAHL, and PsyInfo. Studies were selected according to predefined inclusion and exclusion criteria. The basic characteristics, study designs, frailty dimensions, assessment tools, and postoperative outcomes of the included studies were extracted and analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 21 studies were included, predominantly retrospective and prospective cohort studies, with a noticeable increase in recent publications. The multidimensional frailty assessment tools varied significantly among studies, ranging from widely used tools to newly developed instruments. Physical, cognitive, psychological, and nutritional dimensions were most frequently addressed; however, the combination and selection of these dimensions varied across studies. Postoperative outcomes mainly focused on mortality, poor functional recovery, postoperative complications, and rehospitalization. Multidimensional frailty assessment tools consistently demonstrated superior predictive performance compared with single-dimensional measures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and Implications&lt;/h3&gt;&lt;div&gt;Multidimensional frailty exhibits significant predictive value for adverse postoperative outcomes in older patients with hip fracture, supporting the widespread clinical implementation of early identification and intervention strategies. These findings underscore the need for integrating frailty assessment into routine preoperative evaluation to guide risk stratification and personalized perioperative care. However, because of the lack of standardized frailty assessment tools, further prospective and high-quality studies are warranted to validate and refi","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105769"},"PeriodicalIF":4.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618651","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":"Magnesium Depletion Score as a Novel Predictor of Cognitive Impairment: A Population-Based Cross-Sectional Study From NHANES","authors":"Minchun Chen MD ,&nbsp;Runqing Xue PhD ,&nbsp;Meng Zhang MD ,&nbsp;Jingyi Zhang MD ,&nbsp;Jie Zheng MD ,&nbsp;Dan Ye MD ,&nbsp;Jiaxin Sun MD","doi":"10.1016/j.jamda.2025.105776","DOIUrl":"10.1016/j.jamda.2025.105776","url":null,"abstract":"<div><h3>Objective</h3><div>Magnesium (Mg) deficiency may accelerate neurodegenerative disease progression, but current cognitive impairment biomarkers have significant limitations. This study aimed to investigate the association between Mg depletion score (MDS) and cognitive impairment.</div></div><div><h3>Design</h3><div>This study is a cross-sectional analysis using data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES) to examine the relationship between MDS and cognitive performance.</div></div><div><h3>Setting and Participants</h3><div>The study included 2768 participants aged 60 years and older from the NHANES dataset. Among them, 650 participants (23.48%) showed cognitive impairment on the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, 700 (25.29%) on the Animal Fluency Test, and 676 (24.42%) on the Digit Symbol Substitution Test (DSST).</div></div><div><h3>Methods</h3><div>Univariate and multivariate logistic regression models, multivariable linear regression models, and subgroup analyses were conducted to assess the association between MDS and cognitive performance.</div></div><div><h3>Results</h3><div>Higher MDS scores were significantly associated with increased odds of cognitive impairment across all tests. Multivariable linear regression analysis revealed that MDS was significantly associated with cognitive impairment, particularly on the CREAD test (β, −0.71; 95% CI, 1.42–0.00) and the DSST (β, −2.78; 95% CI, 4.41 to −1.15). In contrast, the Animal Fluency Test demonstrated a weaker and less consistent association (β, −0.71; 95% CI, 1.48–0.06). Subgroup analyses showed that the association between MDS and cognitive impairment was particularly pronounced in individuals who were sedentary or had a dietary Mg intake ≤420 mg/d.</div></div><div><h3>Conclusions and Implications</h3><div>MDS may serve as a predictor of cognitive impairment, with sedentary lifestyle and low dietary Mg intake strengthening this association. Further prospective studies are required to validate these findings. The study suggests that MDS could be an early marker for cognitive decline, with implications for early intervention in individuals with low Mg intake or sedentary behavior.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105776"},"PeriodicalIF":4.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637414","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":"A Cross-Lagged Panel Model Testing the Impact of Physical Activity During Hospitalization on 1- and 6-Month Discharge Physical Activity and Adverse Events Among Older Adults With Dementia","authors":"Shijun Zhu PhD ,&nbsp;Barbara Resnick PhD, CRNP ,&nbsp;Marie Boltz PhD, CRNP ,&nbsp;Elizabeth Galik PhD, CRNP ,&nbsp;Rachel McPherson PhD ,&nbsp;Ashley Kuzmik DrPH, MPH ,&nbsp;Chris Wells PT, PhD ,&nbsp;Soyeon Shim MSN ,&nbsp;Eunji Lee MSN","doi":"10.1016/j.jamda.2025.105767","DOIUrl":"10.1016/j.jamda.2025.105767","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to examine the effects of physical activity during hospital stay on falls, emergency room visits, and rehospitalizations among older patients with dementia at 1 and 6 months post discharge.</div></div><div><h3>Design</h3><div>This is a secondary data analysis. Bidirectional analysis using panel data from a cluster randomized clinical trial was utilized.</div></div><div><h3>Setting and Participants</h3><div>The sample comprised 455 older adults with dementia from a clustered randomized clinical trial among 12 hospitals in 2 east coast states.</div></div><div><h3>Methods</h3><div>The bidirectional relationships between physical activity at 1 and 6 months and falls, emergency room visits, and rehospitalizations at 1 and 6 months post discharge and their relations with physical activity at discharge were assessed using cross-lagged panel models, accounting for the autoregression of physical activity and adverse events over time. Age, race, gender, cognitive status, admission location, comorbidity, and intervention groups were controlled in the modeling.</div></div><div><h3>Results</h3><div>Physical activity at hospitalization discharge showed autoregressive associations for the 3 time points. Patients with a higher level of physical activity at discharge had a lower chance of falling (β = −0.250, SE = 0.094, OR = 0.779, <em>P</em> = .008) and rehospitalizations (β = −0.228, SE = 0.092, OR = 0.796, <em>P</em> = .013) within 1 month post discharge. Falls, emergency room visits, or rehospitalizations at 1 month were not significantly associated with physical activity, or any adverse events at 6 months.</div></div><div><h3>Conclusions and Implications</h3><div>The findings from this study highlighted the significance and value of engaging older adults, particularly those living with dementia, in physical activity when hospitalized, as this reduced the likelihood of adverse events such as falls and rehospitalization at least in the first month post discharge.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105767"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618649","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":"A Multi-Outcome Prognostic Model for Community-Dwelling Older Adults Admitted to Skilled Nursing Facilities for Post-Acute Care","authors":"W. James Deardorff MD ,&nbsp;Siqi Gan MPH ,&nbsp;Bocheng Jing MS ,&nbsp;W. John Boscardin PhD ,&nbsp;Alexander K. Smith MD, MS, MPH ,&nbsp;Sei J. Lee MD, MAS","doi":"10.1016/j.jamda.2025.105775","DOIUrl":"10.1016/j.jamda.2025.105775","url":null,"abstract":"<div><h3>Objectives</h3><div>Nearly 20% of hospitalized older adults are discharged to a skilled nursing facility (SNF) for short-term rehabilitation. Many subsequently experience adverse outcomes, such as hospital readmissions, transitioning to long-term care rather than returning home, or death. To guide shared decision making, we developed a prognostic model for multiple outcomes for older adults admitted to SNFs.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Twenty percent national Medicare sample of community-dwelling older adults aged ≥66 discharged to an SNF after a hospitalization between 2017 and 2019.</div></div><div><h3>Methods</h3><div>We predicted 2 outcomes: 6-month all-cause mortality and “successful community discharge” (discharge to the community without subsequent rehospitalization or death within 30 days). Model predictors were pre-specified as age, sex, Elixhauser comorbidity score, hospital length of stay, elective vs urgent/emergency hospitalization, Medicaid status, principal hospital discharge diagnosis, surgical procedures, and hospitalizations in the past year. We used LASSO to reduce the 38 Elixhauser comorbidities to 12 comorbidities and logistic regression to determine separate predictor coefficients for the mortality and successful discharge outcomes. Model performance was assessed by discrimination [concordance statistic (c-statistic)] and calibration (calibration plots). Internal validation was performed via bootstrapping.</div></div><div><h3>Results</h3><div>The cohort included 523,740 individuals (median age 81, 62% female, 8% Black). Overall, 22% died by 6 months and 54% experienced a successful community discharge. Adjusted odds ratios varied based on outcome (eg, hospital length of stay was a stronger predictor of community discharge than mortality). The optimism-corrected c-statistics for the final model were 0.753 (95% CI, 0.752–0.755) for 6-month mortality and 0.692 (95% CI, 0.691–0.694) for successful community discharge. Calibration plots showed that the model was well calibrated for both outcomes.</div></div><div><h3>Conclusions and Implications</h3><div>In a national sample of older adults, this multi-outcome SNF prognostic model showed good discrimination and calibration. Risk predictions can help guide shared decision making and future planning among SNF clinicians, patients, and caregivers.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105775"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637412","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":"Developing and Implementing an Intervention to Increase Immunization Coverage Among Frontline Long-Term Care Staff","authors":"Elizabeth A. Sobczyk MSW, MPH ,&nbsp;Ellen M. Schultz MS ,&nbsp;Angela K. Shen ScD, MPH ,&nbsp;David M. Casey PhD ,&nbsp;Heather L. Roney MA ,&nbsp;Sheena A. Bumpas CNA, GCS ,&nbsp;Leslie B. Eber MD, CMD ,&nbsp;Amy Parker Fiebelkorn MSN, MPH","doi":"10.1016/j.jamda.2025.105761","DOIUrl":"10.1016/j.jamda.2025.105761","url":null,"abstract":"<div><div>In the years following the COVID-19 pandemic, immunization coverage has declined among frontline post-acute and long-term care (PALTC) staff, such as nurses, certified nursing assistants, and kitchen staff. We took a novel approach to addressing these declines by engaging frontline staff in design of immunization-focused professional development by surveying a convenience sample of 200 frontline PALTC staff to understand their attitudes toward immunization and preferences for job-related education and training. Frontline staff reported being motivated to protect themselves and residents from illness but were skeptical about the ability of vaccines to do so. Many felt strongly that immunization is a personal choice and wanted objective and reliable information on vaccines. We used this learning to design a 45-minute in-service for frontline staff that presented information on the benefits and risks of recommended immunization for PALTC residents and staff in a neutral way that respected staff autonomy. Accompanying brief online training prepared supervisors to deliver the in-service and answer staff questions. To evaluate the training, we surveyed a separate convenience sample of supervisors at 3 PALTC facilities, and all positively evaluated the in-service materials and training. The core focus of this innovative approach is centered on trusted messengers sharing reliable and relevant vaccine information in respectful ways.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105761"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618699","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":"Microstructural Brain Changes Associated With Frailty in Older Adults: Insights From Diffusion Tensor Imaging","authors":"Betul Sumbul Sekerci PhD ,&nbsp;Bahar Atasoy MD ,&nbsp;Ozge Pasin PhD ,&nbsp;Irem Bilgic ,&nbsp;Serdar Balsak MD ,&nbsp;Lee Smith PhD ,&nbsp;Alpay Alkan MD ,&nbsp;Pinar Soysal MD","doi":"10.1016/j.jamda.2025.105738","DOIUrl":"10.1016/j.jamda.2025.105738","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigates the relationship between frailty status and white matter integrity (WMI) in older adults, focusing on associations with frailty status.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>125 older adults aged ≥65 years without dementia were included.</div></div><div><h3>Methods</h3><div>A comprehensive geriatric assessment was conducted. Frailty status was evaluated by Fried Frailty criteria: unintentional weight loss, exhaustion, low levels of activity, weakness, and slowness: 0 for nonfrail, 1 to 2 for prefrail, and 3 to 5 for frail. Brain magnetic resonance imaging with diffusion tensor imaging (DTI) was performed, and mean diffusivity, fractional anisotropy, axial diffusivity, and radial diffusivity values were calculated in white matter integrity using a region of interest–based method. Multinomial logistic regression analyzed the multivariate effects of clinical variables on the frailty-WMI association, whereas canonical correlation analysis examined multivariate relationships between diffusion tensor imaging measurements and geriatric assessment parameters.</div></div><div><h3>Results</h3><div>The mean age was 81.76 ± 7.07 years, and 64% were female. Of the participants, 55.2% were frail, 33.6% prefrail, and 11.2% nonfrail. After adjusting for age and sex, WMI impairment varied in the cingulum, inferior longitudinal fasciculus, and forceps major in the left hemisphere among frailty statuses. Regression analysis showed demyelination of the left cingulum [odds ratio (OR) 0.97, 95% CI 0.95-0.99] and left forceps major (OR 0.99, 95% CI 0.98-0.99) was linked to increased frailty risk. For the frail group, DTI variables and malnutrition were significant. An increase in malnutrition status or risk raised the risk of frailty by 18.86 times. Canonical correlation analysis identified the Lawton-Brody IADL and Epworth Sleepiness Scale scores as the strongest predictors, whereas the cingulum showed the highest association among white matter tracts.</div></div><div><h3>Conclusions and Implications</h3><div>Frailty and prefrailty were associated with deteriorated WMI, particularly in the left cingulum and left forceps major. The strong link between frailty and WMI may reflect shared underlying mechanisms, including sleep, functionality, and nutrition. Therefore, a multidimensional approach to frailty is important.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608663","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":"Mental Health–Related Quality Indicators for Long-Term Care: A Modified Delphi Consensus Study","authors":"Deborah Brooks PhD ,&nbsp;Deepa Sriram PhD ,&nbsp;Rachel Brimelow PhD ,&nbsp;Claire Burley PhD ,&nbsp;Jacqueline Wesson PhD ,&nbsp;Margaret MacAndrew PhD ,&nbsp;Thomas Morris DPsych ,&nbsp;Leander K. Mitchell PhD ,&nbsp;Nancy A. Pachana PhD ,&nbsp;Henry Brodaty DSc ,&nbsp;Elizabeth Beattie PhD ,&nbsp;Leonard C. Gray MD ,&nbsp;Nadeeka N. Dissanayaka PhD","doi":"10.1016/j.jamda.2025.105768","DOIUrl":"10.1016/j.jamda.2025.105768","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the high prevalence of depression, anxiety, and other mental health conditions in long-term care settings, there are no mental health–related quality indicators mandated for use in Australia. This study aimed to gain national consensus on indicators for inclusion in a mental health benchmarking industry tool for residential aged care.</div></div><div><h3>Design</h3><div>A modified Delphi study incorporating 2 rounds of online surveys.</div></div><div><h3>Setting and Participants</h3><div>We invited a panel of clinical, academic, industry, and consumer experts from across Australia.</div></div><div><h3>Methods</h3><div>Experts were asked to rate 35 potential indicators on a 5-point Likert scale for importance and feasibility. Round 2 included new potential indicators based on qualitative feedback, and merged or reworded indicators that did not previously achieve consensus. Indicators with a median rating ≥4 and an interquartile range ≤1 for importance were deemed acceptable. Additional steering group meetings were held between rounds, for decision-making purposes.</div></div><div><h3>Results</h3><div>Rounds 1 and 2 were completed by 49 and 34 experts, respectively. Twenty-seven indicators achieved consensus of agreement for inclusion on importance, with good to excellent item content validity. These included 6 items relating to assessment, 7 items relating to management, 4 items relating to resources, 5 items relating to staff training, and 5 items relating to resident outcomes. Although these indicators also rated highly on feasibility, there was mixed consensus as measured by an interquartile range &gt;1. Qualitative feedback suggests that the indicators are comprehensive, important, and valuable.</div></div><div><h3>Conclusions and Implications</h3><div>Findings provide consensus on a mix of structure (staff training and resources), process (assessment and management), and resident outcome quality indicators. Future research will focus on pilot testing the indicators in residential aged care homes, to ensure and optimize feasibility, reliability, acceptability, and case-mix adjustment considerations. The mental health benchmarking tool has the potential to drive mental health care improvements at both a care home and industry level, in Australia and globally.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105768"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626647","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":"Disproportionate Impact of Respiratory Syncytial Virus (RSV) Among Older Adults in Long-Term Care Settings","authors":"Kevin Popham MPH ,&nbsp;Katherine St. George MS ,&nbsp;Christina Felsen MPH ,&nbsp;Ghinwa Dumyati MD ,&nbsp;Brenda L. Tesini MD","doi":"10.1016/j.jamda.2025.105760","DOIUrl":"10.1016/j.jamda.2025.105760","url":null,"abstract":"<div><h3>Objectives</h3><div>The full burden of respiratory syncytial virus (RSV) infection in the long-term care facility (LTCF) population is not well defined. This study aimed to quantify the burden of RSV infection, hospitalization, and in-hospital death in older adults residing in LTCFs compared with those in the community.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Monroe County, NY, adults aged 65 years and older with positive RSV test results during the 2022–2023 and 2023–2024 RSV seasons.</div></div><div><h3>Methods</h3><div>Data were collected through population-based surveillance. Residence type was classified as LTCF [skilled nursing facilities (SNFs) or assisted living facilities (ALFs)] or community-dwelling (CD). RSV infection and complication rates were calculated; complication rates in LTCF residents were compared with CD adults. SNF-specific attack rates were generated.</div></div><div><h3>Results</h3><div>A total of 1660 RSV infections were identified (270 SNF, 68 ALF, 1322 CD) during the surveillance period. The average infection rates were 4151.9 per 100,000 persons for SNF residents, 1635.0 for ALF residents, and 503.7 for CD older adults. Hospitalization rates were 6.6 times higher in SNF residents and 7.2 times higher in ALF residents compared with CD adults. In-hospital mortality rates were significantly higher in LTCF residents, with the rate in SNF residents 16.6 times and ALF residents 18.5 times higher than in CD adults. Seasonal attack rates in SNFs varied between 0.3% and 28.5%.</div></div><div><h3>Conclusions and Implications</h3><div>RSV disproportionately impacts LTCF residents in both SNFs and ALFs, with these populations experiencing much higher hospitalization and mortality rates compared with CD older adults. Our findings underscore the need for targeted RSV prevention strategies in LTCFs, including routine vaccination and infection detection, to mitigate the impact of RSV. Ongoing surveillance is needed to evaluate the effectiveness of these interventions and monitor RSV trends in this vulnerable population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105760"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618700","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}