Journal of the American Medical Directors Association最新文献

{"title":"Cross-National Evidence on Risk of Death Associated With Loneliness: A Survival Analysis of 1-Year All-Cause Mortality Among Older Adult Home Care Recipients in Canada, Finland, and Aotearoa | New Zealand.","authors":"Bonaventure A Egbujie, Gustavo Betini, Sandra Ochwat, Reem T Mulla, Jokke Häsä, Johanna Edgren, Mari Aaltonen, Irihapeti Bullmore, Gary Cheung, Hamish A Jamieson, Philip Schluter, John P Hirdes","doi":"10.1016/j.jamda.2025.105687","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105687","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105687"},"PeriodicalIF":4.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132609","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 Staffing: Associations With Facility Characteristics, Residents' Experience, and Quality Measures.","authors":"Stephanie L Harrison, Dylan Harries, Hoi Man Fu, Gillian E Caughey, Tracy Comans, Megan Corlis, Maria C Inacio","doi":"10.1016/j.jamda.2025.105686","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105686","url":null,"abstract":"<p><strong>Objectives: </strong>In October 2022, Australia introduced individual targets for total care and registered nurse (RN) minutes for long-term care facilities based on the care needs of their residents. This study examined associations between facility characteristics and the extent to which care minute targets are met, and determined whether care minutes are associated with residents' experience and quality measures.</p><p><strong>Design: </strong>Ecological cross-sectional study using pooled publicly available data from 5 quarterly reporting periods between January-March 2023 and January-March 2024.</p><p><strong>Setting and participants: </strong>A total of 2292 long-term care facilities in Australia.</p><p><strong>Methods: </strong>Generalized linear mixed models were used to examine associations between facility characteristics (ownership type, size, location) and target care minutes met (total and RN minutes). Logistic regression and ordered beta regression models were used to investigate associations between care minutes and residents' experience and quality measures (pressure injuries, restrictive practices, unplanned weight loss, falls, medication management).</p><p><strong>Results: </strong>The proportion of facilities meeting or exceeding their total care minutes target (≥100% of target) increased from 41% (n = 938) in the first reporting period to 53% (n = 1213) in the most recent period. Compared with government ownership, for-profit and not-for-profit ownership were associated with lower percentages of target care minutes met (rate ratio, 0.76; 95% CI, 0.75-0.78; and rate ratio, 0.82; 95% CI, 0.80-0.83, respectively). For-profit and not-for-profit ownership, larger facility size, and rural or socioeconomically disadvantaged location were associated with lower percentages of target RN minutes met. No statistically significant associations were identified between care minutes and residents' experience or quality measures.</p><p><strong>Conclusions and implications: </strong>Variation in meeting target care minutes was observed by different facility characteristics. However, no associations between care minutes and residents' experience or quality measures were observed. Further research should examine care minutes in addition to other factors impacting care quality including staff training, turnover, skills mix, and models of care.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105686"},"PeriodicalIF":4.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132610","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":"Factors Associated with Mood Transitions among Older Canadian Long-Term Care Residents: A Multistate Transition Model","authors":"Reem T. Mulla PhD, MCM, MHM, MBBS ,&nbsp;John P. Hirdes PhD, CM FRSC, FCAHS ,&nbsp;Carrie McAiney PhD ,&nbsp;George Heckman MD, MSc, FRCPC","doi":"10.1016/j.jamda.2025.105612","DOIUrl":"10.1016/j.jamda.2025.105612","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examines the complex transitions between the different mood states and absorbing states out of long-term care settings, as well as the factors affecting those transitions.</div></div><div><h3>Design</h3><div>A retrospective longitudinal analysis of older residents in Canadian long-term care homes in 3 provinces.</div></div><div><h3>Setting and Participants</h3><div>Residents residing in long-term care homes in 3 Canadian provinces (Alberta, British Columbia, and Ontario) over a 10-year period from January 2010 to February 2020, with an age of at least 65.</div></div><div><h3>Methods</h3><div>We used a 1-step Markov multistate transition model to examine transitions in mood over time as well as the factors affecting those transitions using the standardized interRAI MDS 2.0 comprehensive health assessment. The MDS 2.0 assessments are completed by trained assessors within 2 weeks of the resident's admission.</div></div><div><h3>Results</h3><div>Our results showed that 46% of residents initially present with no mood disturbance on admission and 31% with mild mood disturbance on admission and 23% with moderate/severe mood disturbance on admission. Factors associated with worsening of mood include aggressive behavior; health instability; impaired cognition; major comorbidities; pain or poor sleep; conflict with family, friends, or other residents; and anxiety. Of the facility-level attributes, Alberta was associated with worsening of mood.</div></div><div><h3>Conclusions and Implications</h3><div>Our study identified key factors influencing mood transitions, highlighting pain and aggressive behavior as significant contributors to worsening mood, both of which are modifiable through targeted interventions. The findings suggest substantial opportunities for mood improvement in long-term care settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105612"},"PeriodicalIF":4.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006201","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":"Screening/Diagnosing Sarcopenia With Machine Learning-Powered Risk Assessment: The SARCO X Study.","authors":"Murat Kara, Yasin Ceran, Pelin Analay, Mahmud Fazıl Aksakal, Mahmut Esad Durmuş, Tülay Tiftik, Beyzanur Çıtır, Fatıma Edibe Şener, Mehmet Emin Yılmaz, Evrim Coşkun, Zeliha Ünlü, Pelin Yıldırım, Eda Gürçay, Orhan Güvener, Hacer Doğan, Eda Çeker, Esra Çataltepe, Fatih Güngör, Özden Özyemişçi, Duygu Keler Külcü, Elem Yorulmaz, Deniz Palamar, Büşra Kasım, Can Keçeli, Gamze Kılıç, Kadir Songur, Banu Dilek, Fevziye Ünsal Malas, Mustafa Karabulut, Ahmad J Abdulsalam, Sarah Razaq, Jorge Barbosa, Kamal Mezian, Murat Baday, Özgür Kara, Bayram Kaymak, Banu Çakır, Levent Özçakar","doi":"10.1016/j.jamda.2025.105683","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105683","url":null,"abstract":"<p><strong>Objectives: </strong>Sarcopenia imposes significant morbidity and economic burden on health care systems, underscoring the critical need for early/effective screening and diagnosis. This study aimed to develop a machine learning (ML)-based algorithm to facilitate the screening/diagnosis of sarcopenia.</p><p><strong>Design: </strong>A cross-sectional case-control study.</p><p><strong>Setting and participants: </strong>This multicenter study enrolled subjects aged ≥45 years.</p><p><strong>Methods: </strong>Demographic data such as age, weight, height, education/exercise status, smoking, and comorbid diseases were obtained. Sarcopenia was diagnosed using the basic and ML-based algorithms, which incorporate low quadriceps muscle mass/thickness, combined with prolonged chair stand test (CST) duration and/or reduced hand grip strength (HGS).</p><p><strong>Results: </strong>Of 5649 participants (1379 men, 24.4%), 1097 of them (19.4%) were sarcopenic. Using the ML-based model, significantly associated factors with sarcopenia were age, weight, height, education level, exercise status, and presence of hypertension and diabetes mellitus. Of the various ML models, the Gradient Boosting Classifier demonstrated the highest performance in predicting sarcopenia in the holdout test data. For the ML-augmented algorithm, the recall value was 0.979; the precision value was 0.926, and the accuracy value was 0.980 for making the diagnosis of sarcopenia. When compared with the simple sarcopenia algorithm, the ML-augmented algorithm further decreased the need for HGS and ultrasound by 38.1% and 49.5%, respectively, demonstrating its effectiveness in optimizing sarcopenia diagnosis while minimizing testing required for medical device(s).</p><p><strong>Conclusions and implications: </strong>The ML-based algorithm significantly reduces the need for testing/imaging in the diagnosis of sarcopenia. It facilitates the identification of sarcopenia particularly in the primary and secondary care settings and decreases the number of individuals who should be referred for further evaluation.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105683"},"PeriodicalIF":4.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094177","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":"Feasibility of Novel Opioid Assessment Tool for Rehabilitation Patients in a Skilled Nursing Facility.","authors":"Nisha Mathur, Hollis D Day, Rossana Lau-Ng","doi":"10.1016/j.jamda.2025.105679","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105679","url":null,"abstract":"<p><strong>Objectives: </strong>A uniform standardized assessment of opioid treatment does not exist to guide management decisions for patients in skilled nursing facilities (SNFs). The purpose of this study is to determine if (1) a novel opioid assessment tool can be feasibly used to support clinician decision-making in opioid management for patients in rehabilitation, and (2) if this tool can address the existing gaps in care to pain management in SNFs.</p><p><strong>Design: </strong>This qualitative study thematically analyzed anonymous interview responses from SNF providers.</p><p><strong>Setting and participants: </strong>SNF providers and nursing staff from SNFs in 1 hospital system participated in structured interviews.</p><p><strong>Methods: </strong>The Pain Assessment and Documentation Tool, validated to evaluate opioid therapy and its impact on function over time in the outpatient setting, was modified to assess opioid treatment in SNFs. SNF providers were invited to participate in anonymous interviews regarding the tool's use and feasibility. Interview transcripts were analyzed using NVivo data analysis software to generate themes to determine the most significant takeaways.</p><p><strong>Results: </strong>Twenty providers were interviewed and found that the tool was feasible for use in SNFs to improve clinical decision-making. Assessing patient's activities of daily living and opioid misuse risk were the most positively regarded metrics of the tool. The tool was found to provide standardization and specificity for management decisions, address the current gap in standardization and communication between providers, and improve existing variability in treatment of patients with substance use disorder and cognitive impairment. The barriers to implementation include that the tool is too redundant and can contribute to worsening staff burden.</p><p><strong>Conclusions and implications: </strong>This study found that this novel tool of opioid management is feasible in SNFs, and that it standardizes opioid management, improves provider communication, and reduces variability in treating patients with substance use disorder.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105679"},"PeriodicalIF":4.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094074","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":"Transforming Transitional Care: Early Hospital Discharge Through the Care at Home Program.","authors":"Shawn M Doss, Brad Bergum, Lauren Hopkins, Ricaurte Solis, Matthew Lyon","doi":"10.1016/j.jamda.2025.105681","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105681","url":null,"abstract":"<p><strong>Objectives: </strong>Every year, thousands of patients face the challenging transition from hospital to home, resulting in high readmission rates and excessive resource use. Our telemedicine-based Care at Home (CaH) program, which facilitates early discharge, was assessed for its impact on 30-day readmissions, length of hospital stay (LoS), and total charges.</p><p><strong>Design: </strong>Retrospective cohort study comparing standard inpatient care with the CaH program, which features telemedicine support and continuous monitoring provided by nurses, paramedics, and physicians after early hospital discharge. This program prioritizes patients at higher risk for readmission.</p><p><strong>Setting and participants: </strong>Data were derived from 2866 hospital admissions covering select diagnostic-related groups (DRGs) between January and December 2023. Of these, 215 patients were enrolled in CaH and 2651 received standard inpatient care.</p><p><strong>Methods: </strong>We analyzed 30-day readmission rates, LoS, and total charges. Categorical variables were evaluated using χ² tests, and the Mann-Whitney U test was applied for skewed continuous variables. A Cox proportional hazards model assessed time to readmission, using a 1.15 noninferiority margin.</p><p><strong>Results: </strong>The 30-day readmission rate was 11.2% in the CaH group and 12.8% in the control group (P = .57). Hazard ratios (HRs) favored CaH but did not reach the 1.15 noninferiority threshold (adjusted HR, 0.82; 95% CI, 0.54-1.24; P = .35). CaH did achieve significantly lower LoS (4.7 vs 7.7 days, P < .001) and total charges (mean $54,491 vs $84,245, P < .001). DRG-specific analyses revealed variable readmission outcomes, whereas reductions in LoS and costs were consistent across most DRGs for CaH patients.</p><p><strong>Conclusions and implications: </strong>CaH yielded comparable 30-day readmission rates while significantly lowering LoS and total costs, although it did not achieve the predefined noninferiority margin. Potential selection bias and differences in patient acuity may have influenced these findings. Further research should focus on refining patient selection, developing condition-specific protocols, and examining broader applications of telemedicine-driven early discharge models.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105681"},"PeriodicalIF":4.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094179","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, Validation, and Application of the Electronic Frailty Index: A Scoping Review","authors":"Jiaying Zheng PhD ,&nbsp;Ping Yu PhD ,&nbsp;Minmu Yang BS","doi":"10.1016/j.jamda.2025.105577","DOIUrl":"10.1016/j.jamda.2025.105577","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this scoping review was to examine the scope and characteristics of the published literature related to the Electronic Frailty Index (eFI).</div></div><div><h3>Design</h3><div>Scoping review.</div></div><div><h3>Setting and Participants</h3><div>Original studies related to the eFI in older adults.</div></div><div><h3>Methods</h3><div>Six databases were searched for articles published between March 2016 and August 2024: PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang Database. Data extracted included the publication year, country, sample size, data sources for developing an eFI, number of items included in the eFI, performance of the eFI, and application of the eFI.</div></div><div><h3>Results</h3><div>Of the 424 articles initially retrieved, this scoping review included 50 studies for analysis. Thirty-nine (78%) of these studies were conducted after the year 2019. Moreover, we identified 8 distinct eFIs. Twelve studies assessed the performance of eFIs, whereas 30 studies used them. The eFIs covered 4 key domains: diseases, functional information, laboratory tests and measures, and symptoms and signs. The most common outcome examined was mortality. Furthermore, the eFIs were applied for diverse purposes, including exploring the relationship between frailty and health outcomes.</div></div><div><h3>Conclusions and Implications</h3><div>This scoping review revealed that eFIs can be developed using various electronic health care data sources, and they have been extensively employed for various population-level purposes. The observed associations between the eFIs, existing frailty assessment tools, and health outcomes highlight their utility in evaluating the care needs of an aging population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105577"},"PeriodicalIF":4.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753291","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":"Days at Home for Older Adults Receiving a Remote Monitoring Intervention Compared with Usual Home Care Recipients","authors":"Christine Salahub PhD ,&nbsp;Peter C. Austin PhD ,&nbsp;Li Bai PhD ,&nbsp;Noah M. Ivers MD, PhD ,&nbsp;Aaron Jones PhD ,&nbsp;Mina Tadrous PharmD, PhD ,&nbsp;Jake Tran MSc, PhDC ,&nbsp;Lauren Lapointe-Shaw MD, PhD","doi":"10.1016/j.jamda.2025.105611","DOIUrl":"10.1016/j.jamda.2025.105611","url":null,"abstract":"<div><h3>Objectives</h3><div>Many older adults will experience physical and or cognitive decline, limiting their ability to live independently. To better support these individuals, remote monitoring programs use technology to track patient falls, location, and medication adherence. Our main objective was to compare outcomes of patients enrolled in a remote monitoring program with matched individuals who received home care.</div></div><div><h3>Design</h3><div>Propensity score–matched cohort study.</div></div><div><h3>Setting and Participants</h3><div>Toronto, Ontario, Canada. Older adults (aged 65 or older) in a remote monitoring program (N = 1587) compared with a control group of older adults initiating a new episode of home care (N = 33,207).</div></div><div><h3>Methods</h3><div>The primary outcome was days spent at home in the following 100 days. Additional outcomes included days in different health care settings, days alive, and health care costs.</div></div><div><h3>Results</h3><div>Before matching, patients enrolled in the remote monitoring program (946 female) were younger [mean (SD) = 80.1 years (8.2) vs 82.4 (8.5), standardized mean difference 0.21] than those in the home care group (20,877 female). After matching, there were 1494 individuals in each group. In the 100 days following the index date, those in the remote monitoring group spent 3.4 more days at home than the home care group (92.3 vs 88.9 days, 95% CI, 1.9–5.0 days; rate ratio, 1.04; 95% CI, 1.02–1.06). This was attributable to more days alive (98.6 vs 96.4 days; 95% CI, 1.3–3.1 days; rate ratio, 1.03; 95% CI, 1.01–1.03). In addition, the remote monitoring group had lower health care costs overall (difference of $1635.54 CAD, 95% CI, $228.83–$3087.11).</div></div><div><h3>Conclusions and Implications</h3><div>Individuals enrolled in a remote monitoring program spent more days at home compared with those who received home care services, mainly attributed to more days alive. Further study is needed to confirm our findings; however, remote monitoring is a promising solution to support older adults with high care needs.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105611"},"PeriodicalIF":4.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity, Muscle Strength, and Falls among Older Mexican Americans","authors":"Alondra Uribe MS ,&nbsp;Soham Al Snih MD, PhD","doi":"10.1016/j.jamda.2025.105613","DOIUrl":"10.1016/j.jamda.2025.105613","url":null,"abstract":"<div><h3>Objectives</h3><div>Multimorbidity is linked with an increased risk of falls in older adults. The study objective is to determine the relationship of multimorbidity and muscle strength in falls among older Mexican Americans without a history of falls at baseline.</div></div><div><h3>Design</h3><div>Longitudinal study.</div></div><div><h3>Setting and Participants</h3><div>This 12-year prospective cohort study included 899 noninstitutionalized Mexican Americans aged ≥75 years residing in Arizona, California, Colorado, New Mexico, and Texas from the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE).</div></div><div><h3>Methods</h3><div>Measures include the following: sociodemographics, medical conditions, body mass index, disability, handgrip strength (HGS), depressive symptoms, pain, cognitive function, and multimorbidity (≥2 self-reported medical conditions). Participants at baseline were divided into the following 4 groups: high HGS and multimorbidity (n = 349), low HGS and multimorbidity (n = 263), high HGS and without multimorbidity (n = 181), and low HGS and without multimorbidity (n = 104). Generalized estimating equation models estimated the odds ratio (OR) and 95% CI for falls as a function of multimorbidity and HGS group, controlling for all covariates.</div></div><div><h3>Results</h3><div>The mean sample age ± SD was 81.0 ± 4.3 years, and 55.9% were female. The OR for falls was 0.70 (95% CI, 0.52–0.94) for those with multimorbidity and high HGS, 0.50 (95% CI, 0.32–0.80) for those without multimorbidity and high HGS, and 0.46 (95% CI, 0.29–0.74) for those without multimorbidity and low HGS, vs those with multimorbidity and low HGS, after controlling for all covariates.</div></div><div><h3>Conclusions and Implications</h3><div>Mexican American older adults with multimorbidity and high HGS had a 30% decreased risk of falls over time. Increasing muscle strength through exercise may help prevent falls among those with multimorbidity.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105613"},"PeriodicalIF":4.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review of Physical Performance Changes in Dementia: Differences between Community and Nursing Home Setting","authors":"Selina Kasprzak MSc ,&nbsp;Charlotte B. Schmidt PhD ,&nbsp;George L. Burchell MSc ,&nbsp;Sietske A.M. Sikkes PhD ,&nbsp;Erik J.A. Scherder PhD","doi":"10.1016/j.jamda.2025.105614","DOIUrl":"10.1016/j.jamda.2025.105614","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate differences in longitudinal physical performance in individuals with dementia across care settings.</div></div><div><h3>Design</h3><div>Narrative review.</div></div><div><h3>Setting and Participants</h3><div>Older adults with moderate to severe dementia residing in the community or nursing home.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted in PubMed, Embase, and Web of Science. Included studies were longitudinal, with observational or care-as-usual control groups, with a follow-up ≥3 months, assessing physical performance in adults aged ≥65 years with dementia (Mini Mental State Examination score ≤20), in the community or nursing home setting. Eligibility screening and risk of bias were performed by 2 authors. We categorized physical performance-based tests into upper limb strength, lower limb strength, balance, endurance, flexibility, mobility, and combined physical performance. Physical performance changes were quantified within each study as percentage of change from baseline to follow-up, and were compared between community and nursing home setting using narrative synthesis.</div></div><div><h3>Results</h3><div>The search yielded 7813 studies, of which 20 were included (15 from nursing homes). Five of 20 studies were classified as having high risk of bias. In the nursing home setting, physical performance decline was observed across all domains (3- to 4-month follow-up: −6.1% to −7.7%, 5- to 7.5-month follow-up: −4.6% to −30.7%, 12- to 36-month follow-up: −27.3% to −68.2%). In the community setting, only combined physical performance declined (12–24 months: −18.6% to −33.8%).</div></div><div><h3>Conclusions and Implications</h3><div>Studies assessing longitudinal physical performance in the community and nursing home setting were identified and summarized. Physical performance declined after shorter follow-up periods across all domains in the nursing home setting, whereas in the community setting only combined physical performance declined. However, diversity in study characteristics, study populations and outcome measures, along with a deficiency of longer follow-up periods in the community setting, hamper interpretation. Future research should focus on physical performance trajectories in longitudinal within-group designs of community-dwelling individuals with dementia who transition to nursing homes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105614"},"PeriodicalIF":4.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948481","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}