Journal of the American Medical Directors Association最新文献

{"title":"Successful Care Conferences: Nursing Home Staff, Persons with Dementia, and Caregiver Perspectives","authors":"Gail L. Towsley PhD,&nbsp;Linda S. Edelman PhD, RN,&nbsp;Roxanne Geurin MPH","doi":"10.1016/j.jamda.2025.105504","DOIUrl":"10.1016/j.jamda.2025.105504","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study was to identify best practices for nursing home (NH) virtual care conferences using Me &amp; My Wishes—videos that document care preferences of residents, including those living with Alzheimer's disease and related dementias. Videos are shared during care conferences with care partners and staff to ensure that the care provided aligns with the resident's wishes, especially as they approach the end of life.</div></div><div><h3>Design</h3><div>A qualitative descriptive design involving focus groups providing the perspective of 3 groups (people living with dementia, NH staff, and care partners) was used to determine what makes a successful care conference when the care conference is conducted virtually.</div></div><div><h3>Setting and Participants</h3><div>Convenience sampling was used to recruit focus group participants (ie, community advisors) from various geographic locations. Recruitment was facilitated through established relationships with community partner groups. Advisors included NH leaders, community-dwelling older adults, and care partners.</div></div><div><h3>Methods</h3><div>Six virtual focus group sessions were conducted from February to June 2023. A semistructured guide was used to identify key factors of successful virtual care conferences when using the Me &amp; My Wishes intervention. Sessions were recorded, transcribed, and analyzed using content analysis.</div></div><div><h3>Results</h3><div>Three domains for successful virtual care conferences were identified. They are resident-driven, engaging, and structured. They include interdisciplinary care team members most familiar with the resident, prioritize the needs and preferences of residents to ensure they are central to the discussion, and encourage active participation of residents and care partners. Finally, care conferences are led by trained facilitators, with the entire interdisciplinary care team receiving training on conducting and participating in care conferences, including providing technology support to maximize resident and care partner engagement.</div></div><div><h3>Conclusions and Implications</h3><div>Successful care conferences, whether in-person or virtual, require structured approaches that prioritize resident involvement and include people who know the resident best.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105504"},"PeriodicalIF":4.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441290","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":"Corrigendum to ‘Remote Vital Sign Monitoring in Admission Avoidance Hospital at Home: A Systematic Review’ [Journal of the American Medical Directors Association 25 (2024) 105080]","authors":"Rajan Patel MSc ,&nbsp;Tabitha D. Thornton-Swan BA ,&nbsp;Laura C. Armitage MBBCh ,&nbsp;Sarah Vollam PhD ,&nbsp;Lionel Tarassenko DPhil ,&nbsp;Daniel S. Lasserson MD ,&nbsp;Andrew J. Farmer MD","doi":"10.1016/j.jamda.2024.105453","DOIUrl":"10.1016/j.jamda.2024.105453","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105453"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PALTmed Events and Products","authors":"","doi":"10.1016/S1525-8610(25)00079-9","DOIUrl":"10.1016/S1525-8610(25)00079-9","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105562"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561362","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":"General Information","authors":"","doi":"10.1016/S1525-8610(25)00076-3","DOIUrl":"10.1016/S1525-8610(25)00076-3","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105559"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561366","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)00078-7","DOIUrl":"10.1016/S1525-8610(25)00078-7","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105561"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561655","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":"Pharmacists Improving Osteoporosis Management in Long-Term Care Using Fracture Risk Assessments: A Feasibility Study","authors":"Catherine D. Laird BPharm,&nbsp;Kylie A. Williams BPharm, PhD,&nbsp;Helen Benson BPharm, PhD","doi":"10.1016/j.jamda.2025.105494","DOIUrl":"10.1016/j.jamda.2025.105494","url":null,"abstract":"<div><h3>Objectives</h3><div>The primary outcome of this study is to test the feasibility of pharmacists completing Fracture Risk Scale (FRS) assessments using resident data routinely held by long-term care (LTC) facilities. Secondary outcomes are to ascertain the proportion of residents assessed as high fracture risk who currently receive osteoporosis medicines and explore whether under- or overuse of osteoporosis medicines is occurring based on residents' fracture risk.</div></div><div><h3>Design</h3><div>Feasibility study.</div></div><div><h3>Setting and Participants</h3><div>Four LTC facilities from southeast Queensland, Australia, with a total of 281 residents participated in the study during April and May 2024.</div></div><div><h3>Methods</h3><div>A pharmacist reviewed individual resident files for all residents of participating facilities. Necessary data were extracted from resident files to determine their fracture risk using the FRS manual calculation tool. Residents' use of osteoporosis medicines and nutritional supplements (vitamin D and calcium) was analyzed based on their calculated fracture risk.</div></div><div><h3>Results</h3><div>FRS assessments were completed for 275 residents (97.9%). There were 149 residents (54.2%) assessed as having a high fracture risk, of which 43 (28.9%) were prescribed an osteoporosis medicine. Conversely, 28 residents (22.2%) with a low fracture risk received an osteoporosis medicine. Underuse of vitamin D and calcium supplements was found for all residents, irrespective of fracture risk.</div></div><div><h3>Conclusions and Implications</h3><div>The feasibility of pharmacists completing FRS assessments was demonstrated. Incorporating the FRS into routine clinical practice provides a promising means to support pharmacists advising on osteoporosis prescribing decisions for LTC residents. Widespread underuse of vitamin D and calcium for all LTC residents and the underuse of osteoporosis medicines by residents with a high fracture risk were found. Future research is necessary to establish if incorporating the FRS into clinical practice can address this undertreatment and reduce fracture rates in LTC.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105494"},"PeriodicalIF":4.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433370","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":"Postural Sway Characteristics Distinguish Types of Dementia","authors":"Kosuke Fujita PhD ,&nbsp;Taiki Sugimoto PhD ,&nbsp;Hisashi Noma PhD ,&nbsp;Yujiro Kuroda PhD ,&nbsp;Nanae Matsumoto PhD ,&nbsp;Kazuaki Uchida PhD ,&nbsp;Yoko Yokoyama MS ,&nbsp;Yoshinobu Kishino MD ,&nbsp;Takashi Sakurai MD, PhD","doi":"10.1016/j.jamda.2025.105497","DOIUrl":"10.1016/j.jamda.2025.105497","url":null,"abstract":"<div><h3>Objectives</h3><div>The increasing number of patients with dementia necessitates the development of rapid and convenient tools to assist with dementia diagnosis. We previously demonstrated the difference in the postural control characteristics during static standing among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and vascular dementia (VaD). In this study, we evaluated the classification accuracy of the postural sway test to assess its capacity to distinguish between types of dementia.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Memory clinic outpatients aged 65-85 years who were clinically diagnosed with AD, DLB, VaD, and cognitively normal (CN) outpatients.</div></div><div><h3>Methods</h3><div>Static upright standing measurements were conducted under open- and closed-eye conditions to calculate 40 parameters. After variable selection based on statistical significance, 3 dementia classification models (AD vs DLB, AD vs VaD, and DLB vs VaD) based on postural control parameters were created. Bias-corrected accuracy measures using bootstraps were used for assessing the classification performances.</div></div><div><h3>Results</h3><div>The data of 1734 participants (1158 with AD, 105 with DLB, 46 with VaD, and 425 with CN) were analyzed. The area under the curves of receiver operating characteristic curves for AD vs DLB, AD vs VaD, and DLB vs VaD were 0.647 (0.646-0.649), 0.763 (0.761-0.765), and 0.659 (0.656-0.662), respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Postural control characteristics differentiated between dementia types with reasonable to good accuracy, especially in the comparison between AD and VaD. Postural control testing may become a valuable assistive tool for dementia diagnosis in the future.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105497"},"PeriodicalIF":4.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Telehealth Interventions on Cognitive Function and Quality of Life in Adults With Neurological Disorders: A Systematic Review and Meta-Analysis","authors":"Yule Hu MSc ,&nbsp;Yan Li PhD ,&nbsp;Jiaying Li MSc ,&nbsp;Justina Yat Wa Liu PhD ,&nbsp;Sylvia M. Gustin PhD ,&nbsp;Mengqi Li PhD ,&nbsp;Angela Yee Man Leung PhD","doi":"10.1016/j.jamda.2025.105491","DOIUrl":"10.1016/j.jamda.2025.105491","url":null,"abstract":"<div><h3>Objective</h3><div>Telehealth is an encouraging solution for the remote delivery of cognitive interventions. This review aimed to identify the characteristics and effectiveness of telehealth interventions on cognitive functions and related quality of life in adults with neurological disorders.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Settings and Participants</h3><div>Community and residential, adults with neurological disorders.</div></div><div><h3>Methods</h3><div>Six English and 2 Chinese databases were searched from inception to August 2024. Randomized controlled trials that evaluated telehealth interventions for cognitive function in adults with neurological disorders were eligible. The meta-analysis was conducted using R (Version 4.1.3). The Revised Cochrane risk of bias tool for randomized trials (RoB 2) tool was used for risk of bias assessment.</div></div><div><h3>Results</h3><div>Sixteen studies with 952 participants were included, 14 of which were eligible for the meta-analysis. Asynchronous telehealth via apps/websites with regular online supervision was the most commonly used format. The pooled results suggested that telehealth interventions could significantly improve global cognitive function [standardized mean difference (SMD) = 0.95; 95% confidence interval (CI): 0.06∼1.83; <em>P</em> = .035], memory (SMD, 0.79; 95% CI: 0.36∼1.23; <em>P</em> = .0004), and quality of life (SMD, 0.57; 95% CI, 0.14∼1.00; <em>P</em> = .01) compared with controls. However, there was no statistically significant effect on attention (SMD, 0.12; 95% CI, −0.11∼0.35, <em>P</em> = .31), executive function (SMD, 0.06; 95% CI, −0.30∼0.42, <em>P</em> = .73), or language (SMD, 0.44; 95% CI, −0.01∼0.89, <em>P</em> = .054).</div></div><div><h3>Conclusions and Implications</h3><div>Telehealth interventions are safe, feasible and acceptable for adults with neurological disorders, and could potentially reduce health care cost. They have beneficial effects on global cognitive function, memory, and quality of life. More exercise-based telehealth interventions with adequate statistical power and rigorous designs are needed to evaluate the long-term benefits and financial impact.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105491"},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425610","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":"Sex-Specific Body Composition Profile Determined by Pelvic Computed Tomography Associated with Mortality in Older Patients with Hip Fracture","authors":"Wenwei Zhu MD ,&nbsp;Qianyun Liu MD ,&nbsp;Zhimin Yan MD ,&nbsp;Wenming Zhou MD ,&nbsp;Pengfei Rong MD, PhD ,&nbsp;Zhichao Feng MD, PhD","doi":"10.1016/j.jamda.2025.105502","DOIUrl":"10.1016/j.jamda.2025.105502","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous research has demonstrated notable differences in body composition and mortality risk following hip fracture between sexes. This study aimed to investigate the sex-specific associations between body composition profile and mortality in older patients undergoing hip fracture surgery.</div></div><div><h3>Design</h3><div>Dual-center cohort study.</div></div><div><h3>Setting and Participants</h3><div>We included 488 older patients (aged ≥60 years) with hip fracture treated with surgery.</div></div><div><h3>Methods</h3><div>The cross-sectional area and attenuation of skeletal muscle, subcutaneous adipose tissue, and intermuscular adipose tissue at the the upper thigh level on preoperative pelvic computed tomography (CT) were measured. The relationship between body composition and mortality was determined using Cox proportional hazards analysis stratified by sex.</div></div><div><h3>Results</h3><div>The mean age of the cohort was 76.2 ± 8.7 years, and 312 (63.9%) were women. Within 1 year after surgery, 89 (18.2%) patients died. Female patients had greater subcutaneous adipose tissue area [SATA; median (interquartile range), 196.5 (160.1∼228.5) vs 147.1 (111.3∼181.1) cm²; <em>P</em> &lt; .001] and lower skeletal muscle area [SMA; 187.2 (167.3∼212.4) vs 255.5 (223.2∼286.1) cm²; <em>P</em> &lt; .001] compared with male patients. In the sex-stratified multivariable analyses, SATA in females [hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.86∼0.97; <em>P</em> = .003] and SMA in men (HR, 0.93; 95% CI, 0.86∼1.00; <em>P</em> = .05) were significant predictors of 1-year mortality. Incorporation of SATA or SMA within the existing Nottingham Hip Fracture Score (NHFS) showed slightly improved performance in predicting 1-year mortality among women [area under the curve (AUC), 0.70 vs 0.64, <em>P</em> = .11] or men (AUC, 0.76 vs 0.71, <em>P</em> = .06), respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Reduced subcutaneous adiposity is associated with mortality in older women undergoing hip fracture surgery, while reduced muscle mass predicts mortality in men. These findings highlight the importance of considering sexual dimorphism in the development of novel biomarkers and effective treatment strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105502"},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engagement of Relatives in End-of-life Care of Residents in Long-Term Care Facilities: A Cross-Sectional Study in 5 EU Countries","authors":"Natalia Drapała MPH ,&nbsp;Ilona Barańska MSc, MPH, PhD ,&nbsp;Lieve Van den Block MSc, PhD ,&nbsp;Tinne Smets MSc, PhD ,&nbsp;Nele Van Den Noortgate MD, PhD ,&nbsp;Harriet Finne-Soveri MD, PhD ,&nbsp;Giovanni Gambassi MD, PhD ,&nbsp;Bregje D. Onwuteaka-Philipsen PhD ,&nbsp;Katarzyna Szczerbińska MD, PhD","doi":"10.1016/j.jamda.2025.105492","DOIUrl":"10.1016/j.jamda.2025.105492","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the extent and factors associated with relatives' engagement in end-of-life care for residents of long-term care facilities (LTCFs) during the last week before the resident's death.</div></div><div><h3>Design</h3><div>A cross-sectional retrospective survey.</div></div><div><h3>Setting and Participants</h3><div>A total of 814 relatives of deceased LTCF residents in a representative sample of 229 LTCFs in Belgium, Finland, Italy, the Netherlands, and Poland.</div></div><div><h3>Methods</h3><div>LTCFs reported all residents’ deaths in the past 3 months. In each case, standardized questionnaires were sent to the LTCF manager, nurse, physician, and relative most involved in care. A multivariable logistic regression model was applied to assess which factors and characteristics of the relative and deceased resident were associated with more time spent with the resident in the last week of life.</div></div><div><h3>Results</h3><div>Compared with Poland, relatives from the Netherlands [odds ratio (OR), 14.22; 95% CI, 6.56–30.82], Belgium (OR, 10.24; 95% CI 4.87–24.52), and Finland (OR, 2.57; 95% CI, 1.18–5.58) had higher odds of spending more than 14 hours with residents in the last week of life. Female relatives, who were their partners or spouses, and who provided more than 11 hours of care weekly before the resident's admission to the LTCF (OR, 2.96; 95% CI 1.55–5.65) were more likely to visit the dying resident during the last week of life. Residents placed in the LTCF due to their behavioral problems or dependency in activities of daily living (ADL) were less frequently visited by their relatives in the last week of life (OR, 0.34; 95% CI, 0.16–0.71 and OR, 0.54; 95% CI, 0.36–0.82, respectively).</div></div><div><h3>Conclusions and Implications</h3><div>Resident's behavioral problems and dependency in ADLs at the time of admission to the LTCF were associated with their relative's lower engagement in end-of-life care. We also found substantial differences in relatives' engagement among countries. Further research is required to identify the causes of these discrepancies and to develop culture-specific support for relatives.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105492"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425612","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}