Journal of the American Medical Directors Association最新文献

{"title":"Individual- and Facility-Level Factors Related to Quality-of-Life Transitions in Older Adults in Residential Facilities: A Systematic Review.","authors":"Arisa Kawashima, Xueying Jin, Ayane Komatsu, Sakino Niwa, Hiroyuki Shimada, Hidenori Arai, Tami Saito","doi":"10.1016/j.jamda.2025.105721","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105721","url":null,"abstract":"<p><strong>Objectives: </strong>To elucidate factors related to the transitions of quality of life (QoL) and well-being in older adults living in residential facilities.</p><p><strong>Design: </strong>We undertook a systematic review and narrative synthesis.</p><p><strong>Setting and participants: </strong>The participants were individuals >60 years of age living in various types of residential facilities.</p><p><strong>Methods: </strong>We conducted a search in PubMed and Embase (Ovid) using free-text words and Medical Subject Heading terms on December 1, 2024. We included longitudinal studies published after 2000 that quantitatively assessed QoL and/or well-being at ≥2 time points. Studies published before 2000, non-English-language papers, and interventional or qualitative studies were excluded. The title, abstract, and full-text assessments were performed by multiple independent reviewers based on eligibility criteria. The Study Quality Assessment Tool for observational cohort and cross-sectional studies was used to assess methodologic quality.</p><p><strong>Results: </strong>Of the 7705 papers initially identified, 18 studies involving 122,057 participants were included. These studies, predominantly multicenter studies and studies conducted in the United States, revealed that QoL and well-being tended to decline gradually after admission. Key factors associated with maintaining and enhancing QoL and well-being included facility-level factors (eg, age-friendly architectural environments, social support and activities) and individual aspects (eg, cognitive function, activities of daily living, urinary continence). The variation in outcome measures precluded a meta-analysis.</p><p><strong>Conclusions and implications: </strong>We identified both facility- and individual-level factors associated with changes related to QoL and well-being in older adults living in residential facilities. The importance of modifiable facility-level factors should be reconsidered in ensuring quality care for older residents.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105721"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484803","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":"Pattern of Antidiabetic Drug Prescription in Older Persons With Type 2 Diabetes: Results From the German DPV Registry.","authors":"Andrej Zeyfang, Stefan Gölz, Federica Iraci, Christian Wagner, Christian Scheer, Thomas Kubiak, Latife Bozkurt, Martin Heni, Reinhard W Holl","doi":"10.1016/j.jamda.2025.105724","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105724","url":null,"abstract":"<p><strong>Objectives: </strong>To explore prescription patterns of SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) in older adults with type 2 diabetes (T2DM), analyzing age and sex differences.</p><p><strong>Design: </strong>Observational retrospective study.</p><p><strong>Setting and participants: </strong>Data from 103,820 patients aged 60 to 90 years from 518 diabetes centers in Germany, collected between 2017 and 2022 via the DPV registry.</p><p><strong>Methods: </strong>Patients with at least 3 months' T2DM diagnosis were included. Treatment trends were analyzed using regression models adjusted for age and sex. Repeated measures were aggregated annually.</p><p><strong>Results: </strong>Between 2017 and 2022, SGLT2i use rose from 7.3% to 27.4% and GLP-1RA use from 3.4% to 13.8%. Metformin use increased, while sulfonylureas declined. SGLT2i use was lower in women across all age groups. GLP-1RAs use increased more in younger patients.</p><p><strong>Conclusions and implications: </strong>Newer antidiabetic drugs are increasingly prescribed in older adults, but notable disparities by age and gender persist. These findings suggest the need to address potential biases and barriers to optimize equitable care in geriatric diabetes management.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105724"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484805","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":"Decoding the Enigmatic Link Between Sensory Impairment and Organic Mental Disorders: Insights From Biological Aging and Social Support in a Population Cohort Study","authors":"Ce Liu MS ,&nbsp;Li He MS ,&nbsp;Ya Xiao MS ,&nbsp;Hao Zhao MS ,&nbsp;Zhaoru Yang MS ,&nbsp;Huanhuan Wei MS ,&nbsp;Huan Chen MS ,&nbsp;Tong Liu PhD ,&nbsp;Kai Zhang PhD ,&nbsp;Bin Luo PhD","doi":"10.1016/j.jamda.2025.105709","DOIUrl":"10.1016/j.jamda.2025.105709","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study was to investigate the association between sensory impairments and organic mental disorders. We also examined biological age acceleration as a potential mediator and social support as a potential moderator of this association.</div></div><div><h3>Design</h3><div>This was a longitudinal cohort study using Cox proportional hazards models with mediation and moderation analyses.</div></div><div><h3>Setting and Participants</h3><div>A total of 330,983 UK Biobank participants (mean age ± SD, 56.41 ± 8.09 years) were categorized into 4 groups: no sensory impairment (n = 60,636), hearing impairment (n = 22,297), visual impairment (n = 12,271), and dual-sensory impairment (n = 5757).</div></div><div><h3>Methods</h3><div>Sensory status was self-reported, biological age acceleration was assessed through 3 biomarkers (homeostasis disorder, Klemera-Doubal method biological age, and phenotypic age), and organic mental disorders were identified via <em>International Classification of Diseases, 10th Edition</em> codes (F00-F09) from national health registries. Survival analyses were adjusted for sociodemographic factors, lifestyle, and health status.</div></div><div><h3>Results</h3><div>Over a 13.85-year median follow-up, 9645 participants developed organic mental disorders. Dual-sensory impairment showed the strongest association [hazard ratio (HR), 1.54; 95% CI, 1.45-1.64], followed by visual (HR, 1.20; 95% CI, 1.12-1.28) and hearing impairment (HR, 1.12; 95% CI, 1.05-1.20). Biological age acceleration mediated 24.5% to 38.9% of these associations (strongest through Klemera-Doubal method biological age). Social support demonstrated significant moderating effects, particularly in dual-sensory impairment, where high social support reduced risk (HR, 1.34; 95% CI, 1.12-1.60) compared with low social support (HR, 4.76; 95% CI, 2.35-9.65).</div></div><div><h3>Conclusions and Implications</h3><div>Sensory impairments are associated with an increased risk of organic mental disorders, potentially partly mediated by accelerated biological aging, with social support demonstrating a significant moderating effect. The gradient of risk across impairment types and the substantial potential mediating effect of biological age acceleration are consistent with multiple pathways linking sensory and cognitive health. These findings indicate that comprehensive interventions targeting sensory health, biological aging, and social support may represent potential targets for interventions aimed at preventing cognitive disorders in aging populations.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105709"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208854","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: A Qualitative Analysis of the PRE4OS Study","authors":"Bastien Genet MD,&nbsp;Abdoulaye Barry MSc,&nbsp;Prisca Lucas PhD,&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;Claire Davy MSc,&nbsp;Jacques Boddaert MD, PhD,&nbsp;Lorène Zerah MD, PhD","doi":"10.1016/j.jamda.2025.105706","DOIUrl":"10.1016/j.jamda.2025.105706","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105706"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216175","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":"Nursing Home Staffing Expenditures and Levels are Impaired by High Medicaid Payer-Mix.","authors":"John R Bowblis, Christopher S Brunt","doi":"10.1016/j.jamda.2025.105723","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105723","url":null,"abstract":"<p><strong>Objectives: </strong>Medicaid is the primary payer for most nursing home residents and reimburses below the cost of care, limiting the ability of nursing homes to increase staffing levels. This study examined the association of nursing staff levels and expenditures with Medicaid payer-mix and determined whether these associations varied across different ownership types.</p><p><strong>Design: </strong>Retrospective, cross-sectional analysis using 2023 Medicare Cost Reports and Payroll-Based Journal (PBJ) data for freestanding nursing homes.</p><p><strong>Setting and participants: </strong>A nationally representative sample of 11,559 nursing homes was analyzed.</p><p><strong>Methods: </strong>Nursing homes were categorized into 5 groups based on Medicaid payer-mix (0%-50%, 51%-65%, 66%-75%, 76%-85%, and 86%+). We measured nursing staff levels and expenditures per resident day, and the proportion of revenue spent on nursing staff. Linear regression models were used to assess associations between Medicaid payer-mix and these outcomes, allowing effects to vary by ownership type.</p><p><strong>Results: </strong>Nursing staff levels decrease as Medicaid payer-mix increases, with total nursing staff hours per resident day declining from 4.08 in the lowest Medicaid group to 3.40 in the highest. Facilities with a higher Medicaid payer-mix also have lower revenues and nursing staff expenditures per resident day but allocate a greater proportion of their revenue to staffing. For example, facilities with 86%+ Medicaid payer-mix spend 41.5% of their revenue on staffing, compared with 36.9% in facilities with less than 50% Medicaid days. Ownership type moderates these associations, with not-for-profits more sensitive to Medicaid payer-mix changes than for-profits.</p><p><strong>Conclusions and implications: </strong>Nursing homes with a high Medicaid payer-mix face financial constraints that limit staffing levels despite allocating a larger share of revenue to staffing. As policymakers consider staffing mandates, they must address the adequacy of Medicaid reimbursement to support staffing and maintain quality of care.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105723"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484804","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":"Central Nervous System Polypharmacy Among People Living With Dementia","authors":"Elizabeth A. Bayliss MD, MSPH ,&nbsp;J. David Powers MS ,&nbsp;Linda A. Weffald PharmD ,&nbsp;Jon R. Rasmussen PharmD ,&nbsp;Lisa E. Pieper MSHA, MBA ,&nbsp;Mahesh Maiyani MBA ,&nbsp;Jonathan Norton BS ,&nbsp;Ariel R. Green MD, PhD ,&nbsp;Orla C. Sheehan MD, PhD ,&nbsp;Cynthia M. Boyd MD, MPH","doi":"10.1016/j.jamda.2025.105708","DOIUrl":"10.1016/j.jamda.2025.105708","url":null,"abstract":"<div><h3>Objectives</h3><div>The Centers for Medicare and Medicaid Services Polypharmacy-CNS (Poly-CNS) quality metric identifies individuals taking multiple medications with central nervous system side effects. The Poly-CNS measure may reduce risky prescribing for persons living with dementia (PLWD).</div></div><div><h3>Design</h3><div>Secondary analysis of the Optimize cluster randomized pragmatic trial of deprescribing education in primary care conducted between April 1, 2019, and March 31, 2020.</div></div><div><h3>Setting and Participants</h3><div>Two overlapping cohorts of PLWD taking 5+ chronic medications. The “full intervention” cohort was randomized at the clinic level to receive patient and clinician deprescribing education materials. The “clinician education cohort” included additional individuals whose clinicians received educational materials but who did not receive patient materials.</div></div><div><h3>Methods</h3><div>Description of individuals meeting Poly-CNS criteria based on pharmacy dispensing records and their highest frequency combinations of medications. Generalized linear mixed models compared the odds of meeting Poly-CNS criteria by intervention or control group and modeled associations between patient characteristics and CNS polypharmacy at any time. Longitudinal analysis using generalized linear mixed models assessed trends of meeting Poly-CNS criteria over time.</div></div><div><h3>Results</h3><div>The proportion meeting Poly-CNS criteria at any time during the observation period in the full intervention cohort (N = 2908) was 12.3% and 10.8% in the clinician education cohort (N = 5226). Adjusted <em>P</em> value for trend over time in the combined full intervention cohort was .0587, and &lt;.0001 in the clinician education cohort. There was no effect of the intervention on odds of meeting Poly-CNS criteria in either cohort. Characteristics in both cohorts independently associated with meeting Poly-CNS criteria were younger age, greater morbidity burden, and female sex plus hospice use at baseline in the full intervention cohort. The most commonly combined medications were opioids plus antidepressants plus gabapentin.</div></div><div><h3>Conclusions and Implications</h3><div>Individuals with cognitive limitations and multimorbidity pharmacologically treated for mood and/or pain symptoms may be at risk for CNS polypharmacy.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105708"},"PeriodicalIF":4.2,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216174","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":"Late-Life Dementia Care: Identifying Distinct Care Patterns in the Last Years of Life","authors":"Gaia G. Bagnasco MSc,&nbsp;Judith A.M. Bom PhD,&nbsp;Bram Wouterse PhD","doi":"10.1016/j.jamda.2025.105699","DOIUrl":"10.1016/j.jamda.2025.105699","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify common long-term care patterns in the 6 years before death among individuals aged ≥65 years with dementia in the Netherlands and to examine how sociodemographic and health factors are associated with these patterns.</div></div><div><h3>Design</h3><div>A longitudinal retrospective study was conducted using routinely recorded data for the entire Dutch population on health care use, cause of death, and sociodemographics.</div></div><div><h3>Setting and Participants</h3><div>We identified 43,578 individuals who passed away in 2021 with dementia based on their use of dementia-related services and recorded cause of death.</div></div><div><h3>Methods</h3><div>Using ordered logit latent class analysis, we estimated the likelihood of individuals using long-term care (1: no formal LTC; 2: community-based home care services; 3: nursing home care) in each of the 6 years prior to death. Predictors included age, gender, migration background, partner status, polypharmacy, chronic illness groups, homeownership status, and household income quartiles.</div></div><div><h3>Results</h3><div>Three groups with distinct care patterns were identified: the Late Formal Care Group initially did not receive formal LTC but transitioned to community-based home care services and nursing homes 4 years before death, primarily relying on nursing home care. The Mixed Care Group used community-based home care services 6 years before death and shifted to nursing home care in their final years. A large share of the Early Nursing Home Group already used nursing home care 6 years before death, with nearly all individuals residing in nursing homes during their last 3 years. The Late Formal Care Group typically had higher income, greater homeownership rates, more often had a partner, and exhibited better health than the other groups, which accessed formal care earlier.</div></div><div><h3>Conclusions and Implications</h3><div>Variations in care patterns highlight that greater socioeconomic resources, stronger support, and better health relate to later formal care use. Understanding these patterns is vital for informed policy planning and resource allocation.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105699"},"PeriodicalIF":4.2,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199490","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 Relationship Between Frailty and Psychological Functioning in Community-Dwelling Older Adults: A Systematic Review","authors":"Huan Zhao BSc (Hons) ,&nbsp;Yaping Zhong PhD","doi":"10.1016/j.jamda.2025.105707","DOIUrl":"10.1016/j.jamda.2025.105707","url":null,"abstract":"<div><h3>Objectives</h3><div>Frailty and poor psychological functioning remain major aging-related public and clinical health challenges. The multidimensional nature of these constructs, along with diverse assessment methods, complicate the study of their relationship. This study aims to examine the cross-sectional and longitudinal relationships between frailty and psychological functioning and explore how their interplay affects health-related outcomes in community-dwelling older adults.</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Setting and Participants</h3><div>Community-dwelling older adults.</div></div><div><h3>Methods</h3><div>We conducted a systematic search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Web of Science, and Scopus for English-language articles published between January 2001 and November 2024. Two authors independently screened studies, extracted data, and performed quality assessment. Data were analyzed descriptively.</div></div><div><h3>Results</h3><div>A total of 129 studies were included, covering 113 distinct cohorts of community-dwelling older adults from 37 countries. Cross-sectional analyses consistently found positive associations between frailty and depression, psychological distress, and apathy, and negative associations with mental well-being, optimism, and sense of coherence, with mixed findings for anxiety. Longitudinal studies showed that baseline depression, apathy, and poor mental vitality predicted frailty progression, while frailty at baseline predicted incident depression and worsened mental health. The interaction between frailty and depression was associated with poorer health outcomes, including increased mortality, functional disability, and hospitalization risks.</div></div><div><h3>Conclusions and Implications</h3><div>Community-based frailty management strategies should consider a broader range of psychological factors, such as mental vitality, apathy, and mental well-being. Further research is needed to explore additional psychological dimensions beyond depression and anxiety, and their relationship with frailty and aging-related health outcomes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105707"},"PeriodicalIF":4.2,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248423","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":"Prospective Association Between Sarcopenia and Long-Term Risk of Hospitalization for Infection: A Cohort Study","authors":"Wan Yu MM ,&nbsp;Wenxu Wang MBBS ,&nbsp;Xingyue Ye MBBS ,&nbsp;Rui Ren MBBS ,&nbsp;Ru Zhang MBBS ,&nbsp;Linze Xi MBBS ,&nbsp;Yang Peng PhD ,&nbsp;Difei Wang PhD","doi":"10.1016/j.jamda.2025.105702","DOIUrl":"10.1016/j.jamda.2025.105702","url":null,"abstract":"<div><h3>Objectives</h3><div>The relationship between sarcopenia and the long-term risk of hospitalization for infectious diseases is unclear. This study aimed to evaluate this relationship using a large prospective Caucasian cohort from the UK Biobank.</div></div><div><h3>Design</h3><div>This is a large prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Using the UK Biobank data, participants were assessed for handgrip strength and appendicular lean mass at baseline and categorized into the non-sarcopenia, probable sarcopenia, and sarcopenia groups. A total of 243,097 participants (mean age, 55.64 years; 52.7% female) were enrolled in this study; 12,982 (5.3%) had probable sarcopenia and 312 (0.1%) had sarcopenia.</div></div><div><h3>Methods</h3><div>Cox regression analysis was used to evaluate associations between sarcopenia and subsequent hospitalizations for infections. The long-term risk of hospitalization for infections in different sarcopenia statuses was also examined.</div></div><div><h3>Results</h3><div>During the follow-up period (median, 13.54 years), 26,769 participants were hospitalized for infections, of whom 2357 (8.8%) had probable sarcopenia and 60 (0.2%) had sarcopenia. In the fully adjusted model, sarcopenia [hazard ratio (HR), 1.62; 95% confidence interval (CI), 1.25–2.08] and probable sarcopenia (HR, 1.40; 95% CI, 1.34–1.47) at baseline were prospectively associated with the risk of hospitalization for any infection. Sarcopenia was strongly associated with gastrointestinal infections (HR, 2.69; 95% CI, 1.27–5.68), whereas probable sarcopenia was associated with liver infections (HR, 1.76; 95% CI, 1.22–2.54). The average numbers of hospitalizations for infection were significantly higher in the probable sarcopenia and sarcopenia groups than in the non-sarcopenia group (<em>P</em> &lt; .001 and <em>P</em> &lt; .020, respectively). No significant difference was observed between the probable and confirmed sarcopenia groups (<em>P</em> = .684).</div></div><div><h3>Conclusions and Implications</h3><div>Sarcopenia may help identify people at risk of hospitalization for infections, supporting the strategies for enhancing infection prevention among individuals with sarcopenia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105702"},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208856","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":"From Nursing Homes to Home Care: Examining the Impact of the COVID-19 Pandemic on Direct Care Worker Transitions.","authors":"Katherine E M Miller, Yang Yang, Jeromie Ballreich, Karen Shen","doi":"10.1016/j.jamda.2025.105717","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105717","url":null,"abstract":"<p><strong>Objectives: </strong>Due to poor working conditions and low wages, workforce turnover in the long-term care industry has been a longstanding issue. Increased risks to workers caused by the COVID-19 pandemic exacerbated these issues. Thus, many states offered wage supports (eg, hazard pay) to try to stabilize the workforce. Our objective was to examine how exits of direct care workers employed in the long-term care industry changed during the COVID-19 pandemic, and whether hazard pay policies mediated the impact of the pandemic on worker exits.</p><p><strong>Design: </strong>We used the Annual Social and Economic Supplement to identify direct care workers and PHI reports to identify states offering hazard pay during the pandemic.</p><p><strong>Setting and participants: </strong>The analytical sample consisted of 8164 direct care workers employed in long-term care between 2016-2018 and 2020-2022 in 2 settings: (1) home settings and (2) residential care settings (nursing homes and assisted living).</p><p><strong>Methods: </strong>We decomposed direct care worker exits using the Annual Social and Economic Supplement survey responses to (1) unemployment or exiting the labor force, (2) a different health care job or industry, and (3) non-healthcare job (eg, retail). We compared the rates of these components for direct care workers prepandemic (2016-2019) and during the pandemic (2020-2023), and the association of these rates with state wage-support policies.</p><p><strong>Results: </strong>Direct care worker exits were highest in 2020, with most workers becoming unemployed or leaving the labor force. In 2021-2022, worker exits decreased relative to prepandemic periods, driven by fewer people switching jobs. Among those who switched jobs, we found that workers during the pandemic were more likely to stay in a health care industry relative to prepandemic. We found no evidence that wage support policies influenced direct care worker exits during or after the pandemic.</p><p><strong>Conclusions and implications: </strong>Our findings suggest that broader economic trends of a shrinking workforce may be the primary driver of direct care worker exits during the pandemic.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105717"},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310073","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}