Journal of the American Medical Directors Association最新文献

{"title":"Nursing Home Staff Perspectives of the Benefits and Challenges of Providing Dementia Care","authors":"Carin M. Wong PhD ,&nbsp;Dominique H. Como PhD, OTR/L ,&nbsp;Cara Lekovitch CScD, OTR/L, BCG ,&nbsp;Felicia Chew MS, OTR/L ,&nbsp;Natalie E. Leland PhD, OTR/L, BCG, FAOTA, FGSA","doi":"10.1016/j.jamda.2024.105411","DOIUrl":"10.1016/j.jamda.2024.105411","url":null,"abstract":"<div><h3>Objectives</h3><div>To capture nursing home staff perspectives on the benefits and challenges related to caring for residents living with Alzheimer disease and other related dementias. These perspectives will inform the initial development of strategies to help with staff retention.</div></div><div><h3>Design</h3><div>A secondary qualitative analysis of semistructured interviews conducted with nursing home staff, which was embedded within a pragmatic clinical trial.</div></div><div><h3>Setting and Participants</h3><div>Purposive sampling was used to capture perspectives of staff spanning across job roles from 23 nursing homes.</div></div><div><h3>Methods</h3><div>During the parent study primary analysis, staff experiences providing dementia care were consistently described. In response, this study completed a secondary analysis of study data using thematic analysis to identify benefits and challenges of caring for this population.</div></div><div><h3>Results</h3><div>Analysis of nursing home staff (n = 327) interviews captured benefits and challenges of caring for residents living with dementia. Three themes reflected staff perspectives of the benefits, including valuing interpersonal relationship with residents (eg, learning about residents' likes, dislikes, and history), providing care fosters a sense of purpose, and the variability of the job from day to day (eg, getting to use different strategies to interact with residents). Two themes portrayed the challenges staff articulated, including feeling discouraged because of ineffective care strategies (eg, not being able to manage residents’ behaviors) and the toll that caring for this resident population takes on staff mental health (eg, death of residents).</div></div><div><h3>Conclusions and Implications</h3><div>Nursing home staff report benefits and challenges to providing care to people with dementia. To assist with staff retention and lower staff turnover, nursing home administrators need to take into consideration how to help their staff manage the challenges and facilitate the benefits through the implementation of organizational strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105411"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829150","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":"Clinical Predictors of Mortality in People with Severe Behavioral and Psychological Symptoms of Dementia","authors":"Aline Mendes MD ,&nbsp;François R. Herrmann MD, PhD ,&nbsp;Sverre Bergh MD, PhD ,&nbsp;Bruno Mario Cesana MD ,&nbsp;Ron Handels PhD ,&nbsp;Alfonso Ciccone MD, PhD ,&nbsp;Emmanuel Cognat MD, PhD ,&nbsp;Andrea Fabbo MD, PhD ,&nbsp;Sara Fascendini MD ,&nbsp;Giovanni B. Frisoni MD, PhD ,&nbsp;Lutz Froelich MD, PhD ,&nbsp;Maria Cristina Jori MD, PhD ,&nbsp;Patrizia Mecocci MD, PhD ,&nbsp;Paola Merlo MD ,&nbsp;Oliver Peters MD, PhD ,&nbsp;Magdalini Tsolaki MD, PhD ,&nbsp;Carlo Alberto Defanti MD, PhD","doi":"10.1016/j.jamda.2024.105374","DOIUrl":"10.1016/j.jamda.2024.105374","url":null,"abstract":"<div><h3>Objectives</h3><div>Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD).</div></div><div><h3>Design</h3><div>A multicentric longitudinal observational study was conducted, comprising clinical assessments at baseline and every 6 months for 3 years.</div></div><div><h3>Setting and Participants</h3><div>People with severe BPSD (Neuropsychiatric Inventory, NPI ≥32) living at home.</div></div><div><h3>Methods</h3><div>Data on demographics and clinical characteristics were collected at baseline and during 6-monthly follow-ups over 3 years. The main outcome was mortality, documented over a total period of 4 years and analyzed using the Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Of the 508 patients with dementia with severe BPSD, 165 (32.5%) died during the 4-year follow-up. Non-survivors were older (79.8 ± 7.7 vs 77.3 ± 8.0; <em>P</em> &lt; .001), more likely to be male (58.8% vs 38.5%; <em>P</em> &lt; .001), and had higher BPSD severity (NPI: 57.2 ± 20.2 vs 50.3 ± 17.9; <em>P</em> &lt; .001), lower cognitive function according to the Mini-Mental State Examination (MMSE) (13.5 ± 6.6 vs 16.4 ± 5.9; <em>P</em> &lt; .001), and worse functional status according to the Alzheimer's Disease Cooperative Study – Activities of Daily Living Scale (ADCS) (28.8 ± 16.4 vs 36.3 ± 17.2; <em>P</em> &lt; .001) at baseline. Significant predictors of mortality included male sex [hazard ratio (HR), 2.03; 95% confidence interval (95% CI), 1.46–2.82; <em>P</em> &lt; .001], older age at diagnosis (HR, 1.05; 95% CI, 1.03–1.07; <em>P</em> &lt; .001), higher NPI scores (HR, 1.01; 95% CI, 1.01–1.02; <em>P</em> = .002), lower MMSE (HR, 0.95; 95% CI, 0.93–0.98; <em>P</em> = .001), lower ADCS (HR, 0.98; 95% CI, 0.98–0.99; <em>P</em> = .015), and lower quality of life rated by proxy (HR, 0.97; 95% CI, 0.95–0.99; <em>P</em> = .021). The use of antidepressants (HR, 0.69; 95% CI, 0.48–0.98; <em>P</em> = .038) was associated with increased survival. Delusions (HR, 1.0; 95% CI, 1.03–1.12; <em>P</em> &lt; .001), hallucinations (HR, 1.07; 95% CI, 1.02–1.11; <em>P</em> = .002), and agitation/aggression (HR, 1.05; 95% CI, 1.01–1.09; <em>P</em> = .021) were significantly linked to increased mortality.</div></div><div><h3>Conclusions and Implications</h3><div>Older age, male sex, severe BPSD, and lower cognitive and quality of life scores significantly predict increased mortality in patients with severe BPSD.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105374"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751169","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":"The Importance of Quality of Home Health Agencies for Patients in Socioeconomically Disadvantaged Neighborhoods","authors":"Daniel Jung PhD,&nbsp;Suhang Song PhD,&nbsp;Janani Rajbhandari-Thapa PhD","doi":"10.1016/j.jamda.2024.105378","DOIUrl":"10.1016/j.jamda.2024.105378","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigated the role of patients' neighborhood socioeconomic status (SES) on the relationship between home health agency (HHA) care quality and health outcomes among home health care patients.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>We mainly used 2019 Outcome and Assessment Information Set data, Area Deprivation Index, and Quality of Patient Care Star Rating. We included Medicare beneficiaries (aged ≥ 65 years) who received home health care.</div></div><div><h3>Methods</h3><div>We used linear probability regression models to examine whether patients' neighborhood SES moderates the association between care quality of HHAs and health outcomes for 1,657,133 home health care patients.</div></div><div><h3>Results</h3><div>Our findings show that patients in neighborhoods with lower SES were more likely to use low-quality HHAs (lease disadvantaged neighborhoods: 11%, most disadvantaged neighborhoods: 15.2%). Our main model, adjusted by patient- and HHA-level characteristics, reveals patients living in socioeconomically disadvantaged neighborhoods (less disadvantaged: coefficient: −0.017, <em>P</em> &lt; .001; more disadvantaged: coefficient: −0.035, <em>P</em> &lt; .001; most disadvantaged: coefficient: −0.06, <em>P</em> &lt; .001) and receiving care from low-quality HHAs (average-quality HHAs: coefficient: 0.037, <em>P</em> &lt; .001; high-quality HHAs: coefficient: 0.062, <em>P</em> &lt; .001) were less likely to remain in the community during their home health care. Furthermore, our study highlights that patients in the most disadvantaged neighborhoods encounter additional challenges in remaining at their homes and communities when they use low-quality HHAs.</div></div><div><h3>Conclusions and Implications</h3><div>These findings highlight the need for targeted interventions and policy initiatives aimed at addressing disparities in care quality based on neighborhood SES. Efforts directed at enhancing the quality of care provided by HHAs and access to high-quality HHAs in socioeconomically disadvantaged neighborhoods could substantially impact health equity and outcomes for individuals in these settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105378"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791505","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":"","authors":"Yanmin Tao MSN ,&nbsp;Hongyan Wang MSN ,&nbsp;Jingsong Luo MPH ,&nbsp;Hong Zhang MD ,&nbsp;Wen Zhang MSN ,&nbsp;Meng Yu MSN ,&nbsp;Shuyang Ji MSN ,&nbsp;Sihan Peng MD ,&nbsp;Xiangeng Zhang MD","doi":"10.1016/j.jamda.2024.105413","DOIUrl":"10.1016/j.jamda.2024.105413","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105413"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823911","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":"Life-Space Activities and Incident Dementia Among Older Adults: Insights From a Cohort Study","authors":"Takehiko Doi PhD,&nbsp;Keitaro Makino PhD,&nbsp;Kouki Tomida PhD,&nbsp;Kota Tsutsumimoto PhD,&nbsp;Fumio Sakimoto PhD,&nbsp;Soichiro Matsuda PhD,&nbsp;Hiroyuki Shimada PhD","doi":"10.1016/j.jamda.2024.105416","DOIUrl":"10.1016/j.jamda.2024.105416","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examined the association between life-space activities and incident dementia among older adults.</div></div><div><h3>Study Design</h3><div>A prospective study.</div></div><div><h3>Setting and Participants</h3><div>This study included 2740 older adults (mean age 74.4 years; SD ± 6.2 years; range 65–99 years; 58.8% women).</div></div><div><h3>Methods</h3><div>Life-space activities were assessed using the Active Mobility Index (AMI). Incident dementia was determined using medical insurance data and long-term care insurance data (mean follow-up, 53.7 months).</div></div><div><h3>Results</h3><div>During the follow-up period, 326 participants (11.9%) had incident dementia. Participants were classified into 3 groups based on AMI score tertiles: tertile 1, ≤52; tertile 2, 53–77; and tertile 3, ≥78. The Cox proportional hazards model was used to examine the association between AMI scores and incident dementia. Individuals with higher scores had lower hazard ratios (HRs) (tertile 1: reference; tertile 2: adjusted HR, 0.76, 95% CI, 0.59–0.97, <em>P</em> = .027; tertile 3: adjusted HR, 0.49, 95% CI, 0.36–0.68, <em>P</em> &lt; .001; <em>P</em> for trend: &lt;.001). Both the physical and social AMI sub-scores were associated with dementia (<em>P</em> for trend: &lt;.001).</div></div><div><h3>Conclusions and Implications</h3><div>Restricted life-space activity, as assessed using the AMI, was associated with the risk of dementia. In addition, both the physical and social sub-scores were associated with dementia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105416"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Pay-for-Performance Care on the Mortality and Cardiovascular Outcomes in Older Adults with Newly Diagnosed Type 2 Diabetes: A Nationwide Population-Based Cohort Study","authors":"Fu-Shun Yen MD ,&nbsp;James Cheng-Chung Wei MD, PhD ,&nbsp;Shih-Yi Lin MD ,&nbsp;Jeffrey Hsu BS ,&nbsp;Yun-Kai Yeh MD ,&nbsp;Yu-Han Huang MS ,&nbsp;Tzu-Ju Hsu MS ,&nbsp;Der-Yang Cho MD ,&nbsp;Chii-Min Hwu MD ,&nbsp;Chih-Cheng Hsu DrPH","doi":"10.1016/j.jamda.2024.105382","DOIUrl":"10.1016/j.jamda.2024.105382","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the long-term effects of pay-for-performance (P4P) care in the geriatric population with newly diagnosed type 2 diabetes (T2D).</div></div><div><h3>Design</h3><div>Retrospective longitudinal cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 6607 propensity score-matched pairs of patients with newly diagnosed T2D who received either P4P care or standard care as identified from the National Health Insurance Research Database in Taiwan between January 1, 2000, and December 31, 2019.</div></div><div><h3>Methods</h3><div>Cox regression models were used to assess differences in risk of outcomes between P4P and non-P4P care. Primary outcomes and measures include all-cause mortality, hospital admissions due to cardiovascular events, dialysis initiation, severe hyperglycemia, and severe hypoglycemia. Multivariable Cox regression models were performed to calculate hazard ratios among and within groups.</div></div><div><h3>Results</h3><div>The multivariable-adjusted model showed that patients with P4P care had a significantly lower risk of all-cause mortality [adjusted hazard ratio (aHR), 0.37; 95% CI, 0.35–0.39], stroke (aHR, 0.80 95% CI, 0.72–0.88), myocardial infarction (aHR, 0.57; 95% CI, 0.48–0.67), heart failure (aHR, 0.75; 95% CI, 0.69–0.81), and dialysis (aHR, 0.66; 95% CI, 0.53–0.82) compared with those not receiving P4P care. However, there were no significant differences in the risk of severe hyperglycemia (aHR, 0.92; 95% CI, 0.82–1.03) and severe hypoglycemia (aHR, 1.04; 95% CI, 0.92–1.17) between the 2 groups.</div></div><div><h3>Conclusions and Implications</h3><div>This nationwide cohort study suggests that the P4P program may reduce the risk of cardiovascular events, dialysis needs, and mortality in older patients with T2D without increasing the risk of severe hypoglycemia. P4P may be an effective management strategy for older patients with T2D.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105382"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142790694","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 Needs Assessment: From Frameworks to Practice","authors":"Pablo Villalobos Dintrans DrPH","doi":"10.1016/j.jamda.2024.105409","DOIUrl":"10.1016/j.jamda.2024.105409","url":null,"abstract":"<div><h3>Objectives</h3><div>Identify and describe instruments used by countries to perform functional ability assessment as eligibility for their long-term care systems and compare them to existing healthy aging frameworks proposed by the World Health Organization (intrinsic capacity and functionality).</div></div><div><h3>Design</h3><div>Descriptive, case studies.</div></div><div><h3>Setting and Participants</h3><div>Country-level long-term care systems in 27 countries.</div></div><div><h3>Methods</h3><div>Selection of countries with long-term care systems in place and with expected increase in long-term care needs. For each country, data regarding the country features, as well as information of the long-term care systems, and the instruments to assess long-term care needs (functional ability) were collected. Features of the assessment tools were compared with the World Health Organization's intrinsic capacity and functionality domains, identifying the specific activities evaluated and the way the assessment is used to classify people and define benefits.</div></div><div><h3>Results</h3><div>Countries were classified into those with a long-term care system and a standardized instrument for assessing long-term care needs (group 1; n = 6), those that have long-term care initiatives do not have a standardized instrument to identify needs (group 2; n = 8), and those with no information on their systems or instruments for identify long-term care needs (group 3; n = 13). When looking at countries with standardized tools, instruments include several activities related to intrinsic capacity domains such as cognition, mobility, and psychological capacity; for functional ability, all domains except the ability to “contribute” are covered by the instruments.</div></div><div><h3>Conclusions and Implications</h3><div>Long-term care needs assessment is a complex but necessary task to be performed by long-term care systems. Countries embarking in the design and redesign of their systems can use the existing instruments, frameworks, and the experience from other countries to better adapt this process to their own needs and contexts.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105409"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829148","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":"Over- and Underuse of Proton Pump Inhibitors in Nursing Homes: A Multisite Longitudinal Cohort Study","authors":"Nasir Wabe PhD, MScEpid, MScClinPharm, BPharm ,&nbsp;Rachel Urwin PhD, MPH ,&nbsp;Isabelle Meulenbroeks PhD, MPH, BPhysio ,&nbsp;Karla Seaman PhD, MClinEpi, BPharm ,&nbsp;Magdalena Z. Raban PhD, MIPH, BPharm ,&nbsp;Sangita Neupane MPH ,&nbsp;Amy Nguyen PhD, Grad Cert (Research Management and Commercialisation), BMedSc ,&nbsp;Sandun M. Silva PhD, BSc ,&nbsp;Andrea Timothy PhD, MPhil, ProfCertCR, PGDipSc, BSc, DipLaw ,&nbsp;Narjis Batool DPharm, MPhil (Pharm) ,&nbsp;Lisa Pont PhD, MSC, BSc, BPharm ,&nbsp;Johanna I. Westbrook PhD, MHA, GradDipAppEpid, BAppSc","doi":"10.1016/j.jamda.2024.105393","DOIUrl":"10.1016/j.jamda.2024.105393","url":null,"abstract":"<div><h3>Objectives</h3><div>Proton pump inhibitors (PPIs) are used to manage excess stomach acid production and provide gastroprotection from bleeding risk-increasing drugs (BRIDs). We aimed to determine the prevalence of potentially inappropriate PPI use in nursing homes and associated factors.</div></div><div><h3>Design</h3><div>Longitudinal cohort study using 8 years of electronic data.</div></div><div><h3>Setting and Participants</h3><div>The study included 6439 permanent residents aged ≥65 years from 34 homes managed by 2 aged care providers in New South Wales.</div></div><div><h3>Method</h3><div>Continuous PPI use (&gt;12 weeks) in the absence of long-term BRID (&gt;30 days) use was deemed inappropriate overuse whereas long-term BRID use without concomitant PPI for gastroprotection was classified as inappropriate underuse. Binary logistic regression was used to determine factors associated with PPI overuse.</div></div><div><h3>Results</h3><div>Fifty-four percent of residents (n = 3478) received a PPI, with a median duration of 46 weeks, whereas 58.5% (n = 3770) were long-term BRID users. Four of 5 PPI users (83.6%, n = 2906) used PPIs for &gt;12 weeks, and after accounting for BRID use, the prevalence of inappropriate PPI overuse was 27.1% (n = 944). PPI overuse was 4 times more likely in residents in provider A compared with residents in provider B [odds ratio (OR) 4.08, 95% CI 2.73–6.09]. The prevalence of PPI underuse was 38.5% (n = 1452).</div></div><div><h3>Conclusions and Implications</h3><div>One in 4 PPI users exceeded the clinically recommended duration, whereas 2 in 5 long-term BRID users did not receive a PPI for gastroprotection. There is a pressing need for tailored interventions, such as medication reviews and deprescribing initiatives, to improve PPI prescribing.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105393"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792049","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":"Adult Day Care in South Carolina: Identification of Need and Opportunity","authors":"LaNaya A. Martin MPH,&nbsp;Janet O'Connor MA,&nbsp;FNU Rubaiya MS,&nbsp;Linda E. Kelemen ScD","doi":"10.1016/j.jamda.2024.105395","DOIUrl":"10.1016/j.jamda.2024.105395","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate pre- and post-pandemic demographic profiles of attendees at adult day care (ADC) facilities in the US South, and survey providers for their experience during the pandemic.</div></div><div><h3>Design</h3><div>Retrospective analysis and prospective interviews and survey.</div></div><div><h3>Setting and Participants</h3><div>We received administrative data for South Carolina Medicaid recipients in 2019 (pre-pandemic, n = 21,969) and 2022 (post-pandemic, n = 25,118), prospectively interviewed 6 facility owners and surveyed 62 of 82 ADC facilities in South Carolina (75.6% response).</div></div><div><h3>Methods</h3><div>We compared age, sex, race, and county distributions between Medicaid recipients who attended facilities in 2019 and 2022. We summarized interviews qualitatively. We assessed attendee and provider profiles using a 55-item survey.</div></div><div><h3>Results</h3><div>In 2019, 2398 (10.9%) of Medicaid recipients attended ADC facilities at least 24 times, decreasing significantly to 1745 (6.9%) in 2022 (<em>P</em> &lt; .001). Attendees’ median age fell from 62 years in 2019 to 59 years in 2022 (<em>P</em> &lt; .001). Attendance was highest among Black or African American individuals (71.0% in 2019 and 62.2% in 2022, <em>P</em> &lt; .001). Eleven of 46 counties, all rural, did not have a facility. A median of 25 miles was the farthest distance traveled one way by attendees to a facility (range, 4–60). ADC facility nurses were the primary source of medical oversight and COVID-19 information during the 3-month shutdown. More than 90.0% of facilities served adults who had cognitive impairment, multiple chronic conditions, or intellectual or developmental disabilities. Most facilities (53.2%) received government funding during the pandemic. Staffing shortages, decreased attendance, and increased costs were major challenges faced by ADCs post-pandemic.</div></div><div><h3>Conclusions and Implications</h3><div>These findings demonstrate the importance of ADC facilities to the health and well-being of Black or African American individuals, a population that was disproportionately burdened during the COVID-19 pandemic, and suggests potential underutilization of facilities and more resources allocated to one-on-one in-home care than might be economically feasible.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105395"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801343","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":"Response to Comment on “Adverse Lipid Profiles are Associated With Lower Dementia Risk in Older People”","authors":"Jakob L. Schroevers MD,&nbsp;Jan Willem van Dalen PhD","doi":"10.1016/j.jamda.2024.105377","DOIUrl":"10.1016/j.jamda.2024.105377","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105377"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142790643","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}