Journal of the American Medical Directors Association最新文献

{"title":"Days at Home for Older Adults Receiving a Remote Monitoring Intervention Compared with Usual Home Care Recipients","authors":"Christine Salahub PhD ,&nbsp;Peter C. Austin PhD ,&nbsp;Li Bai PhD ,&nbsp;Noah M. Ivers MD, PhD ,&nbsp;Aaron Jones PhD ,&nbsp;Mina Tadrous PharmD, PhD ,&nbsp;Jake Tran MSc, PhDC ,&nbsp;Lauren Lapointe-Shaw MD, PhD","doi":"10.1016/j.jamda.2025.105611","DOIUrl":"10.1016/j.jamda.2025.105611","url":null,"abstract":"<div><h3>Objectives</h3><div>Many older adults will experience physical and or cognitive decline, limiting their ability to live independently. To better support these individuals, remote monitoring programs use technology to track patient falls, location, and medication adherence. Our main objective was to compare outcomes of patients enrolled in a remote monitoring program with matched individuals who received home care.</div></div><div><h3>Design</h3><div>Propensity score–matched cohort study.</div></div><div><h3>Setting and Participants</h3><div>Toronto, Ontario, Canada. Older adults (aged 65 or older) in a remote monitoring program (N = 1587) compared with a control group of older adults initiating a new episode of home care (N = 33,207).</div></div><div><h3>Methods</h3><div>The primary outcome was days spent at home in the following 100 days. Additional outcomes included days in different health care settings, days alive, and health care costs.</div></div><div><h3>Results</h3><div>Before matching, patients enrolled in the remote monitoring program (946 female) were younger [mean (SD) = 80.1 years (8.2) vs 82.4 (8.5), standardized mean difference 0.21] than those in the home care group (20,877 female). After matching, there were 1494 individuals in each group. In the 100 days following the index date, those in the remote monitoring group spent 3.4 more days at home than the home care group (92.3 vs 88.9 days, 95% CI, 1.9–5.0 days; rate ratio, 1.04; 95% CI, 1.02–1.06). This was attributable to more days alive (98.6 vs 96.4 days; 95% CI, 1.3–3.1 days; rate ratio, 1.03; 95% CI, 1.01–1.03). In addition, the remote monitoring group had lower health care costs overall (difference of $1635.54 CAD, 95% CI, $228.83–$3087.11).</div></div><div><h3>Conclusions and Implications</h3><div>Individuals enrolled in a remote monitoring program spent more days at home compared with those who received home care services, mainly attributed to more days alive. Further study is needed to confirm our findings; however, remote monitoring is a promising solution to support older adults with high care needs.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105611"},"PeriodicalIF":4.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942362","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":"Multimorbidity, Muscle Strength, and Falls among Older Mexican Americans","authors":"Alondra Uribe MS ,&nbsp;Soham Al Snih MD, PhD","doi":"10.1016/j.jamda.2025.105613","DOIUrl":"10.1016/j.jamda.2025.105613","url":null,"abstract":"<div><h3>Objectives</h3><div>Multimorbidity is linked with an increased risk of falls in older adults. The study objective is to determine the relationship of multimorbidity and muscle strength in falls among older Mexican Americans without a history of falls at baseline.</div></div><div><h3>Design</h3><div>Longitudinal study.</div></div><div><h3>Setting and Participants</h3><div>This 12-year prospective cohort study included 899 noninstitutionalized Mexican Americans aged ≥75 years residing in Arizona, California, Colorado, New Mexico, and Texas from the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE).</div></div><div><h3>Methods</h3><div>Measures include the following: sociodemographics, medical conditions, body mass index, disability, handgrip strength (HGS), depressive symptoms, pain, cognitive function, and multimorbidity (≥2 self-reported medical conditions). Participants at baseline were divided into the following 4 groups: high HGS and multimorbidity (n = 349), low HGS and multimorbidity (n = 263), high HGS and without multimorbidity (n = 181), and low HGS and without multimorbidity (n = 104). Generalized estimating equation models estimated the odds ratio (OR) and 95% CI for falls as a function of multimorbidity and HGS group, controlling for all covariates.</div></div><div><h3>Results</h3><div>The mean sample age ± SD was 81.0 ± 4.3 years, and 55.9% were female. The OR for falls was 0.70 (95% CI, 0.52–0.94) for those with multimorbidity and high HGS, 0.50 (95% CI, 0.32–0.80) for those without multimorbidity and high HGS, and 0.46 (95% CI, 0.29–0.74) for those without multimorbidity and low HGS, vs those with multimorbidity and low HGS, after controlling for all covariates.</div></div><div><h3>Conclusions and Implications</h3><div>Mexican American older adults with multimorbidity and high HGS had a 30% decreased risk of falls over time. Increasing muscle strength through exercise may help prevent falls among those with multimorbidity.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105613"},"PeriodicalIF":4.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942363","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":"Hospitalization-Associated Disability and 1-Year Mortality Risk in Older Patients With Heart Failure","authors":"Michitaka Kato PhD ,&nbsp;Koji Sakurada PhD ,&nbsp;Masakazu Saitoh PhD ,&nbsp;Tomoyuki Morisawa PhD ,&nbsp;Yuki Iida PhD ,&nbsp;Kentaro Kamiya PhD ,&nbsp;Yuji Kono PhD ,&nbsp;Masanobu Taya MSc ,&nbsp;Kentaro Iwata PhD ,&nbsp;Yoshinari Funami BSc ,&nbsp;Kazuya Kito ,&nbsp;Eiji Nakatani PhD ,&nbsp;Tetsuya Takahashi PhD","doi":"10.1016/j.jamda.2025.105549","DOIUrl":"10.1016/j.jamda.2025.105549","url":null,"abstract":"<div><h3>Objectives</h3><div>Hospitalization-associated disability (HAD) is the loss of the ability to perform one of the basic activities of daily living (ADLs) required for independent living during hospitalization. This study aimed to determine whether HAD is a significant prognostic risk factor in older patients with heart failure (HF) and independent ADLs.</div></div><div><h3>Design</h3><div>Prospective, nationwide, multicenter registry study conducted between December 2020 and March 2022.</div></div><div><h3>Setting and Participants</h3><div>This study was conducted across 96 centers in Japan and included 6519 older patients (aged ≥65 years) with HF who were independent in ADL before hospitalization.</div></div><div><h3>Methods</h3><div>HAD was defined as a drop of at least 5 points in the Barthel Index (BI) at discharge, relative to a stable score before hospitalization. Subgroup analysis classified HAD as mild (a decrease of 5–15 points in the BI) and severe (a decrease of ≥20 points in the BI). The primary outcome was all-cause mortality within 1 year after hospital discharge, and the secondary outcomes were HF-related mortality and rehospitalization.</div></div><div><h3>Results</h3><div>All-cause mortality, HF-related mortality, and rehospitalization rates within 1 year were 12%, 5%, and 41%, respectively. Multivariate Cox regression analysis revealed that HAD increased the risk of 1-year all-cause mortality after hospital discharge (adjusted hazard ratio, 1.749; 95% CI, 1.475–2.075). Subgroup analysis showed a significantly higher risk of all-cause mortality among patients with severe HAD than among those with mild HAD (1.388; 1.109–1.739). HAD was a significant risk factor for HF-related mortality (1.556; 1.216–2.017). However, no relationship was observed between HAD and readmission (1.062; 0.970–1.163).</div></div><div><h3>Conclusions and Implications</h3><div>The development of HAD was identified as a significant risk factor for 1-year post-discharge mortality among older patients with HF who were independent in ADLs before hospitalization. Preventing minor declines in ADL and mitigating any ADL impairments during hospitalization are crucial to avoiding a worsening prognosis.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105549"},"PeriodicalIF":4.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657589","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":"Effects of Hand Strength and Walking Speed Combined and in Isolation on the Prediction of Cognitive Decline and Dementia in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis","authors":"Xiaojie Xie MM ,&nbsp;Deli Li MM ,&nbsp;Meng Zhou MM ,&nbsp;Zhaojun Wang MM ,&nbsp;Xueyan Zhang PhD","doi":"10.1016/j.jamda.2025.105576","DOIUrl":"10.1016/j.jamda.2025.105576","url":null,"abstract":"<div><h3>Objective</h3><div>This review aims to further elucidate the relationship between reduced walking speed and grip function and cognitive decline.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Settings and Participants</h3><div>Adults without dementia.</div></div><div><h3>Methods</h3><div>Six English databases were searched from inception to January 2025. Longitudinal studies that simultaneously investigate the relationship between a decline in grip strength or walking speed and cognitive impairment or dementia were eligible. The meta-analysis was conducted using Stata 17.0. The Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used to assess the quality of evidence in the included studies.</div></div><div><h3>Results</h3><div>A total of 2779 articles were identified through the search strategy. After removing duplicate titles and completing screening, 10 studies were included. Random effects analysis revealed that decreases in physical function [walking speed: hazard ratio (HR), 1.34; 95% CI, 1.13–1.60] and grip strength: HR, 1.30; 95% CI, 1.14–1.49) were significantly associated with decreases in cognitive ability, and this correlation became even more pronounced when pace and grip strength were assessed jointly (HR, 2.72; 95% CI, 1.20-6.17). The results of the subgroup analysis revealed that the study location, follow-up time, cognitive assessment method, sex ratio of the subjects, and other factors affected the results of the study.</div></div><div><h3>Conclusions and Implications</h3><div>This study suggests that grip strength and walking speed are important predictors of cognitive decline and dementia, and highlights the significance of the comprehensive assessment. Early intervention before middle-aged and older adults enter the clinical stage of dementia is needed, which requires standardized and rigorous assessment.The sequential relationships between hand strength and walking speed in relation to different developmental stages of dementia, as well as how they can be integrated with objective indicators to facilitate diagnosis, need to be further investigated.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105576"},"PeriodicalIF":4.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743109","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":"Effects of Paralyzed, Nonparalyzed, and Whole-Body Phase Angle on Physical Performance in Older Patients with Stroke","authors":"Yuto Kameyama MS ,&nbsp;Ryota Ashizawa PhD ,&nbsp;Hiroya Honda PhD ,&nbsp;Ichiro Fujishima MD, PhD ,&nbsp;Tomohisa Ohno DDS, PhD ,&nbsp;Kenjiro Kunieda MD, PhD ,&nbsp;Yoshinobu Yoshimoto PhD","doi":"10.1016/j.jamda.2025.105607","DOIUrl":"10.1016/j.jamda.2025.105607","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigated the association between phase angle (PhA) and physical performance in older patients with stroke, focusing on lower-limb PhA and predicting rehabilitation outcomes.</div></div><div><h3>Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Seventy-one patients with stroke aged ≥65 years at a Japanese rehabilitation hospital.</div></div><div><h3>Methods</h3><div>Bioelectrical impedance analysis was used to measure whole-body PhA, paralyzed side lower-limb PhA, and nonparalyzed side lower-limb PhA. Physical performance was assessed using the Short Physical Performance Battery (SPPB) test at admission and discharge, with subdomains including balance, gait speed, and chair-rise performance. Multiple regression analysis was performed to determine whether different PhAs affected SPPB scores at discharge after adjusting for various potential confounders.</div></div><div><h3>Results</h3><div>Higher nonparalyzed side lower-limb PhA were significantly associated with better SPPB scores at discharge (β = 0.313, <em>P</em> = .004), and improved balance (β = 0.281, <em>P</em> = .016) and chair-rise performance (β = 0.388, <em>P</em> = .004). Paralyzed side lower-limb PhA was a predictor of total SPPB (β = 0.290, <em>P</em> = .020), but nonparalyzed side lower-limb PhA was more associated with total SPPB. Whole-body PhA was not associated with either total SPPB or any of the SPPB subitems.</div></div><div><h3>Conclusions and Implications</h3><div>Lower-limb PhA, particularly on the nonparalyzed side, is a significant predictor of physical performance in older patients with stroke. Paralyzed side lower-limb PhA plays a role, particularly in predicting walking ability. These findings suggest that site-specific PhA may represent valuable biomarkers for rehabilitation planning and prognostic assessment in patients recovering from subacute stroke events.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105607"},"PeriodicalIF":4.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935890","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":"Long-Term Care Ownership and Operator Factors in Probable Delirium: A Population-Based Study from Ontario, Canada","authors":"Rhiannon Roberts MPH ,&nbsp;Peter Tanuseputro MD, MHSc ,&nbsp;Peter Lawlor DMed, FRCPI, MMedSci ,&nbsp;Shirley H. Bush MBBS, MRCGP, FAChPM ,&nbsp;Christine L. Watt MSc, MD, CCFP(PC) ,&nbsp;Michael Pugliese MSc ,&nbsp;Genevieve Casey MD ,&nbsp;Frank Knoefel MD ,&nbsp;Kednapa Thavorn PhD, BPharm, MPharm ,&nbsp;Franco Momoli PhD, MSc ,&nbsp;Colleen Webber PhD","doi":"10.1016/j.jamda.2025.105610","DOIUrl":"10.1016/j.jamda.2025.105610","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the association between long-term care (LTC) home ownership models and operator characteristics and the prevalence of probable delirium.</div></div><div><h3>Design</h3><div>Cross-sectional study using provincial health administrative data.</div></div><div><h3>Setting and Participants</h3><div>All LTC residents aged 65–105 years in Ontario, Canada, who underwent assessment via the Resident Assessment Instrument—Minimum Data Set, version 2.0, between January 1, 2016, and December 31, 2019.</div></div><div><h3>Methods</h3><div>Probable delirium was identified using the delirium Clinical Assessment Protocol on the Resident Assessment Instrument—Minimum Data Set, version 2.0, assessment. LTC home ownership model (for-profit, not-for-profit, and municipal) and operator characteristics (chain status, operator size, and home size) were evaluated in relation to probable delirium using multivariable logistic regression models.</div></div><div><h3>Results</h3><div>Among the 169,762 LTC residents included in this study, 94,014 (55.4%) lived in for-profit homes, 42,051 (24.8%) in not-for-profit homes, and 33,697 (19.8%) in municipal homes. Only 3.6% (n = 6182) had probable delirium. The adjusted odds ratios (aOR) of probable delirium in for-profit and municipal homes were 0.83 (95% CI, 0.66–1.06) and 0.89 (95% CI, 0.64–1.25), respectively, compared with not-for-profit homes. Residents in larger homes had a reduced odds of probable delirium (aOR, 0.49; 95% CI, 0.33–0.72 for 50–99 beds; aOR, 0.68, 95% CI, 0.47–0.99 for 100–149 beds, ≥150 beds vs &lt;50 beds). The adjusted odds of probable delirium did not differ across chain status or operator size.</div></div><div><h3>Conclusions and Implications</h3><div>LTC residents in homes with ≥50 beds had reduced odds of probable delirium. This finding may reflect differences in delirium risk or identification across home ownership models. There was no evidence that the prevalence of probable delirium varied across LTC home ownership models, operator size, or chain status.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105610"},"PeriodicalIF":4.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935893","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":"Protective Effects of Social Activity on the Disability Incidence among Community-Dwelling Older Adults with Chronic Pain","authors":"Soichiro Matsuda PhD,&nbsp;Takehiko Doi PhD,&nbsp;Sho Nakakubo PhD,&nbsp;Fumio Sakimoto PhD,&nbsp;Hiroyuki Shimada PhD","doi":"10.1016/j.jamda.2025.105623","DOIUrl":"10.1016/j.jamda.2025.105623","url":null,"abstract":"<div><h3>Objectives</h3><div>Identifying the factors that contribute to the incidence of disability in older adults and the activities that can be engaged in to reduce the risk of disability is critical to the health of older adults. This study aimed to assess the impact of social activities on the incidence of disability during follow-up examinations in older adults with chronic pain.</div></div><div><h3>Design</h3><div>A prospective cohort study.</div></div><div><h3>Settings and Participants</h3><div>The study included 4692 community-dwelling older adults (aged 73.8 ± 5.5 years, male: n = 2043) without disability at baseline.</div></div><div><h3>Methods</h3><div>Chronic pain and social activity data were assessed at baseline and the incidence of disability was investigated during the follow-up examination after 24 months from baseline.</div></div><div><h3>Results</h3><div>In total, 1587 (33.8%) participants reported chronic pain at baseline, and 206 (4.4%) reported disability at follow-up examination. The Cox proportional hazards model showed that the chronic pain group had a higher hazard ratio (HR) for disability incidence compared with the group without chronic pain [HR, 1.77; 95% confidence interval (CI), 1.33–2.35; <em>P</em> &lt; .001]. High social activity significantly prevented the incidence of disability compared with low social activity in the chronic pain group (HR, 0.57; 95% CI, 0.39–0.84; <em>P</em> = .005). Event participation had a protective effect on disability incidence in the chronic pain group (HR, 0.60; 95% CI, 0.40–0.91; <em>P</em> = .02).</div></div><div><h3>Conclusion and Implications</h3><div>This study shows that chronic pain at baseline increases the risk of developing disability, whereas high social activity reduces that risk compared with low social activities. These results suggest the important role of social activities regarding the incidence of disability in community-dwelling older adults with chronic pain.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105623"},"PeriodicalIF":4.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936102","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":"Qualitative Study of the Context of Health Information Technology in Sepsis Care Transitions: Facilitators, Barriers, and Strategies for Improvement","authors":"Sang Bin You MSN ,&nbsp;Karen B. Hirschman PhD, MSW, FGSA ,&nbsp;Michael A. Stawnychy PhD, CRNP ,&nbsp;Jiyoun Song PhD, AGACNP-BC, APRN ,&nbsp;Elaine Sang MSN ,&nbsp;Katherine Pitcher BSN ,&nbsp;Sungho Oh PhD ,&nbsp;Melissa O'Connor PhD, MBA, RN, FGSA, FAAN ,&nbsp;Patrik Garren MPH ,&nbsp;Kathryn H. Bowles PhD, FAAN, FACMI","doi":"10.1016/j.jamda.2025.105606","DOIUrl":"10.1016/j.jamda.2025.105606","url":null,"abstract":"<div><h3>Objective</h3><div>To examine how health information technology (HIT) supports timely post-acute home health and outpatient care for sepsis survivors by identifying facilitators, barriers, and proposed strategies.</div></div><div><h3>Design</h3><div>Qualitative descriptive study.</div></div><div><h3>Setting and Participants</h3><div>Clinicians, care coordinators, sepsis coordinators, and administrators from 5 US health systems (hospitals and outpatient clinics) and affiliated home health care (HHC) agencies.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews, which were recorded, transcribed, and analyzed using thematic analysis with both deductive and inductive coding. Deductive coding was guided by the Consolidated Framework for Implementation Research to systematically assess barriers and facilitators of the intervention. The analysis achieved more than 90% interrater reliability, and member checking enhanced trustworthiness. After coding was finalized, a query was generated to identify electronic health record (EHR)-related themes that support or hinder health information management in electronic systems.</div></div><div><h3>Results</h3><div>Sixty-one interviews with 91 participants identified 17 themes related to HIT's role in care transitions for sepsis survivors. HIT facilitated sepsis identification, documentation, communication, information sharing, care coordination, and quality monitoring during hospital-to-home transitions. Barriers included missing, delayed, or inaccessible information across disparate EHR systems. Proposed strategies include establishing interoperable EHR systems and leveraging HIT tools to improve identification, communication, and care coordination for timely follow-up care, with continuous monitoring of functionality.</div></div><div><h3>Conclusions and Implications</h3><div>HIT plays a central role in care transitions, improving information sharing, communication, and coordination, ultimately enhancing patient outcomes and safety. Administrators can improve data integration and quality monitoring with interoperable systems, and policymakers can promote adoption through financial incentives. The advancement of technologies, including HIT tools, may offer opportunities to further optimize sepsis identification, communication, and care coordination, promoting seamless care transitions.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105606"},"PeriodicalIF":4.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932170","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":"Impact of Severe Dyspnea on Mortality and Disability: A 9-Year Cohort Study of Older Adults in Japan","authors":"Ryo Katayose RN, MS ,&nbsp;Saki Tanaka RN, MS ,&nbsp;Mika Okura RN, PHN, PhD ,&nbsp;Hidenori Arai MD, PhD ,&nbsp;Mihoko Ogita RN, PhD","doi":"10.1016/j.jamda.2025.105609","DOIUrl":"10.1016/j.jamda.2025.105609","url":null,"abstract":"<div><h3>Objectives</h3><div>We investigated the association of severe dyspnea and frailty with all-cause mortality and disability in Japanese community-dwelling older adults.</div></div><div><h3>Design</h3><div>A 9-year follow-up cohort study.</div></div><div><h3>Setting and Participants</h3><div>We enrolled 3499 community-dwelling adults aged ≥65 years without disabilities or residence in care facilities who completed a baseline survey in 2013.</div></div><div><h3>Methods</h3><div>Dyspnea was assessed via a questionnaire on severe dyspnea during daily activities, and frailty status was determined using the Kihon Checklist. Disability was defined as new long-term care insurance certification. Cox proportional hazard models were used to calculate hazard ratios for mortality and disability. Fine-Gray regression models were used to calculate subdistribution hazard ratios for disability while accounting for mortality as a competing risk and adjusting for confounders. Both analyses were stratified by frailty status.</div></div><div><h3>Results</h3><div>Severe dyspnea was present in 240 participants (6.9%). Overall, the incidence rate of mortality was 6.37 and 2.55 per 100 person-years, and that of disability was 9.96 and 5.06 in the dyspnea and no-dyspnea groups, respectively. Severe dyspnea was associated with a hazard ratio of 1.67 (95% CI, 1.35-2.07) for mortality and 1.38 (95% CI, 1.14-1.67) for incident disability in the frailty group. After accounting for death as a competing risk using the Fine-Gray regression model, the subdistribution hazard ratio for new disability associated with severe dyspnea was 1.38 (95% CI, 1.12-1.70) in the frailty group.</div></div><div><h3>Conclusions and Implications</h3><div>Severe dyspnea was associated with an increased risk of both mortality and incident disability, particularly among participants in the frailty group. These findings highlight the heightened vulnerability of frail older adults to dyspnea-associated adverse outcomes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105609"},"PeriodicalIF":4.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932171","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":"Trajectory of Cardiometabolic Disease–Related Hospitalizations Before and After Dementia Diagnosis: A Matched Cohort Study","authors":"Sakura Sakakibara MSc ,&nbsp;Abigail Dove PhD ,&nbsp;Michelle M. Dunk PhD ,&nbsp;Johan Fastbom PhD ,&nbsp;Giulia Grande PhD ,&nbsp;Ulrika Akenine PhD ,&nbsp;Weili Xu PhD","doi":"10.1016/j.jamda.2025.105594","DOIUrl":"10.1016/j.jamda.2025.105594","url":null,"abstract":"<div><h3>Objectives</h3><div>Dementia is associated with increased health care use; however, the timing of hospitalizations in relation to the development of dementia remains unclear. Cardiometabolic diseases (CMDs) including type 2 diabetes, heart disease, and stroke often co-occur with dementia, but the impact of dementia on hospitalizations related to CMDs remains unknown. We aimed to map the trajectory of CMD-related hospitalization before and after dementia diagnosis and to further identify factors of CMD-related hospitalization.</div></div><div><h3>Design</h3><div>Matched cohort study.</div></div><div><h3>Setting and Participants</h3><div>Within the Swedish Twin Registry, 1657 participants aged ≥65 years (58.8% women) with incident dementia were matched with 1657 dementia-free participants using propensity scores.</div></div><div><h3>Methods</h3><div>Participants were followed for up to 20 years to detect CMD-related hospitalizations. Dementia and CMD-related hospitalizations (both planned and unplanned) were identified from medical records. Potential related factors included age, sex, education, marital status, smoking, drinking, physical activity, body mass index, and hypertension. Data were analyzed using Poisson regression and generalized estimating equation models.</div></div><div><h3>Results</h3><div>Compared with the control patients, the incidence of CMD-related hospitalization among people with dementia started to increase from 4 years before [incidence rate ratio (IRR), 1.25; 95% CI, 1.00-1.57], and started to decrease 3 years after, the diagnosis (IRR, 0.74; 95% CI, 0.58-0.94). People with dementia had a greater number of CMD-related hospitalizations (IRR, 1.19; 95% CI, 1.04-1.36) and longer cumulative length of stay (IRR, 1.27; 95% CI, 1.04-1.56) in the 5 years before dementia diagnosis, but these rates decreased after the diagnosis. Male sex, smoking, obesity, and hypertension were associated with further increases in CMD-related hospitalization among people with dementia.</div></div><div><h3>Conclusions and Implications</h3><div>Patterns of CMD-related hospitalization change over the course of dementia development. Our findings suggest that the health care burden increases even before the diagnosis of dementia, and CMD-related hospitalization may be an early sign of the future onset of dementia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105594"},"PeriodicalIF":4.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923371","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}