Journal of the American Medical Directors Association最新文献

{"title":"Measurement of Quality in Assisted Living in the United States of America: A Scoping Review.","authors":"Tetyana P Shippee, Odichinma Akosionu, Timothy J Beebe, Romil R Parikh, Michelle Brasure","doi":"10.1016/j.jamda.2024.105355","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105355","url":null,"abstract":"<p><strong>Objectives: </strong>To identify different approaches (unique domains) and indicators to evaluate quality in assisted living communities in the United States.</p><p><strong>Design: </strong>Scoping review supplemented with key informant and technical panel guidance.</p><p><strong>Setting and participants: </strong>Assisted living settings and residents.</p><p><strong>Methods: </strong>We obtained feedback on our review protocol and search strategy from key informants with expertise in AL quality, including feedback on a supplementary gray literature search for relevant non-peer-reviewed literature (such as nonempirical policy briefs). We scanned MEDLINE and CINAHL databases for peer-reviewed literature published from 2009 through 2019 assessing quality in assisted living in the United States. We synthesized evidence using the Donabedian framework and presented our analyses in 2 expert panel discussions for additional insights.</p><p><strong>Results: </strong>We screened 833 abstracts, of which 49 studies met our selection criteria. Gray literature search yielded an additional 45 non-peer-reviewed sources. Nine unique domains were assessed: (1) resident quality of life, (2) resident and family satisfaction, (3) staffing and staff-related outcomes, (4) resident safety, (5) resident health outcomes, (6) care planning and integration, (7) physical and social environment, (8) service availability, and (9) core values and philosophy. Resident quality of life and satisfaction were the most prioritized domains in published literature, key informant interviews, and expert panel discussions. Domains such as staffing, safety, resident health outcomes, care planning, and integration were identified as vitally important for the increasing clinical and sociodemographic heterogeneity in the resident population. Expert panels emphasized the importance of including residents' voice in the quality measures development process.</p><p><strong>Conclusions and implications: </strong>Lack of standardized measurement of quality impedes provision of person-centered, value-based care in US-based assisted living settings. Our comprehensive list of domains and indicators should inform future concerted efforts to develop and incorporate standardized quality measurement as part of routine practice in assisted living communities in the United States.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105355"},"PeriodicalIF":4.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648218","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":"Prognostic Value of Sarcopenia Definitions and Outcomes Consortium Criteria in Older Patients With Heart Failure.","authors":"Taisuke Nakade, Daichi Maeda, Yuya Matsue, Nobuyuki Kagiyama, Yudai Fujimoto, Tsutomu Sunayama, Taishi Dotare, Kentaro Jujo, Kazuya Saito, Kentaro Kamiya, Hiroshi Saito, Yuki Ogasahara, Emi Maekawa, Masaaki Konishi, Takeshi Kitai, Kentaro Iwata, Hiroshi Wada, Takatoshi Kasai, Hirofumi Nagamatsu, Shin-Ichi Momomura, Tohru Minamino","doi":"10.1016/j.jamda.2024.105350","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105350","url":null,"abstract":"<p><strong>Objectives: </strong>The Asian Working Group for Sarcopenia in 2019 (AWGS 2019) emphasized muscle mass measurements. In contrast, the Sarcopenia Definitions and Outcomes Consortium (SDOC) prioritizes functional strength and mobility. Therefore, this study aimed to compare the prognostic utility of the SDOC and AWGS 2019 criteria for all-cause mortality in older patients with heart failure.</p><p><strong>Design: </strong>A post hoc analysis of the FRAGILE-HF study, a prospective, multicenter, observational study.</p><p><strong>Setting and participants: </strong>Patients ≥65 years of age hospitalized for heart failure across 15 hospitals in Japan.</p><p><strong>Methods: </strong>Sarcopenia was diagnosed according to the AWGS 2019 and SDOC definitions. According to the SDOC criteria and by integrating insights from previous research, patients were categorized into nonsarcopenia, possible sarcopenia, and sarcopenia groups. The primary outcome was 2-year mortality.</p><p><strong>Results: </strong>Of the 1282 study patients, possible sarcopenia and sarcopenia were diagnosed in 357 and 786 individuals, respectively. Kaplan-Meier analysis revealed a significant difference between the groups. Adjusted Cox proportional hazards analysis indicated a significant stepwise association between sarcopenic status and mortality risk (possible sarcopenia: hazard ratio, 1.22; 95% CI, 0.66-2.28; P = .525; sarcopenia: hazard ratio, 1.89; 95% CI, 1.08-3.34; P = .027). When sarcopenia defined by the SDOC and AWGS 2019 criteria was added to the model incorporating conventional risk factors, no significant difference was observed in the prognostic capabilities between the 2 models (net reclassification improvement, -0.009; 95% CI, -0.193 to 0.174; P = .920, with areas under the receiver operating characteristic curve of 0.697 for SDOC and 0.703 for AWGS 2019; P = .675).</p><p><strong>Conclusions and implications: </strong>Among older patients with heart failure, the SDOC criteria for sarcopenia diagnosis are useful for risk stratification and provide prognostic capabilities equivalent to those of the AWGS 2019 criteria.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105350"},"PeriodicalIF":4.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623046","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":"Person Profile Dementia Intervention in Long-Term Care: A Stepped-Wedge Cluster-Randomized Trial.","authors":"Frank Spichiger, Andrea L Koppitz, Florian Riese, Stephanie Kipfer, Martin Nagl-Cupal, Andreas Büscher, Thomas Volken, Philip Larkin, André Meichtry","doi":"10.1016/j.jamda.2024.105351","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105351","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to assess the efficacy of a person-centered care intervention in improving quality of life (QoL) for people with dementia in long-term care facilities.</p><p><strong>Design: </strong>This study was a stepped-wedge cluster-randomized clinical trial of monthly person-centered outcome measurements, followed by collaborative nurse-led person profile interventions involving nursing staff and family members, compared with monthly person-centered outcome measurements alone.</p><p><strong>Setting and participants: </strong>We included people with a medical diagnosis of Alzheimer's disease or vascular dementia or with clinical symptoms of dementia from 23 long-term care facilities in the German-speaking part of Switzerland.</p><p><strong>Methods: </strong>The primary outcome was QoL, as assessed using the QUALIDEM. Secondary outcomes were the QUALIDEM subscales and the Integrated Palliative Care Outcome Scale for People with Dementia subscales. The study duration was 15 months, and linear mixed-effect models were used for the analysis.</p><p><strong>Results: </strong>We recruited 240 people with dementia from 23 long-term care facilities. Modeling 1143 observations, we found a statistically significant positive intervention effect of 2.6 points according to the QUALIDEM (95% CI, 1.34-3.86; P < .001; total QUALIDEM intervention: 67; 95% CI, 64.8-69.1 vs 64.4; 95% CI, 62.3-66.4 for the control). We also found positive effects of the intervention on all secondary outcomes.</p><p><strong>Conclusions and implications: </strong>Once-a-month person profile interventions based on person-centered outcome measurements provided a small but significant improvement in QoL. Thus, our findings suggest a potential benefit to the broader implementation of person profiles involving nursing staff and family members in long-term care facilities.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105351"},"PeriodicalIF":4.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623044","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 Ideal vs Reality: Is the Pursuit of a \"Good Death\" Hindering End-of-Life Care?","authors":"Chetna Malhotra","doi":"10.1016/j.jamda.2024.105349","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105349","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105349"},"PeriodicalIF":4.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623050","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":"Assisted Living, Residential Care, and Memory Care Staffing Level Dynamics: Oregon, 2017-2023.","authors":"Sarah Dys, Ozcan Tunalilar","doi":"10.1016/j.jamda.2024.105352","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105352","url":null,"abstract":"<p><strong>Objectives: </strong>To examine changes in staffing levels over time in Oregon assisted living and residential care (AL/RC) communities between 2017 and 2023.</p><p><strong>Design: </strong>Longitudinal study of licensed AL/RC communities.</p><p><strong>Setting and participants: </strong>A total of 1720 setting-year observations from 535 individual AL/RC communities in Oregon between 2017 and 2023.</p><p><strong>Methods: </strong>Primary data were collected through the Oregon Community-Based Care (CBC) study. Staffing levels were estimated as care staff hours per resident per day and reported overall and by staff type, including registered nurses, licensed practical nurses, certified nursing assistants, certified medication aides, unlicensed care staff, life enrichment staff, and social workers. Fixed-effects linear regression models were estimated to account for the time-invariant characteristics in the panel data.</p><p><strong>Results: </strong>The mean care staff hours per resident per day was 3 hours and 30 minutes (range, 3 hours and 11 minutes to 4 hours and 1 minute), depending on the survey setting year. The mean occupancy rate was 77.5% and declined significantly from 80.3% to 72.2% during the pandemic (P < .001). Staffing levels (overall and by staff type) varied significantly across AL/RC settings. There was an increase in staffing levels immediately after the pandemic started. Most (64%) of the variation observed in staffing levels could be attributed to between-AL/RC differences. On average, total care staff levels were 19 minutes higher in 2021 and 28 minutes higher in 2023 compared with 2017.</p><p><strong>Conclusions and implications: </strong>The wide range of staffing levels points to significant differences in operational structures, resource allocations, and resident characteristics across different communities, with implications for the quality of care provided to residents. Understanding the significant changes to staffing patterns (levels and mix) after the COVID-19 pandemic is crucial for developing policies to improve adaptability and resilience of AL/RC settings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105352"},"PeriodicalIF":4.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623015","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":"Effectiveness Evaluation of Smart Home Technology in Preventing and Detecting Falls in Community and Residential Care Settings for Older Adults: A Systematic Review and Meta-Analysis","authors":"Chen Xing Yeoh Lui BSc ,&nbsp;Ningshan Yang BSc ,&nbsp;Arthur Tang PhD ,&nbsp;Wilson Wai San Tam PhD","doi":"10.1016/j.jamda.2024.105347","DOIUrl":"10.1016/j.jamda.2024.105347","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the effectiveness of smart home technologies (SHTs) in preventing and detecting falls among older adults in community and residential care settings.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis of controlled trials on SHTs, which reported fall incidence, fear of falling, or hospitalization outcomes, was conducted. Searches were conducted across 6 academic databases for scholarly articles (PubMed, Cochrane, CINAHL, Scopus, Embase, and IEEE Xplore) and 2 databases for gray literature (ProQuest and ClinicalTrials.gov) in August 2023.</div></div><div><h3>Setting and Participants</h3><div>Residents of long-term residential settings ≥60 years of age.</div></div><div><h3>Methods</h3><div>Eight databases were searched in August 2023 for controlled trials on SHT which reported fall incidence, fear of falling, or hospitalization outcomes. Two reviewers independently screened for studies, performed data extraction, and performed quality assessment using the Joanna Briggs Institute critical appraisal checklists. The RevMan Web was used for meta-analysis.</div></div><div><h3>Results</h3><div>A total of 12,756 studies were retrieved from the databases search; after removing duplicates and irrelevant title/abstracts, 46 full texts were examined. Overall, 13 studies comprising 1941 participants were included. Two were classified as low quality, 5 were classified as moderate quality, and 6 were classified as high quality. SHTs were found to significantly decrease fall incidences (relative risk, 0.72; 95% CI, 0.57-0.93; <em>z</em> = 2.55; <em>P</em> = .01) but have no significant impact in influencing the fear of falling (standardized mean difference, 0.19; 95% CI, −0.15 to 0.53; <em>z</em> = 1.11; <em>P</em> = .27), and their effect on hospitalization was inconclusive.</div></div><div><h3>Conclusions and Implications</h3><div>SHTs may be beneficial in reducing fall incidence, enhancing the safety and supporting independent living among older adults in community and residential care settings. Future research should conduct more high-quality studies and use standardized outcome measurements. Long-term residential settings could also consider adopting SHTs for fall prevention and detection to enhance the well-being of older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 1","pages":"Article 105347"},"PeriodicalIF":4.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623016","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":"Transfers among Vulnerable Long-Term Nursing Home Residents","authors":"Dianne C. McWilliam MA ,&nbsp;Pil Park PhD ,&nbsp;Megan Jensen MPH ,&nbsp;Julie P.W. Bynum MD, MPH ,&nbsp;Ana Montoya MD, MPH, MS","doi":"10.1016/j.jamda.2024.105348","DOIUrl":"10.1016/j.jamda.2024.105348","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine whether the risk of nursing home-to-nursing home transfer is higher among long-term nursing home residents with intellectual and developmental disabilities (IDD), or serious mental illness (SMI), and/or Alzheimer's disease and related dementias (ADRD), relative to residents without these clinical diagnoses, and to assess the factors associated with transfer overall and for residents with these diagnoses.</div></div><div><h3>Design</h3><div>Cross-sectional cohort study of nursing home residents in 2019.</div></div><div><h3>Setting and Participants</h3><div>Michigan long-term nursing home residents identified from the Minimum Data Set.</div></div><div><h3>Methods</h3><div>Residents who had a nursing home-to-nursing home transfer were allocated into 5 groups: IDD, SMI and ADRD, ADRD, SMI, and all others. We examined transfer rates for each group. We assessed the odds of transfer for each group, adjusting for resident and nursing home characteristics, and behavioral issue and clinical indicators. We used stratified logistic regression to determine factors associated with transfers within each group.</div></div><div><h3>Results</h3><div>Among 37,638 long-term nursing home residents, 2.3% had a nursing home-to-nursing home transfer. Transfers varied across diagnosis groups: 1.9% in IDD, 2.8% in SMI and ADRD, 1.9% in ADRD, 2.6% in SMI, and 2.5% in all others. After adjustment, residents in the SMI and ADRD group were 39% more likely to transfer than those in the all others group (adjusted odds ratio, 1.39; 95% CI, 1.14–1.68). Aged ≥75 years, moderate to severe cognitive impairment, and falls were associated with a lower odds of transfer. Being married and wandering were associated with a higher odds of transfer. Factors associated with transfers varied within each group.</div></div><div><h3>Conclusions and Implications</h3><div>Among Michigan long-term nursing home residents, residents with both SMI and ADRD are at the highest risk for transfer to another nursing home when compared with residents with SMI or ADRD alone and with IDD and none of these diagnoses. Understanding the drivers of transfer of this vulnerable group warrants further investigation.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 1","pages":"Article 105348"},"PeriodicalIF":4.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623065","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":"Successful Aging Rates of Global Older Adults: A Systematic Review and Meta-analysis.","authors":"Yurong Liu, Xuan Zhang, Xiangrui Fu, Wen Li, Yuan Wang, Wenli Lu","doi":"10.1016/j.jamda.2024.105334","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105334","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis aimed to qualitatively analyze the different aspects of the successful aging (SA) criteria and quantitatively assess the rate of SA and its different dimensions among people aged ≥60 years globally to provide a basis for constructing criteria for SA.</p><p><strong>Design: </strong>This is a systematic review and meta-analysis, which has been registered on PROSPERO (CRD42024585934).</p><p><strong>Setting and participants: </strong>Older adults (≥60 years).</p><p><strong>Methods: </strong>PubMed, Embase, CINAHL, Web of science, SCOPUS, and PsycINFO (inception to July 17, 2023) were used to search for relevant studies to evaluate the comprehensive level of SA. A random effects model was used to synthesize SA rates and 95% CIs. Quality assessment was conducted using the Agency for Healthcare Quality and Research criteria and the Newcastle-Ottawa Scale. Statistical analyses were conducted using Revman 5.3 and Stata 11.0.</p><p><strong>Results: </strong>A total of 546,228 older adults from 64 studies were incorporated into the meta-analysis. In the 64 studies, SA criteria mentioned 11 aspects: psychology, disease, cognitive function, physical function, social engagement, disability, independence, self-rated health, economy, memory impairment, and obesity. The meta-analysis indicated that the summary estimate of SA rate among people aged ≥60 years was 22.0% (95% CI 19.0%-25.0%) globally. A meta-analysis was conducted on the 6 aspects included more commonly in SA criteria, and the results showed that the rate of no disability was the highest (72.0%), followed by good psychological status (69%), active social engagement (65%), high cognitive function (64%), and high physical function (62%), with no major diseases being the lowest (50.0%).</p><p><strong>Conclusions and implications: </strong>The overall estimated SA rate among people aged ≥60 years was 22% globally. The SA criteria mainly include 6 aspects: good psychological status, no major diseases, high cognitive function, high physical function, active social engagement, and no disability. Emphasizing the importance of psychological well-being and chronic disease management, the findings offer valuable insights for future research and policy making related to the welfare of aging populations.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105334"},"PeriodicalIF":4.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623048","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":"Hospitalization Due to Infections Before and After Alzheimer's Disease Diagnosis.","authors":"Heli I Järvinen, Anna-Maija Tolppanen, Sirpa Hartikainen","doi":"10.1016/j.jamda.2024.105346","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105346","url":null,"abstract":"<p><strong>Objectives: </strong>There is a lack of studies on the rate and temporal changes of infections in relation to Alzheimer's disease (AD) diagnosis. We studied the infection rate in persons with and without AD yearly 5 years before and after AD diagnosis.</p><p><strong>Design: </strong>Register-based cohort study.</p><p><strong>Setting and participants: </strong>We used the Medication Use and Alzheimer's Disease cohort with 70,718 Finnish community dwellers diagnosed with AD between 2005 and 2011 and an equal number of age, sex- and region-of-residence-matched comparison persons.</p><p><strong>Methods: </strong>Data on comorbidities, medication use, and hospital days due to infection were retrieved from multiple nationwide registers. The rate of hospitalization and accrued hospital days due to infections were calculated yearly during the follow-up. The accumulation of hospital days was investigated with the negative binomial model.</p><p><strong>Results: </strong>During the follow-up, one-half of persons with AD had inpatient stays due to infections compared with 34% of persons without AD. The infection rate increased substantially 1 to 2 years before AD diagnosis. At AD diagnosis, the rate of inpatient stays and outpatient visits due to infection was higher (15 per 100 person-years) in persons with AD than in comparison persons (9 per 100 person-years), and the accumulation of hospital days in persons with AD was higher a year after the diagnosis (incidence rate ratio, 1.21; 95% CI, 1.11-1.32) due to higher infection rate. The most common infection diagnoses in both groups were pneumonia and genitourinary infections.</p><p><strong>Conclusions and implications: </strong>Compared with matched comparison persons, the higher hospitalization rate due to infections could be caused by systemic inflammation related to AD, infections generally treated in outpatient care, delirium symptoms associated with infections, and caregiver burden. The prevention of infections should be part of the care of cognitive disorders throughout the disease.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105346"},"PeriodicalIF":4.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623024","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 a Multimodal Prehabilitation Program before Elective Knee and Hip Arthroplasty in Older Adults","authors":"Bastien Genet MD ,&nbsp;Judith Cohen-Bittan MD ,&nbsp;Michaël Nicolas PT ,&nbsp;Dominique Bonnet-Zamponi MD, PhD ,&nbsp;Charlotte Naline MD ,&nbsp;Dehbia Ouafi-Hendel MD ,&nbsp;Véronique François MD ,&nbsp;Christopher Cabral MSc ,&nbsp;Anaïs Cloppet MD ,&nbsp;Claire Davy MSc ,&nbsp;Jacques Boddaert MD, PhD ,&nbsp;Lorène Zerah MD, PhD","doi":"10.1016/j.jamda.2024.105345","DOIUrl":"10.1016/j.jamda.2024.105345","url":null,"abstract":"<div><h3>Objectives</h3><div>Hip osteoarthritis and knee osteoarthritis cause significant disability and pain in older adults, often leading to hip or knee replacement surgery. Prehabilitation programs have been established for these surgeries, but there are few programs for orthogeriatrics. We evaluated the feasibility of a new multimodal prehabilitation program (MPP) for older adults before hip or knee replacement due to arthrosis: the Prehabilitation for Os (PRE4OS) study.</div></div><div><h3>Design</h3><div>We conducted a multicenter feasibility study in the Greater Paris area.</div></div><div><h3>Setting and Participants</h3><div>Eligible adults were aged ≥75 years old awaiting hip or knee replacement with at least a 6-week delay before surgery and able to participate in the MPP follow-up. The MPP included weekly hospital sessions providing nutritional, psychological, functional, and cognitive support, along with weekly home sessions featuring physiotherapist visits.</div></div><div><h3>Methods</h3><div>The primary outcome was at least 80% of 1-day hospital (ODH) sessions performed by 80% of participants. Secondary outcomes included intervention achievement, quality of life, and nutritional and functional status changes. Participant's satisfaction was qualitatively assessed via structured phone interviews presurgery and at 30 days postsurgery.</div></div><div><h3>Results</h3><div>From September 2021 to September 2023, a total of 27 individuals participated in the PRE4OS study. The mean (SD) age was 83 (4.3) years, with 7 males (26%) and median baseline Activities of Daily Living score 5.5 (interquartile range 5.5–6.0). Surgeries were for insertion of hip prosthesis in 17 participants (63%) and knee prosthesis in 10 (37%). The primary outcome was achieved in 89% of participants, with comparable rates for hip and knee prostheses. In total, 60% of participants rated the MPP as “excellent” presurgery and 100% at 30 days postsurgery, expressing a willingness to recommend the protocol to a friend or family.</div></div><div><h3>Conclusion and Implications</h3><div>The MPP was feasible for individuals before hip or knee replacement and was well received. Further randomized trials are needed to assess its clinical impact.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 1","pages":"Article 105345"},"PeriodicalIF":4.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623020","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}