Journal of the American Medical Directors Association最新文献

{"title":"Live Hospice Discharge of Individuals With Cognitive Disabilities: A Systematic Review.","authors":"Victoria M Winogora, Christine E DeForge, Kimberlee Grier, Patricia W Stone","doi":"10.1016/j.jamda.2025.105578","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105578","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review the evidence on live hospice discharge for individuals with cognitive disabilities.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Setting and participants: </strong>Adults with cognitive disabilities enrolled in hospice in the United States.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched for US-based, English-language, and peer-reviewed literature focused on live discharges from hospice for individuals with cognitive disabilities. We searched PubMed, CINAHL, and Web of Science for articles published between January 1, 2014, through August 1, 2024. We used the Joanna Briggs Institute Analytical Cross-Sectional Studies Appraisal Tool to assess study quality.</p><p><strong>Results: </strong>After screening 1543 titles and abstracts, we completed a full-text review of 30 articles, of which 8 met inclusion criteria. All included studies were cross-sectional analyses. The indications of cognitive disability varied (ie, dementia diagnosis, positive result on cognitive function assessment), but there were no studies focused on individuals with acquired brain injuries or intellectual and developmental disabilities, nor was the term cognitive disability used in any of the studies. In all studies, the indicator of cognitive disability was associated with live hospice discharge. Other risk factors included female sex (n = 4), minoritized race (n = 4), for-profit hospice ownership (n = 4), and delivery of hospice services at home (n = 2). In all studies, researchers found that individuals with cognitive disabilities had longer hospice lengths of stay.</p><p><strong>Conclusions and implications: </strong>This systematic review is the first to focus on live discharge from hospice for individuals with cognitive disabilities. All studies focused exclusively on individuals with dementias. Although the term cognitive disability was absent from the literature reviewed, cognitive disability was associated with live discharge. Future research should aim to include the greater cognitive disability community to assess hospice and other end-of-life outcomes to identify potential targets for future intervention.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105578"},"PeriodicalIF":4.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753292","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":"Linking Cognitive Screening Tests in Community-Dwelling Older Adults: Crosswalk between the Montreal Cognitive Assessment-Basic and the Mini-Mental State Examination","authors":"Siqi Cheng MD ,&nbsp;Jiafan Qin MM ,&nbsp;Chengbei Hou PhD ,&nbsp;Yue Wu MD ,&nbsp;Xinyan Du MM ,&nbsp;Hongjun Liu BMed ,&nbsp;Shaoyuan Lei PhD ,&nbsp;Rui Li BMed ,&nbsp;Xiaolin Yue MPH ,&nbsp;Yansu Guo PhD","doi":"10.1016/j.jamda.2025.105550","DOIUrl":"10.1016/j.jamda.2025.105550","url":null,"abstract":"<div><h3>Objective</h3><div>To develop the crosswalk between the Montreal Cognitive Assessment-Basic (MoCA-B) and Mini-Mental Status Examination (MMSE) based on a community-dwelling older population to facilitate data synthesis and comparison.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>We used baseline data of 2170 subjects with total MoCA-B and MMSE scores from an ongoing prospective cohort study, the Beijing Longitudinal Disability Survey in Community Elderly (BLINDSCE).</div></div><div><h3>Methods</h3><div>The MoCA-B and MMSE were administered by trained assessors. Equipercentile equating was used to develop the conversion table between MoCA-B and MMSE scores in the total sample and subgroups by age, sex, residency, and education level. The mean absolute error (MAE), intraclass correlation coefficient (ICC), and Bland-Altman plot were used to evaluate the linking performance.</div></div><div><h3>Results</h3><div>MoCA-B and MMSE scores converted bi-directionally for the overall sample and subgroups, with small standardized MAE (SMAE) and high ICC. The linking results between MoCA-B and MMSE scores were consistent across the total sample and the age and sex subgroups, while a 2-score difference was observed within the residency and education subgroups.</div></div><div><h3>Conclusions and Implications</h3><div>This study provides easy-to-use crosswalks between measures of MoCA-B and MMSE with precision among community-dwelling older adults. Our results help to compare and pool data across studies using either of the 2 cognitive screening tests and provide a useful reference to clinicians for better evidence-based practice in patients evaluated using different cognitive tests.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105550"},"PeriodicalIF":4.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workforce Dementia Training Needs and Preferences for Residential Aged Care","authors":"Hannah Gulline BBiomedSci, GradCertProjMgt, MPH ,&nbsp;Lauren Bruce D Psych (Health) ,&nbsp;Marta Woolford BHSc (Hons), PhD ,&nbsp;Phillipa Horsman MEng (Hons) ,&nbsp;Niluksha Morawaka BNurs, MHA ,&nbsp;Silvia Alberti BA, SSW, MSW ,&nbsp;Darshini Ayton BBiomedSci (Hons), MPH, PhD","doi":"10.1016/j.jamda.2025.105495","DOIUrl":"10.1016/j.jamda.2025.105495","url":null,"abstract":"<div><h3>Objective</h3><div>To explore residential aged care (RAC) staff and volunteers' needs and preferences for dementia training.</div></div><div><h3>Design</h3><div>A mixed methods action research study was conducted to codesign a new Dementia Model of Care for RAC homes provider Baptcare. This paper reports on one component of model development and implementation: understanding the training that staff and volunteers receive about dementia, and subsequently, through a needs assessment process, identifying their needs and preferences for dementia training.</div></div><div><h3>Setting and Participants</h3><div>Staff and volunteers from 8 RAC homes participated in a survey (staff n = 275; volunteers n = 11), with a 77.5% completion rate (n = 241). Forty-five staff and 5 volunteers completed focus groups/interviews about their dementia knowledge, current training, future training preferences, and factors influencing access to training.</div></div><div><h3>Methods</h3><div>The survey included the Confidence in Dementia (CODE) Scale and Dementia Knowledge Assessment Scale (DKAS) validated tools and additional training content and delivery questions. Survey data were analyzed descriptively. Transcripts were analyzed thematically and then mapped to training topics/approaches identified from the data.</div></div><div><h3>Results</h3><div>Although staff and volunteers felt “somewhat confident” to care for residents living with dementia, gaps in dementia knowledge were identified. Staff and volunteers addressed this knowledge gap through internal training modules or external informal or formal training. Survey comments resulted in 3 key desired training topics identified: person-centered care, dementia knowledge and behavior management, and understanding the resident's experience. Four approaches to training were recognized: in-person over online training, self-directed learning, peer-to-peer learning, and training new staff/volunteers during onboarding.</div></div><div><h3>Conclusions and Implications</h3><div>Additional staff and volunteer training is required to address knowledge gaps and promote the delivery of quality care. Considering staff and volunteers' needs and preferences as well as addressing barriers to training is crucial to building workforce capacity and improving dementia care provision in RAC.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105495"},"PeriodicalIF":4.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536648","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":"Kinematic Insights Into Older Adult Fall-Related Head Impacts: Boundary Conditions and Injury Risk","authors":"Nicole E.-P. Stark PhD ,&nbsp;Ethan S. Henley ,&nbsp;Brianna A. Reilly ,&nbsp;Damon R. Kuehl MD ,&nbsp;Steve Rowson PhD","doi":"10.1016/j.jamda.2025.105545","DOIUrl":"10.1016/j.jamda.2025.105545","url":null,"abstract":"<div><h3>Objectives</h3><div>To quantify real-world impact conditions of falls, which cause 50% to 90% of older adult traumatic brain injuries, and reconstruct them using dummy headforms to analyze kinematics and injury outcomes.</div></div><div><h3>Design</h3><div>Mixed-methods: Observational and experimental.</div></div><div><h3>Setting and Participants</h3><div>An open-access dataset of 118 videos of head impacts at long-term care facilities was used.</div></div><div><h3>Methods</h3><div>Videos were analyzed to determine head impact occurrence, and for each video with a head impact, fall characteristics were recorded. Perpendicular view fall videos were analyzed using validated model-based image-matching software to track head impact velocities. From the tracked videos, falls were reconstructed with a Hybrid III headform mounted on an inverted pendulum to capture impact kinematics.</div></div><div><h3>Results</h3><div>Of the 118 fall videos with head impacts, we tracked 29 videos, finding a normal velocity of 1.76 ± 1.02 m/s and a tangential velocity of 1.27 ± 0.95 m/s. Twenty-three of these impacts were reconstructed, producing peak linear acceleration (PLA) 50.2 ± 36.4 g and peak rotational acceleration (PRA) 2.91 ± 2.16 krad/s². Impacts that occurred against the floor had a 38% higher PLA and a 25% higher PRA compared with wall impacts. Compared with backward and forward falls, lateral falls resulted in 46 and 52 g higher PLA and 3.12 and 4.66 krad/s² higher PRA, respectively.</div></div><div><h3>Conclusions and Implication</h3><div>Fall direction and impact surface influenced head impact accelerations, with certain fall configurations, such as lateral falls against tile, posing a greater risk for traumatic brain injuries. These findings provide critical insights into the biomechanics of older adult head impact falls and highlight the need for targeted fall prevention strategies, such as interventions that reduce the occurrence of lateral falls. In addition, this work offers foundational data for designing protective equipment, including headgear and energy-absorbing flooring, optimized for these specific kinematics.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105545"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634151","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 Effects of Commercial Conversational Agents on Older Adults' Mental Health: A Scoping Review.","authors":"Jolene Zi Tong Teo, Si Qi Yoong, Yi Xuan Chan, Ying Jiang","doi":"10.1016/j.jamda.2025.105523","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105523","url":null,"abstract":"<p><strong>Objectives: </strong>With increasing life expectancy, more older adults are experiencing poor mental health because of the significant life transitions they face. Commercial conversational agents (CAs) are emerging devices that can potentially support older adults' mental well-being. However, limited literature has evaluated the influence of commercial CAs on older adults' mental health. This study aims to examine what is known about the effects of commercial CAs on older adults' mental health and the associated features.</p><p><strong>Design: </strong>This scoping review was conducted in accordance with Arksey and O'Malley's framework.</p><p><strong>Setting and participants: </strong>The review primarily focused on community-dwelling older adults aged 60 and above who used any commercial CAs.</p><p><strong>Methods: </strong>Quantitative, qualitative, mixed-method peer-reviewed studies and dissertations were included. Eleven databases were searched for relevant articles published from January 1, 2010, until April 9, 2024. Data extracted included the author(s), year, country, objective, population details, eligibility criteria, study design, commercial CA type, and findings related to research questions. Inductive basic content analysis was used for data synthesis.</p><p><strong>Results: </strong>Twenty-nine articles from 28 studies (n = 1017 older adults) were included. Five categories were synthesized: social wellness, emotional reactions, cognitive stimulation, autonomy, and depression. Common features impacting older adults' mental health were the CAs' conversational capacity and anthropomorphism, voice-activated functions, music, calling and other functions, and technological limitations. There were more positive than adverse effects on older adults' mental health categories.</p><p><strong>Conclusion and implications: </strong>Commercial CAs can potentially mitigate mental health in older adults, but the evidence is still very preliminary. Their effects must be verified in randomized controlled trials using objective and validated tools and through mixed-method studies.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105523"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743120","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":"Effects of Hand Strength and Walking Speed Combined and in Isolation on the Prediction of Cognitive Decline and Dementia in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis.","authors":"Xiaojie Xie, Deli Li, Meng Zhou, Zhaojun Wang, Xueyan Zhang","doi":"10.1016/j.jamda.2025.105576","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105576","url":null,"abstract":"<p><strong>Objective: </strong>This review aims to further elucidate the relationship between reduced walking speed and grip function and cognitive decline.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Settings and participants: </strong>Adults without dementia.</p><p><strong>Methods: </strong>Six English databases were searched from inception to January 2025. Longitudinal studies that simultaneously investigate the relationship between a decline in grip strength or walking speed and cognitive impairment or dementia were eligible. The meta-analysis was conducted using Stata 17.0. The Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used to assess the quality of evidence in the included studies.</p><p><strong>Results: </strong>A total of 2779 articles were identified through the search strategy. After removing duplicate titles and completing screening, 10 studies were included. Random effects analysis revealed that decreases in physical function (walking speed: hazard ratio [HR], 1.34; 95% CI, 1.13-1.60) and grip strength: HR, 1.30; 95% CI, 1.14-1.49) were significantly associated with decreases in cognitive ability, and this correlation became even more pronounced when pace and grip strength were assessed jointly (HR, 2.72; 95% CI, 1.20-6.17). The results of the subgroup analysis revealed that the study location, follow-up time, cognitive assessment method, sex ratio of the subjects, and other factors affected the results of the study.</p><p><strong>Conclusions and implications: </strong>This study suggests that grip strength and walking speed are important predictors of cognitive decline and dementia, and highlights the significance of the comprehensive assessment. Early intervention before middle-aged and older adults enter the clinical stage of dementia is needed, which requires standardized and rigorous assessment.The sequential relationships between hand strength and walking speed in relation to different developmental stages of dementia, as well as how they can be integrated with objective indicators to facilitate diagnosis, need to be further investigated.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105576"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743109","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 Effectiveness of Tai Chi Assisted by Virtual Environments for Chronic Musculoskeletal Pain.","authors":"Rui Wang, Hao-Yu Wang","doi":"10.1016/j.jamda.2025.105570","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105570","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105570"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743117","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":"Telehealth Use at the End of Life Among US Nursing Home Residents.","authors":"Maki Karakida, Yaoting Li, Hye-Young Jung, Mark Aaron Unruh, Christie Lee Luo, Phyllis Johnson, Jiani Yu","doi":"10.1016/j.jamda.2025.105574","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105574","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105574"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743114","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":"Reply to the Letter to the Editor Regarding: \"Clinical Efficacy of Virtual Reality Cave Automatic Virtual Environments (CAVE) for Chronic Musculoskeletal Pain in Older Adults: A Randomized Controlled Trial\".","authors":"Regina Wing Shan Sit, Hermione Hin Man Lo","doi":"10.1016/j.jamda.2025.105571","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105571","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105571"},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743112","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":"What do Professionals Think of Specific Care Recommendations for Vascular Cognitive Impairment? A Delphi Study With Health Care Professionals","authors":"Sara A.J. van de Schraaf MSc ,&nbsp;Hanneke F.M. Rhodius-Meester MD, PhD ,&nbsp;Majon Muller MD, PhD ,&nbsp;Johanna M.A. Visser-Meily MD, PhD ,&nbsp;Marjolein E. de Vugt PhD ,&nbsp;Eefje M. Sizoo MD, PhD ,&nbsp;Cees M.P.M. Hertogh MD, PhD","doi":"10.1016/j.jamda.2025.105546","DOIUrl":"10.1016/j.jamda.2025.105546","url":null,"abstract":"<div><h3>Objectives</h3><div>Vascular cognitive impairment (VCI) is an umbrella term covering all cognitive impairment from mild cognitive deficits to dementia due to vascular etiologies. VCI is highly prevalent within dementia and stroke care pathways, but specific recommendations for care for people with VCI are lacking. Therefore, we formulated specific recommendations for care for people with VCI and tested these in a panel of health care professionals.</div></div><div><h3>Design</h3><div>Modified Delphi study.</div></div><div><h3>Setting and Participants</h3><div>Purposefully sampled health care professionals in the dementia and stroke fields.</div></div><div><h3>Methods</h3><div>Based on Dutch care standards for dementia and stroke and previous studies, the research team formulated 27 statements. In 3 rounds, participants were asked on a 4-point Likert scale how much they agreed with statements. They could elaborate on their answer in open fields. After each round, level of agreement was calculated. Subsequently, it was evaluated whether consensus was reached. Qualitative data guided potential modifications to the statements and was analyzed for overarching themes in argumentation.</div></div><div><h3>Results</h3><div>Thirty-four participants (primary and secondary care physicians, nurses, psychologists, occupational therapists, and case managers in dementia care) were included in the expert panel. Of the formulated statements, 23 were accepted after 3 rounds. Accepted statements included recommendations on recognition and management of specific symptoms, awareness of care opportunities in and collaboration between care pathways and networks, and the importance of timely care. Some nuancing comments were raised on feasibility and specificity of the recommendations.</div></div><div><h3>Conclusions and Implications</h3><div>Experts agreed on multiple specific recommendations for VCI care across the patient journey, balancing specific and targeted care with further integration of the different care networks. Despite some concerns on feasibility and the balance between disease-centered and person-centered care, the expert-agreed statements can provide guidance in striving toward tailored care and aid in bringing together stroke and dementia networks for people with VCI.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105546"},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}