Journal of the American Medical Directors Association最新文献

{"title":"Enhanced Sarcopenia Detection in Nursing Home Residents Using Ultrasound Radiomics and Machine Learning","authors":"Hongbo Fu MS ,&nbsp;Shuyue Luo MS ,&nbsp;Yan Zhuo MS ,&nbsp;Rongna Lian MS ,&nbsp;Xiaoyan Chen MS ,&nbsp;Wenhua Jiang MS ,&nbsp;Lei Wang MD ,&nbsp;Ming Yang MD","doi":"10.1016/j.jamda.2025.105830","DOIUrl":"10.1016/j.jamda.2025.105830","url":null,"abstract":"<div><h3>Objective</h3><div>Ultrasound only has low-to-moderate accuracy for sarcopenia. We aimed to investigate whether ultrasound radiomics combined with machine learning enhances sarcopenia diagnostic accuracy compared with conventional ultrasound parameters among older adults in long-term care.</div></div><div><h3>Design</h3><div>Diagnostic accuracy study.</div></div><div><h3>Setting and Participants</h3><div>A total of 628 residents from 15 nursing homes in China.</div></div><div><h3>Methods</h3><div>Sarcopenia diagnosis followed AWGS 2019 criteria. Ultrasound of thigh muscles [rectus femoris (ReF), vastus intermedius (VI), and quadriceps femoris (QF)] was performed. Conventional parameters [muscle thickness (MT), echo intensity (EI)] and radiomic features were extracted. Participants were split into training (70%)/validation (30%) sets. Conventional (muscle thickness + EI), radiomics, and integrated (MT, echo intensity, radiomics, basic clinical data including age, sex, and body mass index) models were built using 5 machine learning algorithms [including logistic regression (LR)]. Performance was assessed in the validation set using the area under the receiver operating characteristic curve (AUC), calibration, and decision curve analysis (DCA).</div></div><div><h3>Results</h3><div>Sarcopenia prevalence was 61.9%. The LR algorithm consistently exhibited superior performance. The diagnostic accuracy of the ultrasound radiomic models was superior to that of the models based on conventional ultrasound parameters, regardless of muscle group. The integrated models further improved the accuracy, achieving AUCs (95% CIs) of 0.85 (0.79–0.91) for ReF, 0.81 (0.75–0.87) for VI, and 0.83 (0.77–0.90) for QF. In the validation set, the AUCs (95% CIs) for the conventional ultrasound models were 0.70 (0.63–0.78) for ReF, 0.73 (0.65–0.80) for VI, and 0.75 (0.68–0.82) for QF. The corresponding AUCs (95% CIs) for the radiomics models were 0.76 (0.69–0.83) for ReF, 0.76 (0.69–0.83) for VI, and 0.78 (0.71–0.85) for QF. The integrated models demonstrated good calibration and net benefit in DCA.</div></div><div><h3>Conclusions and Implications</h3><div>Ultrasound radiomics, especially when integrated with conventional parameters and clinical data using LR, significantly improves sarcopenia diagnostic accuracy in nursing home residents. This accessible, noninvasive approach holds promise for enhancing sarcopenia screening and early detection in long-term care settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 11","pages":"Article 105830"},"PeriodicalIF":3.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958868","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":"Recovering After COVID-19: A Comparison of Burnout Levels Among Care Aides From 2014 to 2024","authors":"Seyedehtanaz Saeidzadeh PhD ,&nbsp;Cybele Angel PhD ,&nbsp;Vikram Nichani MD ,&nbsp;Tatiana Penconek PhD ,&nbsp;Peter G. Norton MD ,&nbsp;Carole A. Estabrooks PhD","doi":"10.1016/j.jamda.2025.105842","DOIUrl":"10.1016/j.jamda.2025.105842","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine recovery (prepandemic to postpandemic), specifically related to burnout for care aides working in nursing homes.</div></div><div><h3>Design</h3><div>This repeated cross-sectional study used 5 data collection points spanning 10 years (2014–2024) collected by Translating Research in Elder Care (TREC). Time points were prepandemic: T1 (September 2014 to May 2015), T2 (May to December 2017), and T3 (September 2019 to March 2020); pandemic: T4 (June 2021to September 2021); and postpandemic: T5 (September 2023 to May 2024).</div></div><div><h3>Setting and Participants</h3><div>Participants were health care aides (care aides) working in nursing homes in the urban health zones of Calgary and Edmonton in the province of Alberta, Canada.</div></div><div><h3>Methods</h3><div>Measurements included demographic variables, unit and nursing home characteristics, and burnout, specifically the Maslach Burnout Inventory, short form 9 (MBI-GS9). The MBI has 3 subscales, emotional exhaustion, cynicism, and professional efficacy. We used descriptive statistics to describe the sample characteristics. We used hierarchical linear models (3 levels) to account for the nested structure of data to examine the change in burnout over time and examine factors associated with it.</div></div><div><h3>Results</h3><div>Our total sample for each time point was as follows: T1 (n = 1620), T2 (n = 1789), T3 (n = 1590), T4 (n = 760), and T5 (n = 1727). Comparing burnout levels prepandemic to postpandemic showed that care aides’ level of emotional exhaustion postpandemic was higher than prepandemic and that their level of professional efficacy was lower, which was statistically significant. Care aides’ age and shift often worked were significantly associated with emotional exhaustion, cynicism, and professional efficacy.</div></div><div><h3>Conclusions and Implications</h3><div>Care aides have not fully recovered to prepandemic burnout levels, specifically their emotional exhaustion and professional efficacy levels. This study has important implications for the retention of this essential workforce in nursing homes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 11","pages":"Article 105842"},"PeriodicalIF":3.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Serum Alkaline Phosphatase Levels and Sarcopenia in US Adults: A Cross-sectional Study","authors":"Yanlei Li MD ,&nbsp;Senjun Jin MD ,&nbsp;Shengang Zhou MD ,&nbsp;Liming Xu MD ,&nbsp;Chenghang Jiang MD ,&nbsp;Yingge Xu MD ,&nbsp;Liujie Qi MD ,&nbsp;Shengan Hu MD","doi":"10.1016/j.jamda.2025.105834","DOIUrl":"10.1016/j.jamda.2025.105834","url":null,"abstract":"<div><h3>Objectives</h3><div>Serum alkaline phosphatase (ALP) is an important biomarker associated with various physiological processes and diseases. Although alkaline phosphatase's impact on health has been extensively studied, its specific relationship with sarcopenia remains unclear.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>This study is based on the National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, including 6098 eligible participants aged 20 years and older.</div></div><div><h3>Methods</h3><div>Serum ALP was obtained through biochemical tests, and sarcopenia was assessed by adjusting appendicular skeletal muscle mass for body mass index (BMI). The study employed weighted logistic regression, restricted cubic splines, stratified analysis, and interaction tests to analyze the relationship between the two, and conducted sensitivity analyses to examine the stability of the associations. Further stratification was performed based on vigorous recreational activity.</div></div><div><h3>Results</h3><div>Multivariate logistic regression analysis showed that after adjusting for other confounding factors, ALP levels were significantly positively correlated with sarcopenia. Compared with participants in the lowest quartile of ALP, those in the highest quartile had an increased risk of sarcopenia by 1.96 times (odds ratio 1.96, 95% CI 1.19-3.23, <em>P</em> &lt; .01). This association was more pronounced in individuals with BMI ≥25. Restricted cubic spline analysis revealed a linear relationship between the 2 variables. Notably, individuals lacking in vigorous recreational activity may have a higher prevalence of sarcopenia.</div></div><div><h3>Conclusions and Implications</h3><div>Our study found that elevated serum ALP levels are significantly associated with an increased risk of sarcopenia. Monitoring serum ALP levels and engaging in moderate physical activity may be effective strategies to reduce the risk of sarcopenia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 11","pages":"Article 105834"},"PeriodicalIF":3.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958851","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":"Racial and Rural Disparities in Stroke Discharge Disposition Stratified by 90-Day Survival Status","authors":"Mengyuan Cheng MPhil ,&nbsp;Winston Kennedy PT, DPT, PhD, MPH ,&nbsp;Brady Post PhD ,&nbsp;Nasim Ferdows PhD","doi":"10.1016/j.jamda.2025.105847","DOIUrl":"10.1016/j.jamda.2025.105847","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine racial and rural-urban disparities in discharge disposition following hospitalization for ischemic stroke, stratified by 90-day postdischarge survival status.</div></div><div><h3>Design</h3><div>Retrospective cross-sectional study using Medicare claims data.</div></div><div><h3>Setting and Participants</h3><div>A nationally representative 5% sample of Medicare Fee-For-Service beneficiaries hospitalized with a primary diagnosis of ischemic stroke in 2021 (N = 6804); 18% identified as racial or ethnic minorities, and 19% resided in rural areas.</div></div><div><h3>Methods</h3><div>Data were drawn from the 2021 Inpatient Standard Analytical Files and Medicare Beneficiary Summary File. The primary outcome was discharge disposition, categorized as (1) home or home health care, (2) skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), or (3) hospice or other settings. Race or ethnicity and rurality were key independent variables, with rurality categorized using Rural-Urban Commuting Area (RUCA) codes. We stratified analyses by survival status (died during hospitalization or within 90 days vs survived beyond 90 days). Multinomial logistic regression models adjusted for demographic, clinical, and socioeconomic covariates.</div></div><div><h3>Results</h3><div>Among all beneficiaries, 44.4% were discharged to home or home health care, 39.9% to SNF or IRF, 10.5% to hospice or another hospital, and 5.2% died during hospitalization. Among those who survived to discharge, 13.6% died within 90 days. Among these, Black and Hispanic patients had lower odds of discharge to hospice or other settings compared with White patients [odds ratio (OR) 0.38, 95% CI 0.20-0.73]. Patients residing in rural-adjacent areas had lower odds of discharge to hospice or other settings compared with urban counterparts (OR 0.56, 95% CI 0.31-1.01). No significant disparities were found among survivors.</div></div><div><h3>Conclusions and Implications</h3><div>Disparities in discharge disposition were concentrated among patients nearing end of life. These findings highlight gaps in hospice and institutional care access for rural and minority populations, underscoring the need for targeted policy and clinical interventions to promote equity in poststroke care transitions.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 11","pages":"Article 105847"},"PeriodicalIF":3.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958504","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":"Interactive Associations of Age, Apolipoprotein E ε4 Gene, Physical Activity, and Physical Functioning on Processing Speed","authors":"Ricardo Aurélio Carvalho Sampaio PhD ,&nbsp;Yukiko Nishita PhD ,&nbsp;Chikako Tange PhD ,&nbsp;Shu Zhang PhD ,&nbsp;Mitsuru Shinohara PhD ,&nbsp;Mana Tateishi MSc ,&nbsp;Kanae Furuya PhD ,&nbsp;Sayaka Kubota PhD ,&nbsp;Priscila Yukari Sewo Sampaio PhD ,&nbsp;Naoyuki Sato MD, PhD ,&nbsp;Hiroshi Shimokata MD, PhD ,&nbsp;Hidenori Arai MD, PhD ,&nbsp;Rei Otsuka PhD","doi":"10.1016/j.jamda.2025.105489","DOIUrl":"10.1016/j.jamda.2025.105489","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigated the interactive associations of age, apolipoprotein E ε4 (APOE4) genetic status, physical activity energy expenditure (PAEE), and physical functioning on processing speed over a 10-year period.</div></div><div><h3>Design</h3><div>In this longitudinal study, participants underwent biennial assessments from 2002 to 2012 as part of the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA).</div></div><div><h3>Setting and Participants</h3><div>We used data from 2518 middle-aged and older community-dwelling adults in Japan.</div></div><div><h3>Methods</h3><div>Processing speed was assessed using the Digit Symbol Substitution Test, and additional data included APOE4 genotyping, objective PAEE measurement via accelerometry (in kcal/d), and physical functioning assessments (handgrip strength and walking speed, dichotomized according to specific cutoffs: &lt;18 kg for women and &lt;28 kg for men [weakness], and &lt;1 m/s [slowness], respectively). Mixed-effects models were used to analyze the data, accounting for time-varying covariates, including living arrangement, hypertension, hyperlipidemia, diabetes, depressive symptoms, smoking, sleep duration, energy intake, and body mass index.</div></div><div><h3>Results</h3><div>Results revealed significant 3-way interactive associations among PAEE × age × APOE4 carrier (β = 0.000025, <em>P</em> = .021) and among slowness × age × APOE4 carrier (β = −0.014187, <em>P</em> = .013) on cognitive processing speed. Higher PAEE was associated with better processing speed, whereas slowness was associated with poorer processing speed, particularly in older APOE4 carriers. Although weakness showed significant interactions with age and APOE4 carrier, no 3-way interaction was observed.</div></div><div><h3>Conclusions and Implications</h3><div>Our findings underscore the complex interplay among physical activity, physical functioning, age, and genetic risk on processing speed. The protective associations of higher PAEE levels and better physical functioning, especially in older APOE4 carriers, suggest that maintaining an active lifestyle and mobility may be crucial for individuals with a genetic predisposition to cognitive decline.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 11","pages":"Article 105489"},"PeriodicalIF":3.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414589","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":"Comprehensiveness vs Efficiency: A Cross-Sectional Analysis of the Association Between Allostatic Load and the Frailty Index Using the CLSA","authors":"Luke Duignan MSc ,&nbsp;Daniel Dutton PhD","doi":"10.1016/j.jamda.2025.105829","DOIUrl":"10.1016/j.jamda.2025.105829","url":null,"abstract":"<div><h3>Objectives</h3><div>The goal of this study was to investigate the associations between the frailty index (FI) and allostatic load (AL) to determine if allostatic load contains “key” biomarkers of frailty. If so, AL may offer a more concise health measure using only routine, administrative data.</div></div><div><h3>Design</h3><div>A cross-sectional study design was used to assess the relationships between AL and FI and compare these relationships with an extensively validated health measure, self-rated health.</div></div><div><h3>Setting and Participants</h3><div>The data used for this study were obtained from the Canadian Longitudinal Study on Aging (CLSA) baseline comprehensive cohort (n = 26,367).</div></div><div><h3>Methods</h3><div>Simple linear and logistic regression models were built to measure associations between AL and the FI, which was standardized for improved interpretability. Both indices associations with another validated health measure, self-rated health, were then compared.</div></div><div><h3>Results</h3><div>Increased levels of AL were associated with higher FI scores, consistent across both sexes. In fully adjusted models, an AL score of 4 was associated with a 0.504 SD and 0.500 SD increase in FI in both male and female individuals, respectively (99% CI_M, 0.379–0.496; 99% CI_F, 0.357–0.643). Both increased FI and AL were also associated with increased odds of reporting poor or fair health.</div></div><div><h3>Conclusions and Implications</h3><div>These results suggest that AL and the FI are related, and that allostatic load may indeed contain “key” biomarkers of frailty. Given this, it is reasonable to suggest that AL could be used in at least an equivalent capacity to the FI currently and may represent a more practical and efficient measure of health and health risk.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 11","pages":"Article 105829"},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958840","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":"Apathy in Korsakoff Syndrome: A Call for Clinical Awareness in Long-Term Care Settings","authors":"Misha J. Oey MSc ,&nbsp;Wiltine Moerman-van den Brink MSc ,&nbsp;Albert Postma PhD ,&nbsp;Roy P.C. Kessels PhD ,&nbsp;Erik Oudman PhD","doi":"10.1016/j.jamda.2025.105797","DOIUrl":"10.1016/j.jamda.2025.105797","url":null,"abstract":"<div><h3>Objectives</h3><div>Apathy is a prominent neuropsychiatric symptom in Korsakoff syndrome (KS), yet its multidimensional aspects and correlates remain underexplored. This study evaluates the prevalence, subtypes, and associated factors of apathy in patients with KS residing in long-term care facilities.</div></div><div><h3>Design</h3><div>A cross-sectional study analyzing apathy prevalence, subtypes, and associated factors.</div></div><div><h3>Setting and Participants</h3><div>Twelve specialized long-term care facilities in the Netherlands; a total of 175 patients with KS residing in long-term care facilities.</div></div><div><h3>Methods</h3><div>Apathy was assessed using the Apathy Evaluation Scale–Informant version (AES-I) and the Apathy Motivation Index–Caregiver version (AMI-CG), categorizing subtypes into behavioral activation, social motivation, and emotional sensitivity. Demographic variables and psychotropic medication use were analyzed.</div></div><div><h3>Results</h3><div>Apathy was highly prevalent, with 76% of patients classified as apathetic on the AES-I and 82.3% on the AMI-CG. All apathy subtypes demonstrated high total scores, particularly social motivation. Antipsychotic use was significantly associated with increased apathy levels. During COVID-19 lockdown, apathetic patients exhibited a significant decline in activity levels, with only partial recovery post-lockdown.</div></div><div><h3>Conclusions and Implications</h3><div>Apathy is a pervasive symptom in KS, significantly associated with antipsychotic medication use and contributing to reduced activity levels. These findings emphasize the need for routine apathy assessment, cautious antipsychotic use, and tailored nonpharmacologic interventions to address apathy in this vulnerable population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 10","pages":"Article 105797"},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821647","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 and Validation of the Care Risk Perception Scale (CRPS) for Caregivers of Older Adults With Dementia in Long-Term Care Facilities","authors":"Liqin Wei BSN ,&nbsp;Lihui Pu PhD ,&nbsp;Mengying Qiu PhD ,&nbsp;Jiayi Zhu BSN ,&nbsp;Shuai Yuan BSN ,&nbsp;Xiaofeng Xie PhD ,&nbsp;Fengying Zhang PhD","doi":"10.1016/j.jamda.2025.105759","DOIUrl":"10.1016/j.jamda.2025.105759","url":null,"abstract":"<div><h3>Objectives</h3><div>Global aging has increased the demand for long-term care facilities (LTCFs) for older adults with dementia. This challenge is further exacerbated by systemic barriers such as insufficient infrastructure and a shortage of trained caregivers within LTCFs. These limitations heighten care risks for vulnerable populations and underscore the urgent need for tools to evaluate caregivers’ risk perceptions—a critical determinant of safety practices. This study developed and validated the Care Risk Perception Scale (CRPS), a specialized instrument designed to assess caregivers’ perceived risk associated with dementia care and inform targeted interventions in LTCFs.</div></div><div><h3>Design</h3><div>A mixed-method design was used, including literature review, 2 rounds of Delphi expert consultation (n = 22), and psychometric validation with 501 caregivers in LTCFs.</div></div><div><h3>Setting and Participants</h3><div>Participants were caregivers of older adults with dementia in LTCFs in Sichuan Province, China. Inclusion criteria required at least 3 months of caregiving experience and cognitive competence, March–September 2024.</div></div><div><h3>Methods</h3><div>A mixed-method design was used: (1) literature review and 2 Delphi rounds (22 experts) generated a preliminary scale; (2) psychometric validation involved 501 caregivers from 150 Chinese LTCFs, including item analysis, exploratory factor analysis (n = 200), and confirmatory factor analysis (n = 301).</div></div><div><h3>Results</h3><div>The final CRPS contains 23 items across 4 dimensions: institutional, environmental, psychological support, and competency risks. The scale demonstrated strong reliability (Cronbach's α = 0.882 overall; 0.753–0.905 for subscales) and validity (content validity = 0.928). Exploratory factor analysis extracted 4 factors explaining 69.78% variance (Kaiser-Meyer-Olkin = 0.888, Bartlett's χ² = 3753.073, <em>P</em> &lt; .001). Confirmatory factor analysis confirmed model fit (χ²/<em>df</em> = 2.725, Comparative Fit Index = 0.928, Root Mean Square Error of Approximation = 0.075). Split-half reliability was 0.457 (<em>P</em> &lt; .001), and test-retest reliability was 0.714 (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions and Implications</h3><div>The CRPS is a scientifically robust tool to assess care risk perceptions in LTCFs. By identifying caregivers’ risk awareness gaps, it supports targeted interventions and policy reforms for standardized safety audits to enhance dementia care quality and safety.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 10","pages":"Article 105759"},"PeriodicalIF":3.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626645","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":"Social Connectedness and Successful Nursing Home Discharge After Heart Failure Hospitalization","authors":"Andrew L. Chen BS ,&nbsp;Blythe G. Chen BA ,&nbsp;Lan Jiang MS ,&nbsp;Matthew Howe MD, PhD ,&nbsp;Matthew F. Thompson PhD ,&nbsp;Julia Browne PhD ,&nbsp;Zachary J. Kunicki PhD, MS, MPH ,&nbsp;John McGeary PhD ,&nbsp;James L. Rudolph MD ,&nbsp;Thomas A. Bayer MD, MS","doi":"10.1016/j.jamda.2025.105824","DOIUrl":"10.1016/j.jamda.2025.105824","url":null,"abstract":"<div><h3>Objectives</h3><div>Social connectedness is associated with positive health outcomes. Patients discharged to skilled nursing facilities (SNFs) after heart failure (HF) hospitalization face a high risk of hospital readmission, but the association between social connectedness and successful discharge from postacute SNF care is unknown. This study aimed to quantify the association between social connectedness and successful discharge from postacute SNF care among veterans with HF.</div></div><div><h3>Design</h3><div>This retrospective cohort study's primary outcome was successful discharge, defined as discharge to the community within 90 days of admission to the SNF, and survival 30 days after discharge without hospitalization or institutionalization. Social connectedness was measured by the Social Connectedness Index [SCI, range 0–5: binarized into low (SCI = 0–4) or high social connectedness (SCI = 5)].</div></div><div><h3>Setting and Participants</h3><div>Veterans admitted to a Department of Veterans Affairs Medical Center for HF and subsequently discharged to a SNFs between January 2011 and June 2019.</div></div><div><h3>Methods</h3><div>We estimated the association of high SCI with successful discharge using a modified Poisson regression with robust error variance.</div></div><div><h3>Results</h3><div>A total of 29,725 veterans were included. Veterans with high social connectedness (SCI = 5) in SNF settings were more likely to have successful discharge than those with lower social connectedness [adjusted relative risk (95% CI): 1.21 (1.13–1.31)]. This association was seen in patients with Alzheimer disease or Alzheimer disease and related dementias (AD/ADRD) [1.32 (1.16–1.49)] and without ADRD [1.14 (1.04–1.25)] cohorts.</div></div><div><h3>Conclusions and Implications</h3><div>Veterans with HF who were more socially connected in the SNF setting had higher rates of successful discharge than those with lower social connectedness. Low social connectedness may be an indicator of care needs that make discharge from SNF to home more challenging. Clinical social isolation measurement may be a useful tool in identifying successful discharge candidates.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 10","pages":"Article 105824"},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932866","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":"Acute Care for Elders Risk Score: A Practical Machine Learning–Based Tool for Screening High-Risk Older Inpatients","authors":"Sunghwan Ji MD ,&nbsp;Geon Young Jang MD ,&nbsp;Ji Yeon Baek MD, PhD ,&nbsp;Hee-Won Jung MD, PhD ,&nbsp;Eunju Lee MD, PhD ,&nbsp;Jae Yong Yu PhD ,&nbsp;Yura Lee MD, PhD ,&nbsp;Il-Young Jang MD, PhD","doi":"10.1016/j.jamda.2025.105818","DOIUrl":"10.1016/j.jamda.2025.105818","url":null,"abstract":"<div><h3>Objectives</h3><div>To develop and validate a machine learning–based risk score—the Acute Care for Elders (ACE) Risk Score—that integrates the Clinical Frailty Scale (CFS) with readily available clinical and laboratory data to predict adverse outcomes in older hospitalized patients.</div></div><div><h3>Design</h3><div>A retrospective cohort study using a machine learning framework (AutoScore) to develop an interpretable clinical risk score.</div></div><div><h3>Setting and Participants</h3><div>This study included 21,757 hospital admissions of patients aged ≥65 years at a tertiary academic hospital between May 2021 and November 2023. The patients were randomly allocated to training (50%), test (45%), and validation (5%) cohorts.</div></div><div><h3>Methods</h3><div>Eighteen candidate variables were extracted from electronic medical records (EMRs) on the first day of admission. The composite outcome included in-hospital delirium, pressure ulcers, falls, and mortality. Using the AutoScore framework, a parsimonious model with 5 variables (CFS, albumin, C-reactive protein, hemoglobin, and number of pre-admission medications) was selected. Predictive performance was evaluated using receiver operating characteristic analysis and compared with CFS and age.</div></div><div><h3>Results</h3><div>The ACE Risk Score showed superior predictive performance for the composite outcome [area under the curve (AUC) 0.837] compared with CFS alone (AUC 0.798) and age (AUC 0.630; <em>P</em> &lt; .001 for both). Higher ACE scores were also associated with greater risks of safety events, 30-day readmissions and emergency visits after discharge, longer hospital stays, and rapid response team activations.</div></div><div><h3>Conclusions and Implications</h3><div>The ACE Risk Score is a practical, interpretable, and scalable tool for early identification of high-risk older inpatients, using data available on the first day of admission. It supports timely, targeted interventions by geriatric teams. The score may facilitate broader implementation of risk-guided care strategies for older adults in hospital settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 10","pages":"Article 105818"},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932867","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}