Journal of the American Medical Directors Association最新文献

{"title":"Disrupted Circadian Rhythm of Heart Rate Variability in Pre-frail Adults Compared to Nonfrail Individuals.","authors":"Huiling Chen, Mimi Mun Yee Tse, Joanne Wai Yee Chung, Sui Yu Yau, Thomas Kwok Shing Wong","doi":"10.1016/j.jamda.2025.105903","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105903","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105903"},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280543","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 Level of Technophobia Among Older Adults in China in the Context of Digital Health: A Systematic Review and Meta-Analysis.","authors":"Zhehui Yang, Hong Yan, Shijin Wang, Yuling Luo, Yan Liu, Yuanyuan Tang, Tingting Zhang","doi":"10.1016/j.jamda.2025.105919","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105919","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review the level of technophobia among Chinese older adults in digital health and compare it with global studies to identify characteristics and differences.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting and participants: </strong>Chinese adults aged 60 and older.</p><p><strong>Methods: </strong>We conducted a computer-based search in 12 databases for cross-sectional studies using the Chinese Version of the Technophobia Scale (TS-CN) that reported technophobia levels among older adults in China, covering publications from the inception until August 5, 2025. Literature screening, data extraction, and bias risk assessment of included studies were independently completed by 2 researchers. Meta-analysis was performed using Stata 15.0 software.</p><p><strong>Results: </strong>The study included 15 papers with a total of 7452 participants. The pooled mean total score of technophobia among older adults in China was 37.25 (95% CI, 35.82-38.68). The pooled mean item scores for techno-anxiety, techno-paranoia, and privacy concerns dimensions were 2.87 (95% CI, 2.68-3.05), 2.82 (95% CI, 2.51-3.12), and 2.98 (95% CI, 2.73-3.23), respectively. Subgroup analysis showed statistically significant differences in technophobia levels among older adults in China based on different age, education level, average monthly personal income, and residence place (P < .05).</p><p><strong>Conclusions and implications: </strong>In China, technophobia among older adults is moderate, particularly concerning privacy concerns dimensions. Higher technophobia levels are observed in those who are older, have lower education and income, and live in rural areas. This trend is global amid aging and digitalization. Health care professionals and policymakers should identify high-risk groups and risk factors, developing targeted interventions through multidisciplinary collaboration to reduce technophobia, offering a Chinese perspective for international exchange.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105919"},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280619","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":"Care Trajectories for a Cohort of First-Time Nursing Home Admissions: A 5-Year Longitudinal Study in Minnesota","authors":"Dongjuan Xu PhD, RN ,&nbsp;Emily Garcia ,&nbsp;Greg Arling PhD","doi":"10.1016/j.jamda.2025.105885","DOIUrl":"10.1016/j.jamda.2025.105885","url":null,"abstract":"<div><h3>Objectives</h3><div>This study modeled 5-year care trajectories of first-time, dual-eligible older adults admitted to Minnesota nursing homes (NHs), capturing discharges to the community, NH readmissions, hospitalizations, and mortality. A secondary aim was to examine associations between care trajectories and dementia, baseline cognitive function, and demographic, clinical, and functional profiles.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>We analyzed 9853 older adults first admitted to Minnesota NHs in 2015 and followed them for up to 60 months. Minimum Data Set were linked to Medicaid claims from the Minnesota Medicaid Management Information System.</div></div><div><h3>Methods</h3><div>Latent class growth analysis identified trajectories based on monthly NH stay, hospitalization, and community stay, with mortality treated as a discrete time survival outcome. Dementia was included as a binary covariate. Resident characteristics across trajectories were compared using bivariate analyses and multinomial logistic regression.</div></div><div><h3>Results</h3><div>The following 4 distinct trajectories were identified: (1) trajectory 1 (early mortality with continued NH use, 38%) experienced shortest survival, highest NH utilization, and peak hospitalizations in year 1; (2) trajectory 2 (steady return to long-term NH care, 11%) had longer survival and frequent hospitalizations in years 2 and 3, ultimately spending 90% of time alive in NHs by year 5; (3) trajectory 3 (transitional care with multiple moves, 22%) had better survival and longer community stays but the most transitions, with increased NH use over time; and (4) trajectory 4 (short stay then return to community, 29%) experienced best outcomes with longest survival, minimal NH readmissions, and few hospitalizations. Trajectories were significantly associated with baseline differences in cognitive function, physical dependency, and sociodemographic characteristics.</div></div><div><h3>Conclusions and Implications</h3><div>Care trajectories among dual-eligible NH residents are highly heterogeneous. Although 38% remained in NHs until death, 29% sustained community living, and 33% experienced frequent transitions. These patterns underscore the need for individualized care planning and system-level strategies to meet complex, evolving needs.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 12","pages":"Article 105885"},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191927","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":"Parkinson's Disease Medication Administration Timing Deviations and Contraindicated Medicine Use in Residential Aged Care: A Retrospective Cohort Study","authors":"Rachel Urwin PhD, MPH,&nbsp;Nasir Wabe PhD, MScEpid, MScClinPharm, BPharm,&nbsp;Sangita Neupane MPH,&nbsp;Andrea Timothy PhD, MPhil,&nbsp;Magda Z. Raban PhD, MIPH, BPharm,&nbsp;Johanna I. Westbrook PhD, MHA, GradDipAppEpid, BAppSc","doi":"10.1016/j.jamda.2025.105889","DOIUrl":"10.1016/j.jamda.2025.105889","url":null,"abstract":"<div><h3>Objectives</h3><div>Parkinson's disease (PD) is a common condition among older people and requires tailored, time-sensitive pharmacologic therapy for optimal symptom management. No prior studies have examined the extent to which doses of time-critical PD medicines are delayed or missed in residential aged care (RAC) settings. We aimed to identify deviations in PD medication administration timing and the use of medicines that are contraindicated in PD.</div></div><div><h3>Design</h3><div>A retrospective longitudinal cohort study.</div></div><div><h3>Setting and Participants</h3><div>Twenty-three RAC facilities in New South Wales, Australia. Permanent residents aged ≥65 years who received PD medicines.</div></div><div><h3>Methods</h3><div>Routinely collected electronic data from January 1 to September 30, 2024, was used to investigate deviations in PD medication administration timing, defined as the difference between scheduled and actual administration times. We quantified the extent of dose administration timing deviation using 30-minute and 60-minute thresholds. The proportion of residents prescribed medicines contraindicated in PD, based on the Beers Criteria, was determined.</div></div><div><h3>Results</h3><div>A total of 202 permanent residents (7.9% of all residents) received PD medicines. All 202 residents experienced at least 1 instance of dose timing deviations of &gt;30 minutes, and almost all (98%) experienced a deviation of &gt;60 minutes during the 9-month study. Of 166,028 scheduled doses, 1.1% (n = 1776) were not administered and 72.8% of residents (n = 147) missed at least 1 dose. Of 164,252 total administered doses of PD medicines, 25.6% (n = 42,069) were given &gt;30 minutes before or after the scheduled time, equivalent to 605.8 incidents of wrong timing per 1000 resident days (95% CI, 572.0–641.6). Contraindicated medicines were given to 12.4% of residents (n = 25) who received PD medicines. The most commonly administered contraindicated medicines were metoclopramide (9 of 25, 36%), risperidone (8 of 25, 32%) and aripiprazole (5 of 25, 20%).</div></div><div><h3>Conclusions and Implications</h3><div>Our study identified extensive deviations in dose timing of PD medicines in RAC. Implementing strategies to enhance adherence to prescribed schedules for time-critical treatments may improve symptom management for residents with PD and reduce additional negative health outcomes and associated health care costs.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 12","pages":"Article 105889"},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191117","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":"Vaccination Rates Among Long-Term Care Staff During the SARS-COVID-19 Pandemic.","authors":"Linette N Leng, Cassandra L Hua, David M Dosa, Debra Dobbs, Lindsay J Peterson","doi":"10.1016/j.jamda.2025.105913","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105913","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic had a profound impact on long-term care facilities, particularly nursing homes and assisted living communities (ALCs), leading to high mortality rates among residents. Vaccination of residents and staff in long-term care mitigated virus spread. However, we know little about vaccine uptake in assisted living compared with the nursing home setting. The purpose of this paper was to compare assisted living staff vaccination rates with similarly collected data on nursing homes soon after the vaccines became available, and to elucidate organizational factors that may have influenced assisted living staff vaccination.</p><p><strong>Design: </strong>Cross-sectional study using data collected by the State of Florida through its emergency reporting system.</p><p><strong>Setting and participants: </strong>Florida nursing homes and ALCs that provided data to the state on total numbers of staff who received 2 doses of the COVID-19 vaccine by February 8, 2021 (n = 2585), and February 15, 2021 (n = 2731).</p><p><strong>Methods: </strong>The study compared vaccination rates for nursing homes and ALCs during 2 time points a week apart. It used logistic regression models to understand the organizational factors (eg, size, rurality, ownership status) associated with vaccination rates in assisted living, given the lack of knowledge on this setting.</p><p><strong>Results: </strong>ALCs, particularly smaller communities, had lower initial vaccination rates, but vaccination rates in the smaller communities (<25 beds) increased significantly by February 15, 2025. Organizational factors such as for-profit status and rural location were identified as significant predictors of vaccination, with higher rates among smaller, urban ALCs that accept state supplemental funding and lower rates among larger, for-profit ALCs.</p><p><strong>Conclusions and implications: </strong>This study suggests that planning for future pandemics and emergency response in assisted living should include preparedness strategies that consider long-term care organizational barriers and facilitators, including size, location, and profit status.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105913"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275145","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":"Enhancing Dementia Care Training: The Value of Mixed Methods Research in Educational Interventions.","authors":"Manuel Millán-Hernández, Daniela F Albarrán-Pérez","doi":"10.1016/j.jamda.2025.105906","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105906","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105906"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275005","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":"Psychological Risk Factors Associated With Mental Health Outcomes Among Bereaved Care Partners: A Meta-Regression Analysis of Prospective Studies.","authors":"Chetna Malhotra, Isha Chaudhry, Ishwarya Balasubramanian, Irene Teo","doi":"10.1016/j.jamda.2025.105909","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105909","url":null,"abstract":"<p><strong>Objective: </strong>Bereaved informal care partners are at a risk of developing symptoms of prolonged grief, depression, anxiety, and posttraumatic stress disorder. This meta-analytic review investigated whether certain predeath psychological factors heighten these risks.</p><p><strong>Design: </strong>Systematic review of longitudinal studies and meta-analysis.</p><p><strong>Settings and participants: </strong>Care partners aged ≥18 years, providing informal care, across any care setting.</p><p><strong>Methods: </strong>We systematically searched 4 databases for prospective studies assessing predeath psychological risk factors of postdeath mental health outcomes at >6 months postdeath. Correlation coefficients (r) were used as effect sizes in a multilevel meta-analysis, with random-effects meta-regressions identifying sources of heterogeneity.</p><p><strong>Results: </strong>We included 49 studies (published between 1990 and 2024) assessing 14,274 informal care partners. Strongest risk factors for prolonged grief symptoms (PGS) were predeath grief (r, 0.46; 95% CI, 0.31-0.60), depressive (r, 0.22; 95% CI, 0.09-0.34), and anxiety (r, 0.15; 95% CI, 0.09-0.21) symptoms. Predeath depressive (r, 0.33; 95% CI, 0.23-0.42) and anxiety (r, 0.23; 95% CI, 0.12-0.35) symptoms predicted postdeath depressive and anxiety symptoms, respectively. Studies with a higher proportion of spousal care partners showed a weaker association between predeath grief symptoms and PGS. Pooled prevalence estimates were 15% (8%-22%) for prolonged grief disorder (PGD) and 11% (4%-17%) using only PG-13 instrument; 27% (20%-33%) for depression and 22% (18%-26%) for anxiety. PGD prevalence was similar at 6 to 12 months (17% [12%-22%]) and 1-year postdeath (18% [12%-24%]).</p><p><strong>Conclusions and implications: </strong>Predeath psychological factors influence care partners' postdeath mental health outcomes. Predeath grief offers some protection for spousal care partners against PGS highlighting its dual nature-both as a risk and protective factor. Assessment tools should be standardized for accuracy of prevalence assessment.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105909"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275039","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":"Exercise Interventions Involving Minimal Equipment for Community-Dwelling Adults With Dementia: A Systematic Review and Meta-analysis.","authors":"Nien Xiang Tou, Lay Khoon Lau, Jonathan Gao, Jia Ying Tang, Liang Guo, Munro Yasmin Lynda, Yew Yoong Ding, Yee Sien Ng","doi":"10.1016/j.jamda.2025.105917","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105917","url":null,"abstract":"<p><strong>Objective: </strong>Although exercise is an appealing nonpharmacological intervention for patients with dementia, the use of specialized equipment or facility in some interventions limits its translation into community settings. However, the effectiveness of minimal equipment exercise programs is unclear. We aimed to synthesize the effects of exercise interventions involving minimal equipment in community-dwelling adults with dementia.</p><p><strong>Design: </strong>A systematic review and meta-analysis.</p><p><strong>Settings and participants: </strong>Randomized controlled trials enrolling community-dwelling adults diagnosed with dementia, examining the effects of exercise interventions involving minimal equipment.</p><p><strong>Methods: </strong>A systematic literature search was conducted in MEDLINE, EMBASE, CENTRAL, CINAHL, and PsycINFO databases for studies published from inception to September 2024. A meta-analysis was performed to synthesize the effects on 6 outcome domains including cognitive function, physical performance, ability to perform activities of daily living (ADLs), behavioral and psychological symptoms (BPSD), quality of life, and caregivers' burden. The methodological quality of studies was assessed using Cochrane's RoB 2, and the certainty of evidence was evaluated using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. The study protocol was prospectively registered in PROSPERO (CRD42023428573).</p><p><strong>Results: </strong>Twenty-six studies (1843 participants) were included. Despite high heterogeneity between studies, modest significant improvements were found in cognitive function (standardized mean difference [SMD] = 0.56; 95% CI, 0.06-1.06; low certainty), physical performance (SMD = 0.51; 95% CI, 0.13-0.89; low certainty), ADLs (SMD = 0.39; 95% CI, 0.08-0.71; low certainty), BPSD (SMD = -0.39; 95% CI, -1.24 to 0.46; very low certainty), QoL (SMD = 0.22; 95% CI, 0.01-0.43; low certainty), and caregivers' burden (SMD = -0.12; 95% CI, -0.69 to 0.46; very low certainty).</p><p><strong>Conclusions and implications: </strong>Our findings suggest that exercise interventions involving minimal equipment show promising benefits in various outcome domains among community-dwelling adults with dementia. However, given the low certainty of evidence, more studies of higher quality are needed to confirm these findings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105917"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275038","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":"Nil per os on Admission and Dehydration Are Risk Factors for Delirium in Hospitalized Older Adults With Dementia and Dysphagia.","authors":"Liron Sinvani, Stephanie Izard, Alexandra Perrin, Yan Liu, Codruta Chiuzan, Stefani Slotnick, Rebecca Affoo, Nicole Rogus-Pulia, Alexander Makhnevich","doi":"10.1016/j.jamda.2025.105912","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105912","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with Alzheimer's disease and related dementias (ADRD) experience oral intake restriction. The objective of this study was to determine whether nil per os (NPO) and dysphagia diets (thickened liquids) are associated with delirium in patients with ADRD and whether dehydration mediates these relationships.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting and participants: </strong>Data were obtained from a large integrated health system in New York (11 hospitals) and included hospitalized older adults (aged ≥65 years) with ADRD admitted between 2017 and 2022 with clinical suspicion of dysphagia.</p><p><strong>Methods: </strong>The main variables were NPO on admission (≥24 vs <24 hours; cohort 1) and prescription of thickened liquids (vs thin liquids; cohort 2). The primary outcome was new delirium developed 48 hours after admission. Multivariable logistic regression was used to determine the association between NPO time and new delirium while adjusting for all prespecified covariates of interest. The relationship between thickened liquids and new delirium was assessed similarly to NPO time.</p><p><strong>Results: </strong>Of 11,933 patients, the average age ± SD was 85.8 ± 7.92 years. In a multivariable model of cohort 1, NPO (odds ratio [OR], 1.398; 95% CI, 1.273-1.536; P < .001) and dehydration (OR, 1.837; 95% CI, 1.678-2.012; P < .001) were associated with higher odds of new delirium. In a multivariable model of cohort 2, thickened liquids were associated with decreased odds of new delirium (OR 0.867; 95% CI: 0.796, 0.945; P = .001), whereas NPO (OR, 1.480; 95% CI, 1.340-1.634; P < .001) and dehydration (OR, 1.804; 95% CI, 1.634-1.991; P < .001) were associated with increased odds of new delirium. Dehydration did not mediate the relationship between restriction and new delirium.</p><p><strong>Conclusions and implications: </strong>Limiting NPO and preventing dehydration could lower delirium risk and improve outcomes for patients with ADRD. Future research is needed to confirm these results.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105912"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275055","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":"Improving Access to Intermediate Care Through Flexibility: Simulation Study.","authors":"Ismail Aydemir, Casper G van Loon, René Bekker, Bianca M Buurman, Rob D van der Mei","doi":"10.1016/j.jamda.2025.105899","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105899","url":null,"abstract":"<p><strong>Objective: </strong>Growing demand for intermediate care, combined with nurse shortages, is increasing the pressure on the accessibility of these services. This study uses simulation as an innovative approach to assess the effectiveness of policy interventions on waiting times and hospital admissions, aiming to identify strategies that better meet rising care demands and improve accessibility.</p><p><strong>Design: </strong>A discrete-event simulation study modeling patient flows in intermediate care facilities.</p><p><strong>Setting and participants: </strong>The simulation model incorporates insights from health care professionals to represent patient flows, admissions, bed capacities, and operational constraints across both intermediate care and hospital settings.</p><p><strong>Methods: </strong>The simulation model incorporates patient arrivals, admissions, and discharges within intermediate care. The study evaluates the impact of the following interventions on patient flow and accessibility: bed pooling between care types, flexible admission hours and transfer times, and the use of emergency beds.</p><p><strong>Results: </strong>Partial bed pooling (10%) between high-complex and geriatric rehabilitation beds reduces waiting times by more than 1 day (a 25% to 42% reduction). Currently, average waiting times are approximately 2 days for low-complex care, and around 4 days for both high-complex care and geriatric rehabilitation. Expanding admission hours, particularly with 24/7 availability, decreases waiting times and hospital congestion. Eliminating emergency beds increases hospital admissions by 18%. By implementing multiple interventions, such as bed pooling and 24/7 admissions, accessibility shows the greatest improvement, with waiting times for high-complex patients reduced by more than 2 days (a 60% reduction) and decreased hospital admissions by 60%.</p><p><strong>Conclusion and implications: </strong>This study illustrates that access to intermediate care can be improved through bed pooling, flexible admission hours and transfer times, and the use of emergency beds, without the need to expand bed capacity. The results demonstrate that these interventions can optimize patient flow, reduce hospital admissions, and enhance overall system efficiency. Furthermore, the study demonstrates that simulation models are valuable tools for exploring policy and system changes within intermediate care settings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105899"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275063","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}