Journal of the American Medical Directors Association最新文献

{"title":"Trends in Assisted Living and Memory Care Supply From 2019 to 2023.","authors":"Eric Jutkowitz, Gauri Gadkari, Erh-Chi Hsu, Ozcan Tunalilar, Lindsey Smith, Cassandra L Hua, Jennifer N Bunker, Kali S Thomas","doi":"10.1016/j.jamda.2025.105890","DOIUrl":"10.1016/j.jamda.2025.105890","url":null,"abstract":"<p><strong>Objectives: </strong>Describe geographic variation from 2019 to 2023 in assisted living (AL) and memory care supply, and its correlation with county-level characteristics.</p><p><strong>Design: </strong>Descriptive study of the supply of AL and memory care.</p><p><strong>Setting and participants: </strong>Licensed AL communities in the United States operating in 2019 and 2023.</p><p><strong>Methods: </strong>Data come from a national list of licensed ALs and the US Census Bureau's American Community Survey. The primary outcomes of interest were AL supply and memory care supply (beds per 1000 adults aged 65+ at the county level). We descriptively evaluated county characteristics by AL supply in 2019 and the change in AL supply from 2019 to 2023.</p><p><strong>Results: </strong>In 2023, counties with the highest AL and memory care supply were more likely to have greater wealth, higher educational attainment, and were urban. Between 2019 and 2023, 43% of counties had a decrease in AL supply, 35% of counties had no change in AL supply, and 22% of counties had an increase in AL supply. Counties with a decrease or no change in AL supply compared with increase in AL supply had a larger proportion of the population aged 65+ years, lower median household income, and were more rural. Between 2019 and 2023, 29% of counties had a decrease in memory care supply, 37% had no change in memory care supply, and 34% had an increase in memory care supply. Counties with unchanged or a decrease in memory care supply had lower educational attainment, more poverty, lower home values, and were more rural.</p><p><strong>Conclusions and implications: </strong>We found low overall availability of AL and memory care supply and decreases in their supply in rural and socioeconomically disadvantaged counties. It is important to incentivize ALs, including memory care, to operate in underserved areas to ensure equitable access to these important long-term care settings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105890"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191677","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":"Validation and Comparison of 4 Fall Risk Assessment Tools for Older Adults in Chinese Nursing Homes: A Prospective Cohort Study.","authors":"Lu Shao, Zhong Wang, Xiang Qi, Jing Wang, Hongtao Cheng, Xichenhui Qiu, Ting Xu, Jun-E Zhang, Bei Wu","doi":"10.1016/j.jamda.2025.105882","DOIUrl":"10.1016/j.jamda.2025.105882","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluates and compares the predictive performance of 4 widely used fall risk assessment tools-Morse Fall Scale (MFS), St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Hendrich II Fall Risk Model (Hendrich II), and Timed Up and Go Test (TUGT)-in Chinese nursing homes, with a focus on optimizing cutoff values for better applicability.</p><p><strong>Design: </strong>A prospective cohort study.</p><p><strong>Setting and participants: </strong>The study was conducted in 4 nursing homes in China, including 866 older adults capable of providing informed consent and completing verbal communication.</p><p><strong>Methods: </strong>Participants were assessed using the 4 fall risk tools, and their fall events were recorded over 6 months. Predictive performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve. Calibration curves were generated to assess the agreement between predicted and observed fall probabilities.</p><p><strong>Results: </strong>Using the original cutoff values, the MFS (≥45) and TUGT (≥12 seconds) both showed high sensitivity (0.889 and 0.933, respectively) but low specificity (0.284 and 0.261, respectively). In contrast, the STRATIFY (≥2) and Hendrich II (≥5) exhibited high specificity (0.964 and 0.827, respectively) but low sensitivity (0.117 and 0.328, respectively). After optimization, the MFS (≥65) improved specificity (0.592) with moderate sensitivity (0.689), the STRATIFY (≥1) increased sensitivity (0.856) while reducing specificity to 0.407, the Hendrich II (≥2) achieved specificity of 0.519 with sensitivity of 0.739, and the TUGT (≥26.6 seconds) maintained high sensitivity (0.739) but had a specificity of 0.622. The TUGT demonstrated the strongest overall predictive accuracy (area under the receiver operating characteristic curve, 0.722).</p><p><strong>Conclusions and implications: </strong>All tools showed limitations in balancing sensitivity and specificity. Adjusting thresholds improved performance but did not yield optimal results. The findings highlight the importance of tailoring fall risk assessments to specific populations with thresholds adjusted to optimize performance. Future research should explore integrating clinical assessments with data-driven predictive models to enhance fall risk evaluation in long-term care settings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105882"},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191972","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":"Development of Prediction Models for Healthy Ageing in Community-Dwelling Middle-Aged and Older Adults: A Longitudinal Study Using Machine Learning.","authors":"Daniel E C Leme, Adriane R Costodio, Cesar de Oliveira, Michael Marmot","doi":"10.1016/j.jamda.2025.105843","DOIUrl":"10.1016/j.jamda.2025.105843","url":null,"abstract":"<p><strong>Objectives: </strong>Healthy ageing is a central issue in public health; however, there is a lack of consensus regarding its determinants. We developed machine learning (ML) models to predict healthy ageing based on the characteristics of community-dwelling middle-aged and older adults.</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Setting and participants: </strong>This cohort study included participants aged 50 years or older from the English Longitudinal Study of Ageing.</p><p><strong>Methods: </strong>We selected sociodemographic, health, lifestyle, and psychosocial characteristics at baseline. The outcome was healthy ageing at a 4-year follow-up, assessed based on functional status, preserved mobility, preserved muscle strength, absence of elevated depressive symptoms, absence of chronic diseases, and preserved cognitive function. We used the decision tree, logistic regression, neural network, and random forest algorithms to develop ML models and applied the SHapley Additive exPlanations algorithm to determine the contribution, positive or negative, of each predictor to the outcome.</p><p><strong>Results: </strong>Of the 6332 participants at baseline (median age 64 years), 27.9% were ageing healthily after 4 years. The ML model based on the random forest algorithm achieved the best performance on the test data set (area under the curve = 0.78, 95% CI 0.76-0.80). Normal physical performance, greater household wealth, chronological age, and self-perceived age between 50 and 59 years positively contributed, whereas physical inactivity, abdominal obesity, and not using the internet or email at baseline negatively affected the outcome.</p><p><strong>Conclusions and implications: </strong>ML models can help predict healthy ageing based on the characteristics of community-dwelling middle-aged and older adults. The available evidence can provide the basis for health strategies to promote active aging.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105843"},"PeriodicalIF":3.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058307","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":"Frailty Status and Dysphagia Trajectory Among Hospitalized Nursing Home Residents With Advanced Dementia","authors":"Raele Donetha Loy PhD ,&nbsp;Rebecca Howe MD, MAS ,&nbsp;Sweta Patel MPH ,&nbsp;Nicole Rogus-Pulia PhD ,&nbsp;James L. Rudolph MD","doi":"10.1016/j.jamda.2025.105860","DOIUrl":"10.1016/j.jamda.2025.105860","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this analysis was to describe the association of dysphagia and frailty in persons living with dementia (PLWD) residing in skilled nursing facilities (SNFs) who experienced hospitalization.</div></div><div><h3>Design</h3><div>Retrospective cohort.</div></div><div><h3>Setting and Participants</h3><div>Long-stay US nursing home residents from 2012–2018 with advanced dementia who experienced a hospitalization.</div></div><div><h3>Methods</h3><div>Among the cohort, we captured Minimum Data Set (MDS) assessments of dysphagia before and after hospitalization. MDS items were also used to measure FRAIL-NH (fatigue, resistance, ambulation, incontinence, weight loss, nutritional approach, help with dressing) scale components before hospitalization. Adjusted analyses identified the risk for dysphagia in the pre-hospital cohort and new dysphagia in the post-hospital cohort according to pre-hospital frailty status.</div></div><div><h3>Results</h3><div>Among the pre-hospital cohort (n = 1,207,345), 85% (n = 1,026,736) were classified as frail. Almost half of the cohort (n = 562,574, 46.6%) was on a mechanically altered diet. Dysphagia frequency was higher among frail residents (6.2% vs 2.4% prefrail vs 1.1% nonfrail). After adjustment for demographics and comorbidities, frailty was associated with greater risk of dysphagia [adjusted incidence rate ratio (IRR), 3.97; 95% CI, 3.49–4.49]. Among those who survived hospitalization (n = 1,078,321), frailty was also associated with new dysphagia (adjusted IRR, 1.7; 95% CI, 1.6–1.7).</div></div><div><h3>Conclusions and Implications</h3><div>Frailty is associated with increased risk of dysphagia among PLWD residing in SNFs. Additionally, frail PLWD who experience hospitalization are at increased risk of new dysphagia. These results have important implications for designing interventions to decrease dysphagia among frail PLWD. Given the wide disparity between the rates of mechanically altered diets and dysphagia as determined by MDS items, additional validation studies on the use of the MDS in dysphagia are warranted.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 12","pages":"Article 105860"},"PeriodicalIF":3.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058340","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":"Music Moves: Intergenerational Silent Disco Parties in Long-Term Care","authors":"Rynnie C.E. Son MEd ,&nbsp;Ilan Meghelli ,&nbsp;Julia Banco ,&nbsp;Oliver H.K. Yu ,&nbsp;Shambhavi Arora ,&nbsp;Swastika Mondol ,&nbsp;Charlotte Wang ,&nbsp;Lillian Hung PhD","doi":"10.1016/j.jamda.2025.105833","DOIUrl":"10.1016/j.jamda.2025.105833","url":null,"abstract":"<div><h3>Objectives</h3><div>Older adults in long-term care (LTC) often experience loneliness and social isolation. This study explores the experiences of residents participating in silent disco headphones (SDH) parties alongside an intergenerational group of facilitators. The objective was to examine the acceptability of intergenerational SDH parties in fostering social engagement, inclusion, and emotional well-being.</div></div><div><h3>Design</h3><div>Qualitative study using video ethnography and thematic analysis.</div></div><div><h3>Setting and Participants</h3><div>The study took place in an LTC home in British Columbia, Canada. Participants included 22 residents, 2 family caregivers, and 40 staff members who engaged in or observed the SDH parties.</div></div><div><h3>Methods</h3><div>Over 6 weeks, data were collected through video recordings, conversational interviews, observations, and focus groups with staff members. Thematic analysis was conducted to identify key themes in residents’ experiences. The study was reported in accordance with the COREQ Checklist.</div></div><div><h3>Results</h3><div>Three themes emerged: (1) Dancing with students fosters intergenerational togetherness—residents valued the presence of younger facilitators who promoted social connection and emotional well-being. (2) Music connects and includes everyone—personalized music selections evoked memories, encouraged participation, and fostered nonverbal engagement. (3) Party twice a week builds social capacity—regular SDH sessions created anticipation, strengthened social bonds, and offered moments of shared joy.</div></div><div><h3>Conclusions and Implications</h3><div>Intergenerational SDH parties show promise in reducing social isolation and enhancing well-being in LTC residents. The customizable format promotes autonomy and meaningful engagement, particularly for individuals with cognitive or physical impairments. Findings support the integration of interactive, music-based interventions in LTC settings to foster social connection and improve residents' quality of life. Future research should explore the long-term effects of SDH parties on residents’ emotional and social health, as well as best practices for sustaining these programs within LTC communities.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 11","pages":"Article 105833"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054153","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":"Letter to the Editor Regarding: \"Predictive Accuracy of the 3-m Backward Walk Test for Fall Risk in Q2 Older Adults\".","authors":"Liqiu Kou","doi":"10.1016/j.jamda.2025.105895","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105895","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105895"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228573","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":"Directions & Connections","authors":"","doi":"10.1016/S1525-8610(25)00454-2","DOIUrl":"10.1016/S1525-8610(25)00454-2","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 10","pages":"Article 105937"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219926","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":"PALTmed Events and Product","authors":"","doi":"10.1016/S1525-8610(25)00455-4","DOIUrl":"10.1016/S1525-8610(25)00455-4","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 10","pages":"Article 105938"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219927","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":"Best Practices Recommendations for Microtransitions in Care-An Emerging Classification of Care Transitions: A Consensus Statement.","authors":"Benjamin E Canter, Sing T Palat, Kenneth S Boockvar, Barbara Resnick, Jason R Falvey, Beth Fields, Cari Levy, Karl Steinberg, Sandeep Pagali, Isaac O Longobardi, Suzanne M Gillespie, Christian Bergman, Donna Kaba, Allison Villegas, Leslie Eber, Jessica Kalender-Rich, H Edward Davidson, Cecilia Y Cai, Jamyl N Walker, Manisha Parulekar, Paige Hector, Chloe Bomberger, Aval-Na'Ree S Green","doi":"10.1016/j.jamda.2025.105898","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105898","url":null,"abstract":"<p><strong>Objectives: </strong>Microtransitions-defined as brief, nonurgent transitions in care-occur in post-acute and long-term care (PALTC) settings (eg, room changes, nonmedical outings, and medical outings). They occur at least as frequently as major transitions (eg, hospitalizations, discharges) and carry similar risks for adverse clinical outcomes if not properly managed. Limited evidence exists to guide safe microtransition coordination. This study aimed to establish best practice recommendations for staff facilitating microtransitions and evaluate the level of feasibility and clinical benefit of these recommendations in PALTC.</p><p><strong>Design: </strong>Modified Delphi study.</p><p><strong>Setting and participants: </strong>A total of 39 expert panelists.</p><p><strong>Methods: </strong>Initial statements were developed based on a focus group and literature review. Consensus was defined as ≥80% agreement. Over 3 rounds, statements on safely facilitating room changes, recreational trips, and nonurgent (eg, outpatient) medical appointments were evaluated by panelists, then amended based on qualitative survey and focus group feedback until consensus was reached that statements were feasible and clinically beneficial. Five principles of important considerations for successful microtransitions were developed, and recommendations were categorized according to these principles: (1) communication; (2) adverse event monitoring, preparation, and prevention; (3) purpose and destination of transition; (4) equipment and environmental safety; and (5) skill level of the escort.</p><p><strong>Results: </strong>Fifty-one of the 70 finalized (72.9%) statements reached consensus for feasibility and/or clinical benefit for at least 1 type of microtransition. Of these, 41 of 51 (80.4%) reached consensus for feasibility, 49 of 51 (96.1%) reached consensus for clinical benefit, 39 of 51 (76.5%) statements reached consensus for both feasibility and clinical benefit, and 19 of 70 (27.1%) statements did not reach consensus or were rejected.</p><p><strong>Conclusions and implications: </strong>This is the first study to develop recommendations guiding PALTC staff in facilitating microtransitions. Implementing these recommendations may mitigate adverse event risk, such as falls and emergency departments transfers. Recommendations can guide situation-specific, patient-centered processes in coordinating safe microtransitions.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105898"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228613","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":"Global Framework for Comprehensive Geriatric Assessment Implementation Following Frailty Screening","authors":"Takuya Omura MD, PhD,&nbsp;Taiki Sugimoto PhD,&nbsp;Takahiro Kamihara MD, PhD","doi":"10.1016/j.jamda.2025.105801","DOIUrl":"10.1016/j.jamda.2025.105801","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 10","pages":"Article 105801"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821649","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}