Journal of the American Medical Directors Association最新文献

{"title":"Effects of Combined Physical and Cognitive Interventions on Older Adults With Dementia: A Systematic Review and Meta-Analysis","authors":"Dandan Xue PhD, RN ,&nbsp;Yanqiu Hu MSN, RN ,&nbsp;Rui Zhang MSN, RN ,&nbsp;Jiaying Li PhD, RN","doi":"10.1016/j.jamda.2025.105757","DOIUrl":"10.1016/j.jamda.2025.105757","url":null,"abstract":"<div><h3>Objectives</h3><div>Physical and cognitive interventions provide benefits to persons with dementia (PwD); however, the evidence on the effects of combined physical and cognitive interventions on PwD remains inconsistent. This review aimed to synthesize existing evidence and compare the effects of combined interventions with those of each intervention alone on cognitive, physical, psychological, functional, and health-related quality of life (HRQoL) outcomes for PwD.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>Older adults with dementia.</div></div><div><h3>Methods</h3><div>Searches were conducted across 8 English and Chinese databases from their inception dates to September 10, 2024. Quality appraisal was performed using Cochrane's risk of bias tool. Random-effects models were used for meta-analysis, and subgroup analyses and meta-regression were applied to explore potential moderators.</div></div><div><h3>Results</h3><div>A total of 23 studies involving 1716 participants were included. Combined interventions significantly improved global cognition [standardized mean difference (SMD), 0.65; 95% CI, 0.35–0.95; <em>P</em> &lt; .001], processing speed (SMD, 0.33; 95% CI, 0.03–0.63; <em>P</em> = .03), functional mobility (SMD, 0.85; 95% CI, 0.18–1.53; <em>P</em> = .01), strength (SMD, 0.95; 95% CI, 0.28–1.61; <em>P</em> = .005), depression (SMD, −1.04; 95% CI, −1.73 to −0.36; <em>P</em> = .003), and HRQoL (SMD, 0.71; 95% CI, 0.24–1.18; <em>P</em> = .003) compared with active or passive controls. Combined interventions did not provide better overall benefits than using either intervention alone. Further analysis showed that the effectiveness of combined interventions on global cognition depended on the age of PwD.</div></div><div><h3>Conclusions and Implications</h3><div>Combined interventions are effective in improving cognitive, physical, psychological, and HRQoL outcomes in PwD. They should be integrated into dementia management protocols. Future research should focus on multiarm randomized controlled trials with long-term follow-up to directly compare the effects of combined interventions with those of single interventions and explore their long-term sustainability.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105757"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618701","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":"Normative Data for Timed-Up-and-Go and One-Leg-Standing for 66-Year-Old Koreans: A Nationwide Study","authors":"Jeehae Chung PhD ,&nbsp;Matthew Smuck MD ,&nbsp;Ruopeng Sun PhD ,&nbsp;Seonjeong Byun MD, PhD","doi":"10.1016/j.jamda.2025.105773","DOIUrl":"10.1016/j.jamda.2025.105773","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate updated, sex-stratified normative data for timed-up-and-go and one-leg-standing tests among 66-year-old Koreans.</div></div><div><h3>Design</h3><div>Retrospective cross-sectional study using a large, nationally representative data set.</div></div><div><h3>Setting and Participants</h3><div>Data were obtained with official permission from the Korean National Health Insurance Service database. This study included 66-year-old citizens who participated in the National Screening Program for Transitional Ages between January 1, 2008, and December 31, 2017. Participants with missing values for the timed-up-and-go or one-leg-standing tests were excluded from the analysis. A total of 2,704,715 participants were included (53.7% female), with 2,231,397 analyzed for one-leg-standing.</div></div><div><h3>Methods</h3><div>The timed-up-and-go and one-leg-standing results were sex-stratified, and means, SDs, and the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were calculated for each group. The influence of demographic, health behavior, clinical, and comorbidity variables on test performance was analyzed.</div></div><div><h3>Results</h3><div>Men outperformed women in both timed-up-and-go (men: 8.20 ± 3.33 seconds; women: 8.59 ± 3.30 seconds; <em>P</em> &lt; .001) and one-leg-standing (men: 20.39 ± 9.19 seconds; women: 18.26 ± 8.72 seconds; <em>P</em> &lt; .001). Both sexes showed improvements in the 2 tests over the 9-year period. Female sex, low income, obesity, and chronic conditions negatively impacted performance.</div></div><div><h3>Conclusions and Implications</h3><div>This study provides updated normative values for timed-up-and-go and one-leg-standing, facilitating more accurate mobility assessments and risk screening. Observed improvements in both tests among 66-year-olds over the time course of the study reflect positive public health trends in Korea. These findings emphasize the need for population-specific reference values and standardized protocols. Tailored health interventions are necessary for vulnerable populations. Updating cutoff values based on demographic trends may improve early intervention strategies, ultimately enhancing functional health and quality of life in older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105773"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637415","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":"Staff Satisfaction and Burnout in Assisted Living and Validity of the DCW Job Satisfaction Scale","authors":"Elizabeth R. Morton ,&nbsp;Sheryl Zimmerman PhD ,&nbsp;Lea Efird-Green MSW, MPA ,&nbsp;Scott A. Davis PhD","doi":"10.1016/j.jamda.2025.105777","DOIUrl":"10.1016/j.jamda.2025.105777","url":null,"abstract":"<div><h3>Objectives</h3><div>Professional caregivers (ie, direct care workers) provide the majority of support for long-term care residents. Unfortunately, they have consistently high turnover, which is associated with low job satisfaction and decreased care quality. Most research on this topic has been conducted in nursing homes; in contrast, this study investigated relationships between staff satisfaction, burnout, and community and staff characteristics in assisted living (AL). Additionally, it evaluated the validity of the Direct Care Worker Job Satisfaction Scale in this population, a notable contribution to the literature.</div></div><div><h3>Design</h3><div>Questionnaires completed by AL staff and administrators.</div></div><div><h3>Setting and Participants</h3><div>559 staff from 68 AL communities in North Carolina.</div></div><div><h3>Methods</h3><div>Staff reported satisfaction, burnout, and demographics. Administrators reported community characteristics. Correlations were computed for bivariate relationships among variables. The Direct Care Worker Job Satisfaction Scale was evaluated with a principal component analysis.</div></div><div><h3>Results</h3><div>Staff reported satisfaction of 3.05 (scale 1-4; “satisfied”), and 18.5% were burned out; satisfaction and burnout were negatively correlated (adjusted −0.43, <em>P</em> &lt; .001). Satisfaction was positively associated with the percent of residents with dementia (0.19, <em>P</em> &lt; .001) and provision of special/memory care (0.17, <em>P</em> &lt; .001); it was negatively associated with the staff-to-resident ratio (−0.18, <em>P</em> &lt; .001) and presence of licensed nurses (−0.27, <em>P</em> &lt; .001). Principal component analysis produced a single-factor solution with an eigenvalue of 10.8, the only eigenvalue above 1. All scale items loaded at least 0.70 on the single factor.</div></div><div><h3>Conclusions and Implications</h3><div>AL staff satisfaction and burnout are negatively associated, and almost one-fifth are burned out; the extent of burnout has not been reported previously and merits attention. Associations suggest caring for individuals with dementia may be particularly rewarding, while being responsible for more residents and working alongside nurses or with higher acuity residents may lessen satisfaction. These findings may inform approaches to staffing and have implications for resident well-being.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105777"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642814","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 and Bridging Roles of Social Relationships Within the Multilayer Health Ecology Model in Motoric Cognitive Risk Syndrome: A Network Analysis","authors":"Liming Su MD ,&nbsp;Linfu Jiang MD ,&nbsp;Yiting Ma MD ,&nbsp;Zhonghua Wang PhD ,&nbsp;Xiaoying Wang MBBS ,&nbsp;Yang Lin BSN","doi":"10.1016/j.jamda.2025.105771","DOIUrl":"10.1016/j.jamda.2025.105771","url":null,"abstract":"<div><h3>Objectives</h3><div>Motoric cognitive risk (MCR) syndrome signals dementia risk in older adults, with social relationships recognized as modifiable influences; however, their interconnectedness with the multilayer factors of the health ecology model remains underexplored. This study aims to investigate the central and bridging functions of social activities, social networks, and social support within the health ecology model in the context of MCR.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>A total of 561 community-dwelling older adults with MCR were recruited from the Aging Survey in Mountainous and Island Counties in China. Participants completed the 15-item Chinese version of the social relationships scale.</div></div><div><h3>Methods</h3><div>Multivariable linear regression was conducted to identify significant associations between the multidimensional aspects of social relationships and the multilayer factors within the health ecology model. These variables were subsequently incorporated into the mixed graphical model–based network analysis to examine structural associations. Network centrality, predictability, and bridging metrics were further assessed to identify key influential nodes.</div></div><div><h3>Results</h3><div>Mixed graphical model–based network analysis revealed that social networks exhibited the highest values of strength, bridge strength, and predictability, followed by social support and activities. Notably, strong correlations were observed between social networks and education level (≥1 year) (r = 0.635), social networks and self-reported financial status (wealthy) (r = 0.623), social activities and self-reported financial status (wealthy) (r = 0.557), and social support and self-esteem (r = 0.523).</div></div><div><h3>Conclusions and Implications</h3><div>Social networks, social activities, and social support function as central and bridging roles within the multilayer health ecology model, linking socioeconomic and behavioral factors in MCR. These findings underscore the importance of social relationships as culturally sensitive and modifiable targets for multilevel interventions from a mechanistic perspective, offering a theoretical foundation for practices and policies aimed at slowing MCR progression and promoting healthy cognitive aging.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105771"},"PeriodicalIF":4.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618653","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":"Physician Billing in Long-Term Care Homes and the Association With the Prescribing of End-of-Life Symptom Management Medications: A Population-Based Retrospective Cohort Study","authors":"Rhiannon L. Roberts MScPH ,&nbsp;Anna E. Clarke MSc ,&nbsp;Michelle Howard PhD ,&nbsp;Darly Dash MSc ,&nbsp;Daniel Kobewka FRCPC, MSc ,&nbsp;Shirley H. Bush MBBS, MRCGP, FAChPM ,&nbsp;Aynharan Sinnarajah MD, MPH ,&nbsp;Jessica Simon MB, ChB ,&nbsp;Sarina R. Isenberg MA, PhD ,&nbsp;Amit Arya MD, CCFP (PC), FCFP ,&nbsp;Benoit Robert MD ,&nbsp;Jenny Lau MD, MSc ,&nbsp;Peter Tanuseputro MD, MHSc ,&nbsp;James Downar MDCM, MHSc, FRCPC ,&nbsp;Colleen Webber PhD","doi":"10.1016/j.jamda.2025.105766","DOIUrl":"10.1016/j.jamda.2025.105766","url":null,"abstract":"<div><h3>Objectives</h3><div>Medications are often needed to manage distressing end-of-life symptoms (eg, pain, agitation, dyspnea). We evaluated whether physician billing in long-term care (LTC) was associated with LTC residents’ receipt of an end-of-life symptom management medication prescription.</div></div><div><h3>Design</h3><div>Retrospective cohort study using administrative health data.</div></div><div><h3>Setting and Participants</h3><div>All LTC decedents in Ontario's 626 publicly funded LTC homes who died between January 1, 2017, and March 17, 2020, were matched to a physician most responsible for their care (MRP) in LTC.</div></div><div><h3>Methods</h3><div>We measured the proportion of an MRP's billings that occurred in LTC. The prescribing of 1+ end-of-life symptom management medications was captured in LTC residents' last 2 weeks of life using prescription claims data.</div></div><div><h3>Results</h3><div>The study included 54,445 LTC decedents and 1855 MRPs. MRPs had a median of 9% of their total billings in LTC (interquartile range 3% to 23%). Two-thirds of LTC decedents (36,682, 67.4%) had at least one end-of-life medication prescription, the most common of which was opioids (prescribed to 65.4% of decedents). There was no difference in the odds of a decedent having a prescription for an end-of-life medication based on their MRP's proportion of billings in LTC (adjusted odds ratio for a 10% increase in an MRPs' billings in LTC 1.01, 95% CI, 0.99–1.02).</div></div><div><h3>Conclusions and Implications</h3><div>Across Ontario's LTC homes, there are large variations in prescribing rates for end-of-life symptom management medications; however, a physician's proportion of billings in LTC was not associated with a greater likelihood of prescribing.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105766"},"PeriodicalIF":4.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618706","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":"Use of Paid Family Care in the Community: National Trends Among Older Adults With Functional Impairment, 2011–2022","authors":"Jennifer M. Reckrey MD ,&nbsp;Karen Shen PhD ,&nbsp;Yifan Liu MS ,&nbsp;Yiqing Qian PhD, MPH ,&nbsp;Andrew D. Jopson MPH ,&nbsp;Katherine E.M. Miller PhD ,&nbsp;Chanee D. Fabius PhD, MA ,&nbsp;Katherine A. Ornstein PhD","doi":"10.1016/j.jamda.2025.105770","DOIUrl":"10.1016/j.jamda.2025.105770","url":null,"abstract":"<div><h3>Objectives</h3><div>Paying family caregivers (eg, children, friends) is an innovative approach to support older adults in the community and ease direct care workforce shortages. Yet, data about the receipt of paid family care are lacking. In this study, we used a nationally representative sample of Medicare beneficiaries to (1) identify characteristics associated with receipt of paid family care in 2022, and (2) describe national trends in receipt of paid family care between 2011 and 2022.</div></div><div><h3>Design</h3><div>Cross-sectional study and time trend analysis.</div></div><div><h3>Setting and Participants</h3><div>Community-dwelling participants in the National Health and Aging Trends Study (NHATS) who reported receiving help with self-care and mobility tasks between 2011 and 2022.</div></div><div><h3>Methods</h3><div>We compared characteristics among those who received paid family care (vs paid nonfamily care) in 2022. We examined trends in use and hours of paid family between 2011 and 2022 using the Mann-Kendall Trend test.</div></div><div><h3>Results</h3><div>Of the 941 older adults who reported help with self-care or indoor mobility tasks in 2022, 30% received paid care. Of those, 28.8% received paid family (8.1% of the overall sample). This group was more likely than those with paid nonfamily care to be Medicaid-enrolled (62.5% vs 33.1%, <em>P</em> &lt; .001) and have more living children (3.36 vs 2.53, <em>P</em> &gt; .001). There were no significant trends in the proportion of older adults receiving paid family care between 2011 and 2022 (range from 5.9% to 8.8%). Yet during this time, hours of paid care received decreased among those with paid nonfamily care (<em>P</em> = .005).</div></div><div><h3>Conclusions and Implications</h3><div>A substantial subgroup of older Medicare beneficiaries, including both those with and without Medicaid, received paid family care between 2011 and 2022. Especially given direct care workforce shortages, evidence-based expansion of models of paid family care is an important approach to meet the care needs of older adults living in the community.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105770"},"PeriodicalIF":4.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618718","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":"Relative Reliability of Muscle Function Measured With Electronic Handgrip Dynamometry and Accelerometry","authors":"Ryan McGrath PhD,&nbsp;Yeong Rhee PhD,&nbsp;Bryan K. Christensen PhD,&nbsp;Donald Jurivich DO,&nbsp;Megan Orr PhD,&nbsp;Sherri N. Stastny PhD,&nbsp;Grant R. Tomkinson PhD,&nbsp;Kyle J. Hackney PhD","doi":"10.1016/j.jamda.2025.105763","DOIUrl":"10.1016/j.jamda.2025.105763","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105763"},"PeriodicalIF":4.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618707","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":"Mouth Care Without a Battle: Change in Assisted Living Staff Self-Efficacy and Attitudes.","authors":"Sheryl Zimmerman, Lynne A Sampson, Patricia Poole, Philip Sloane, Jane A Weintraub, Chuwen Liu, Johanna V T S Hickey, John S Preisser","doi":"10.1016/j.jamda.2025.105754","DOIUrl":"10.1016/j.jamda.2025.105754","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105754"},"PeriodicalIF":4.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618704","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":"Black-White Differences in Long-Term Services and Supports (LTSS) Deserts: Implications for Unmet Care Needs","authors":"Chanee D. Fabius PhD ,&nbsp;Kali S. Thomas PhD ,&nbsp;Jennifer C. Cornman PhD ,&nbsp;Vicki A. Freedman PhD","doi":"10.1016/j.jamda.2025.105758","DOIUrl":"10.1016/j.jamda.2025.105758","url":null,"abstract":"<div><h3>Objectives</h3><div>Little is known about the impacts of living in a long-term services and supports (LTSS) “desert,” where there are few community-based care options. We sought to understand whether racial disparities exist in LTSS availability and variety and associations with unmet care needs for non-Hispanic White and Black older adults.</div></div><div><h3>Design</h3><div>Cross-sectional study of national survey data linked to contextual LTSS market measures.</div></div><div><h3>Setting and Participants</h3><div>Non-Hispanic White (n = 1751) and Black (n = 603) adults aged 70 and older with activity limitations from the 2019 National Health and Aging Trends Study (NHATS).</div></div><div><h3>Methods</h3><div>The outcome of interest is any adverse consequence as the result of unmet care needs for household, self-care, or mobility activities. We estimate multivariable logistic regression models adjusting for a novel measure reflecting LTSS availability and variety (fertile, typical, desert), consisting of the number of home health agencies, residential care/assisted living beds, and adult day care providers in a county per 100,000 older adults.</div></div><div><h3>Results</h3><div>Relative to White older adults, Black older adults more often experienced adverse consequences due to unmet need (35.0% vs 27.6%, <em>P</em> &lt; .03). Although not statistically significant, older Black adults were more likely to live in an LTSS desert (<em>P</em> &lt; .058). In fully adjusted within-group multivariable logistic regression models, living in an LTSS desert was associated with greater odds of experiencing adverse consequences due to unmet need among White, but not Black, older adults (adjusted odds ratio, 1.50; 95% CI, 0.95–2.36). For both White and Black older adults, single older adults and those receiving unpaid or paid community-based care were more likely to experience adverse consequences due to unmet need.</div></div><div><h3>Conclusions and Implications</h3><div>Findings underscore differences in how LTSS availability and variety relate to unmet care needs for Black and White older adults. Future research should examine these associations in other racial and ethnic minoritized groups.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105758"},"PeriodicalIF":4.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618652","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":"Change in Distressed Behavior in Dementia During the COVID-19 Pandemic in Veterans Affairs Community Living Centers","authors":"Thomas A. Bayer MD, ScM ,&nbsp;Frank DeVone ScM ,&nbsp;Mriganka Singh MD ,&nbsp;Ciera Leeder MD, MSc ,&nbsp;Alexander Garbin DPT, PhD ,&nbsp;Christopher Halladay ScM ,&nbsp;Kevin McConeghy PharmD, PhD ,&nbsp;Stefan Gravenstein MD, MPH ,&nbsp;James L. Rudolph MD, MS","doi":"10.1016/j.jamda.2025.105752","DOIUrl":"10.1016/j.jamda.2025.105752","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare distressed behavior in Veterans with Alzheimer disease and related dementias (ADRD) residing in Veterans Affairs (VA) Community Living Centers (CLCs) during the COVID-19 pandemic to previous years.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Veterans with ADRD and without baseline distressed behavior residing in CLCs in March 2020 (Early-COVID) and March 2018 or March 2019 (Pre-COVID).</div></div><div><h3>Methods</h3><div>We measured distressed behavior with the Distressed Behaviors in Dementia Indicator. Using a Cox regression, we compared the 180-day hazard of distressed behavior in the Early-COVID group to that in the Pre-COVID group.</div></div><div><h3>Results</h3><div>Of 4383 sampled Veterans, 1190 (27%) had recently taken an antipsychotic medication. In the Pre-COVID (n = 2795) and Early-COVID groups (n = 1588), new distressed behavior occurred in 629 (22.5%) and 313 (19.7%) Veterans, respectively. The adjusted hazard ratio (HR) of new distressed behavior was 0.82 (95% CI 0.71-0.95) for Early-COVID compared with Pre-COVID. Antipsychotic medication was associated with new distressed behavior (HR 1.61, 95% CI 1.40-1.86).</div></div><div><h3>Conclusions and Implications</h3><div>New distressed behavior decreased during the first 6 months of the COVID-19 pandemic compared with the previous 2 years. The observed association between antipsychotic medication use and distressed behavior may reflect clinical recognition and treatment of a predisposition toward distressed behavior. Recorded changes in distressed behavior in Veterans with dementia residing in CLCs opposed the trend of decreased well-being in residents of non-VA nursing homes, but changes in resident assessment fidelity during the Early-COVID period could have confounded the study.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105752"},"PeriodicalIF":4.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618698","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}