Journal of the American Medical Directors Association最新文献

{"title":"Association Between Nursing Home Five-Star Ratings and Consumer Satisfaction","authors":"","doi":"10.1016/j.jamda.2024.105322","DOIUrl":"10.1016/j.jamda.2024.105322","url":null,"abstract":"<div><h3>Objective</h3><div>Consumers can currently access the Centers for Medicare and Medicaid Services Five-Star Quality Rating System when they choose a nursing home (NH). However, the system does not incorporate NH consumers’ opinions. Without having access to satisfaction or quality-of-life measures, consumers could make uninformed decisions. This study aims to investigate the association between five-star ratings and family/resident satisfaction scores.</div></div><div><h3>Design</h3><div>Secondary data analysis was used.</div></div><div><h3>Setting and Participants</h3><div>A unique, NH-level dataset of Ohio NHs that contains star ratings, satisfaction scores, and NH characteristics was constructed (<em>N</em> = 701). Data were drawn from the 2018 star rating data, 2018 Ohio Nursing Home Family Satisfaction Survey, 2017 Ohio Nursing Home Resident Satisfaction Survey, 2017 Ohio Biennial Survey of Long-Term Care Facilities, and the Certification and Survey Provider Enhanced Reports.</div></div><div><h3>Methods</h3><div>Chi-square and logistic regression analyses were conducted controlling other NH characteristics.</div></div><div><h3>Results</h3><div>Chi-square results showed consumer satisfaction and star ratings were correlated, but imperfectly related. Regression results found that NHs with higher family satisfaction score received significantly higher star ratings across all domains except the quality-measure star rating. For each 1% point increase in the family satisfaction score, the probability of being a 4 or 5 overall star NH increases by 1.1% point (<em>P</em> &lt; .01), and being a 4 or 5 health inspection star NH increases by 1.2% points (<em>P</em> &lt; .01). NHs with higher resident satisfaction score received significantly higher star ratings. For every 1% point increase in the resident satisfaction score, the probability of being a 4 or 5 star NH increases by 0.7% point (<em>P</em> &lt; .05) across all star ratings.</div></div><div><h3>Conclusions and Implications</h3><div>Early studies found little relationship between five-star ratings and consumer satisfaction scores. This study found consumer satisfaction is associated, although imperfectly, with star ratings. This highlights the need to publicly report NH consumer perspectives to help them make informed care decisions.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502778","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":"Point-of-Care Ultrasound in Post-acute and Long-Term Care: A Scoping Review.","authors":"Lior Abramson, Chelsea Perfect, Sarah Cantrell, Yuriy S Bronshteyn, Mamata Yanamadala, Gwendolen T Buhr","doi":"10.1016/j.jamda.2024.105320","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105320","url":null,"abstract":"<p><strong>Objectives: </strong>Point-of-care ultrasound (POCUS) is an emerging application of ultrasonography that is being integrated into patient care in many medical specialties. The post-acute and long-term care (PALTC) setting has opportunities to adopt POCUS as a diagnostic aid to improve patient outcomes. We aim (1) to describe the current use of POCUS in PALTC and (2) to examine how the use of POCUS can advance in PALTC settings.</p><p><strong>Design: </strong>Scoping review.</p><p><strong>Setting and participants: </strong>PALTC facilities and residents.</p><p><strong>Methods: </strong>The MEDLINE, Embase, CINAHL Complete, and Web of Science databases were searched by a medical librarian for studies on the use of POCUS in PALTC. All studies underwent dual, independent review during 2 phases of screening. We included all study designs where POCUS was obtained and interpreted by a provider at the bedside.</p><p><strong>Results: </strong>Six studies met inclusion criteria. Most studies were conducted in the setting of COVID19 outbreaks in nursing homes and communities. The organ systems examined using POCUS were lung and vasculature. Lung ultrasound was shown to have variable diagnostic and prognostic utility in assessing lung injury secondary to COVID19. Ultrasound measurements of the vasculature were not useful for predicting hydration status.</p><p><strong>Conclusion and implications: </strong>Implementation of POCUS in PALTC is feasible, but current literature is limited to use in only 2 organ systems. These results suggest potential for expanding POCUS in PALTC. Further work is required to ascertain if POCUS use can improve patient outcomes in this health care setting.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502782","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":"Predictors, Diagnoses, and Costs of Emergency Department Visits Among Home Care Clients.","authors":"Eeva Björkstedt, Ari Voutilainen, Virva Hyttinen-Huotari, Johanna Jyrkkä, Pekka Mäntyselkä, Eija Lönnroos","doi":"10.1016/j.jamda.2024.105308","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105308","url":null,"abstract":"<p><strong>Objectives: </strong>To examine factors, diagnoses, and costs associated with emergency department (ED) visits among home care clients.</p><p><strong>Design: </strong>A prospective 1-year follow-up study.</p><p><strong>Settings and participants: </strong>More information is needed regarding the reasons and costs associated with ED visits by home care clients. Participants were persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293).</p><p><strong>Methods: </strong>Data collection included clients' demographics, health status (Charlson Comorbidity Index), medication use, assessments of physical (Timed Up and Go) and cognitive functioning (Mini-Mental State Examination), Basic and Instrumental Activities of Daily Living, mood (Geriatric Depression Scale, GDS-15) and health-related quality of life (HRQoL, EuroQol [EQ-5D-3 L]). Logistic regression and univariate analyses of variance were conducted. The costs (total and per person-year) of ED visits were calculated.</p><p><strong>Results: </strong>The number of ED visits was 775 during the follow-up (mean 350 days). The likelihood of ED visits was reduced by better HRQoL and increased by a higher GDS-15 score, longer TUG times, and a history of heart failure and decreased glomerular infiltration. The most common primary diagnoses for ED visits were heart failure (8.4%), atrial fibrillation (4.0%), respiratory infection (4.0%), and cystitis (3.5%). The total costs of all ED visits during the follow-up were 251,247 € and internal medicine and surgery accounted for 142,726 € and 89,212 € of the cost, respectively. The costs per person-year were 981 €.</p><p><strong>Conclusions and implications: </strong>HRQoL, depressive symptoms, mobility, and heart and renal failure were associated with the number of ED visits. The most common reasons for ED visits were chronic heart conditions and infectious diseases and the highest costs were incurred by internal medicine treatment. With advanced care planning and active symptom screening and cooperation of home care nurses and physicians, some of the ED visits, for example due to heart failure, might be preventable.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468554","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":"A 3-Wave Longitudinal Study of eHealth Literacy and Older People's Health-Related Quality of Life in China: The Mediating Role of General Self-Efficacy","authors":"","doi":"10.1016/j.jamda.2024.105310","DOIUrl":"10.1016/j.jamda.2024.105310","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Health-related quality of life (HRQoL) is an important indicator to reflect the independence and well-being of older adults in their later life. Improving the HRQoL of older adults is of great importance for achieving healthy aging. The internet provides extensive health information and being able to effectively use the electronic health (eHealth) resources (reflected as “eHealth literacy”) potentially empowers older adults to manage health and improve HRQoL. However, there is limited evidence about the relationship between eHealth literacy and HRQoL in this population. This study aims to examine the longitudinal association and temporal relationship between eHealth literacy and HRQoL among older adults, and to explore potential underlying mechanisms.</div></div><div><h3>Design</h3><div>A 3-wave longitudinal study.</div></div><div><h3>Setting and Participants</h3><div>Chinese older adults aged 55 or older in Jiangxi Province, China.</div></div><div><h3>Methods</h3><div>Data were collected at baseline (T1) and 3-month (T2) and 6-month (T3) follow-ups during February to December 2022, using online self-reported questionnaires. eHealth literacy, HRQoL, and general self-efficacy were measured using validated tools. Statistical analyses, including longitudinal Tobit regression, cross-lagged panel model (CLPM), and longitudinal mediation analysis were performed.</div></div><div><h3>Results</h3><div>A total of 611 participants were included at T1, and 464 (75.9%) completed both 3- and 6-month follow-ups. Longitudinal Tobit regression suggested that older individuals with higher eHealth literacy showed better HRQoL over time (adjusted β, 0.023; 95% CI, 0.011–0.035; <em>P</em> &lt; .001), after accounting for covariates. The CLPM supported that higher eHealth literacy significantly predicts improved HRQoL over time (standardized β, 0.09, <em>P</em> = .008), but not the reverse. In addition, general self-efficacy at T2 fully mediated the relationship from eHealth literacy at T1 and HRQoL at T3, with mediated proportion of 28.3%.</div></div><div><h3>Conclusions and Implications</h3><div>This study highlighted the importance of eHealth literacy and self-efficacy in improving HRQoL among older adults, supporting the development of tailored interventions to promote their HRQoL.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468615","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":"Defining and Categorizing Nonpharmacologic Interventions in the Older Population: A Systematic Review.","authors":"Eline C M Kooijmans, Emiel O Hoogendijk, Natalia Drapała, Olena Antonenko, George L Burchell, Ilona Barańska, Jitka Pokladníková, Katarzyna Szczerbińska, Daniela Fialová, Hein P J van Hout, Karlijn J Joling","doi":"10.1016/j.jamda.2024.105306","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105306","url":null,"abstract":"<p><strong>Objectives: </strong>Nonpharmacologic interventions (NPIs) constitute an important part of treatment for older adults, cover a broad and diverse range of interventions, and have advantages over pharmacologic interventions (eg, limited adverse side effects). However, an unambiguous definition of NPIs is still lacking. Defining NPIs may facilitate research on this topic and enhance comparability of results between studies, and might help to face the challenges of recognition, acceptation, funding, and implementation. Therefore, the aim of this review was to provide an overview and comparison of the definitions of NPIs used in the current literature on older adults.</p><p><strong>Design: </strong>A systematic review was performed to provide an overview of the definitions of NPIs that are used in the current literature on older populations and to organize the characteristics involved in the definitions.</p><p><strong>Setting and participants: </strong>People ≥60 years of age were included, not limited to a specific setting.</p><p><strong>Methods: </strong>A systematic search was performed in the following 5 databases: PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature, and Wiley/Cochrane Library. The time frame within the databases was from inception to December 4, 2023. Review articles, editorials and consensus papers were included.</p><p><strong>Results: </strong>We included 28 articles. We organized the definitions of NPI according to 4 different aspects: types of interventions involved, target population, goals the interventions addressed, and requirements of the interventions. Definitions in the current literature can generally be divided into 2 groups: NPIs described as not involving medication, and more elaborated multidomain definitions. Based on the results, we formulated criteria for types of interventions that can be considered an NPI.</p><p><strong>Conclusions and implications: </strong>Using current descriptions and characteristics, elements for a new definition for NPIs were proposed. To improve research in this field, consensus needs to be reached regarding elements covered by a definition of NPIs.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468548","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":"Medical Care Provider Involvement in Ontario Assisted Living Homes: A Descriptive Cross-Sectional Survey Analysis","authors":"","doi":"10.1016/j.jamda.2024.105309","DOIUrl":"10.1016/j.jamda.2024.105309","url":null,"abstract":"<div><h3>Objectives</h3><div>Assisted living is growing in Ontario. Medical services are not regulated in Ontario, resulting in variability of physician involvement. We described medical service provider involvement and practice characteristics in assisted living homes.</div></div><div><h3>Design</h3><div>Descriptive cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>A total of 88 assisted living homes in Ontario, Canada, which responded to a survey in 2023.</div></div><div><h3>Methods</h3><div>Administrators responded to questions on recruiting various health professionals, their involvement in the retirement home, support available, documentation in the home, and availability of palliative care. We reported absolute and relative proportions for survey items. We used regression analysis to assess if there is a statistically significant difference in the proportion of patients accessing care from the community in homes with and without a recruited medical service provider.</div></div><div><h3>Results</h3><div>Fifty-four (61.4%) of homes had a medical service provider, primarily an attending medical doctor. Attending medical doctors cared for more than 50 patients in 36% of homes, and 46% visited homes weekly. Administrators reported that medical providers spent most of the time providing appointments, responding to phone calls and faxes, conducting medication reviews, and discussing with residents’ families. Nearly two-thirds of homes had nurses accompany physicians on rounds and provided medical service providers with clinic space and equipment. Two-thirds of homes provided residents with palliative care, primarily through community support. Residents of homes with a recruited medical service provider had 76% lower odds of seeking care from their physician in the community than those without a recruited provider (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions and Implications</h3><div>Our findings describe high variability in recruiting medical service providers in assisted living homes and their practice characteristics. Residents may benefit from on-site accessible and patient-centered medical care. This study provides contextual information to inform future research on assisted living in Ontario and enables policy comparisons to other provinces and countries.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468552","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":"Inequalities in Transitions to Home Care: A Longitudinal Analysis of the Canadian Longitudinal Study on Aging","authors":"","doi":"10.1016/j.jamda.2024.105307","DOIUrl":"10.1016/j.jamda.2024.105307","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate inequalities in transitions to home care across a broad set of demographic and socioeconomic factors in Canadian middle-aged and older adults.</div></div><div><h3>Design</h3><div>Longitudinal, retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 51,338 community-dwelling adults aged 45+ years, using national data from the Canadian Longitudinal Study on Aging across 3 timepoints from 2011 to 2021.</div></div><div><h3>Methods</h3><div>We analyzed transitions in home care use using multistate Markov models, with home care use and nonuse as transient states, and loss to follow-up as a terminal state. We calculated hazard ratios for transitions between states adjusting for factors related to home care need (ie, functional limitations, chronic conditions) within the following equity strata: income, education, immigration history, sex, gender, rurality, racial background, and tangible social support.</div></div><div><h3>Results</h3><div>Across all timepoints, 5.4% of non–home care users transitioned to home care by the next timepoint and 33.2% of home care users continued to use home care at the next timepoint. Among non–home care users, identifying as a woman, female, white, completing higher levels of education, having higher income, and having less support available was associated with an increased likelihood of transitioning to home care use. Among home care users, higher income was also associated with a greater likelihood to discontinue using home care compared with lower income users. The association between income and home care use was stronger among female individuals.</div></div><div><h3>Conclusions and Implications</h3><div>We found meaningful differences in home care transitions across several equity strata. Individuals with higher income have greater ability to access to private care, creating inequity in access to home care services. Gendered factors such as income and social support have important associations with home care use. Home care planning and policy must address the unique barriers and disadvantages diverse populations face to ensure equitable use of home care and promote healthy aging.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468551","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":"Clinician Perspectives on Supporting Advance Care Planning in Long-Term Care Homes.","authors":"George A Heckman, Anooshah Nasim, Heather Keller, Patrick Quail, Clare Ramsey, Veronique Boscart, Allan Garland","doi":"10.1016/j.jamda.2024.105303","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105303","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468547","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":"Associations of Regular Internet Usage with All-Cause and Cause-Specific Mortality: A Prospective Cohort Study","authors":"","doi":"10.1016/j.jamda.2024.105301","DOIUrl":"10.1016/j.jamda.2024.105301","url":null,"abstract":"<div><h3>Objectives</h3><div>The impact of internet usage on mortality is not widely known. This study intended to investigate the associations between regular internet usage and the risks of all-cause and cause-specific mortality, while also ascertaining potential factors that may modify these correlations.</div></div><div><h3>Design</h3><div>A community-based prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>The study included 21,481 individuals [mean (SD) age, 64.1 (11.0) years] from the Health and Retirement Study, with data collected between 2006 and 2020.</div></div><div><h3>Methods</h3><div>The Cox proportional hazards regression model was used to evaluate the associations between regular internet usage and the risks of all-cause and cause-specific mortality, adjusting for demographic factors, lifestyle behaviors, and other potential confounding factors. Moreover, we explored the association between daily hours of internet usage and the risk of outcomes.</div></div><div><h3>Results</h3><div>Regular internet usage was significantly associated with a lower risk of all-cause mortality (hazard ratio, 0.78; 95% CI, 0.74-0.83) and cardiovascular mortality (hazard ratio, 0.72; 95% CI, 0.64-0.82). No significant interaction effects were observed for age, sex, regular exercise, or current alcohol consumption (all <em>P</em> interactions &gt; .05). Additionally, estimations for daily hours of usage indicated a U-shaped relationship with all-cause mortality. Adults who used 2.1 to 4 hours per day had the lowest risk; however, not all estimations showed their significance on account of the limited sample size.</div></div><div><h3>Conclusions and Implications</h3><div>Regular internet usage was associated with a lower risk of all-cause and cardiovascular mortality, which may prompt consideration of the beneficial impact of internet usage on lifespan.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468545","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":"Clinical Practice Guideline for Diabetes Management in the Post-Acute and Long-Term Care Setting","authors":"","doi":"10.1016/j.jamda.2024.105342","DOIUrl":"10.1016/j.jamda.2024.105342","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468571","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}