Journal of the American Medical Directors Association最新文献

{"title":"Expanding PACE Benefits/Services to Naturally Occurring Retirement Communities and More","authors":"Richard G. Stefanacci DO, MGH, MBA, AGSF, CMD","doi":"10.1016/j.jamda.2025.105501","DOIUrl":"10.1016/j.jamda.2025.105501","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105501"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649400","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":"Physicians Who Provide Primary Care in US Nursing Homes: Characteristics and Care Patterns","authors":"Seiyoun Kim PhD ,&nbsp;Hyunkyung Yun MS, MSW ,&nbsp;Yutong Zhang MS ,&nbsp;Soong-Nang Jang PhD ,&nbsp;Mark Aaron Unruh PhD ,&nbsp;Hye-Young Jung PhD","doi":"10.1016/j.jamda.2024.105475","DOIUrl":"10.1016/j.jamda.2024.105475","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine practice trends and characteristics of primary care physicians providing care in US nursing homes.</div></div><div><h3>Design</h3><div>Retrospective cohort study using Medicare Fee-for-Service claims.</div></div><div><h3>Setting and Participants</h3><div>Physicians who provided primary care to long-stay nursing home residents.</div></div><div><h3>Methods</h3><div>Residents were attributed to physicians based on a plurality of evaluation and management visits in a given year. Trends in the proportion of nursing home residents seen by physicians in each primary care specialty over the period 2012-2019 were examined using linear regression. Comparisons of resident, physician, and nursing home characteristics in 2019 were made using analysis of variance tests and χ² tests for multiple comparisons.</div></div><div><h3>Results</h3><div>Internal medicine specialists provided care to the largest portion of nursing home residents (47.3%), followed by family practitioners (42.6%), geriatricians (4.8%), general practice physicians (2.8%), and physical medicine and rehabilitation specialists (2.5%). Geriatricians and physical medicine and rehabilitation physicians had the highest average percentage of services provided in nursing homes (63.8% and 73.0%, <em>P</em> &lt; .001) and were more likely to be specialized nursing home physicians (42.0% and 61.3%, <em>P</em> &lt; .001). They also tended to care for residents with more complex needs. Geriatricians were more frequently concentrated in higher-quality nursing homes with more resources, and in metropolitan areas, compared with facilities where other types of physicians provided care.</div></div><div><h3>Conclusions and Implications</h3><div>There is wide variation associated with physician primary care specialty in the amount of care provided to nursing homes residents, in the characteristics of residents treated, and in the types of nursing homes where primary care physicians provide care. Further study is warranted to determine the sources of this variation, including whether it is associated with systemic problems in nursing home care (eg, shortages of geriatricians, low clinician reimbursements, undervaluation of nursing home clinicians compared with their counterparts, malpractice liability).</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105475"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066528","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":"Directions & Connections","authors":"","doi":"10.1016/S1525-8610(25)00156-2","DOIUrl":"10.1016/S1525-8610(25)00156-2","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105639"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906118","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":"General Information","authors":"","doi":"10.1016/S1525-8610(25)00155-0","DOIUrl":"10.1016/S1525-8610(25)00155-0","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105638"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906338","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":"Factors Associated With Mood Transitions Among Older Canadian Long-Term Care Residents: A Multistate Transition Model.","authors":"Reem T Mulla, John P Hirdes, Carrie McAiney, George Heckman","doi":"10.1016/j.jamda.2025.105612","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105612","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines the complex transitions between the different mood states and absorbing states out of long-term care settings, as well as the factors affecting those transitions.</p><p><strong>Design: </strong>A retrospective longitudinal analysis of older residents in Canadian long-term care homes in 3 provinces.</p><p><strong>Setting and participants: </strong>Residents residing in long-term care homes in 3 Canadian provinces (Alberta, British Columbia, and Ontario) over a 10-year period from January 2010 to February 2020, with an age of at least 65.</p><p><strong>Methods: </strong>We used a 1-step Markov multistate transition model to examine transitions in mood over time as well as the factors affecting those transitions using the standardized interRAI MDS 2.0 comprehensive health assessment. The MDS 2.0 assessments are completed by trained assessors within 2 weeks of the resident's admission.</p><p><strong>Results: </strong>Our results showed that 46% of residents initially present with no mood disturbance on admission and 31% with mild mood disturbance on admission and 23% with moderate/severe mood disturbance on admission. Factors associated with worsening of mood include aggressive behavior; health instability; impaired cognition; major comorbidities; pain or poor sleep; conflict with family, friends, or other residents; and anxiety. Of the facility-level attributes, Alberta was associated with worsening of mood.</p><p><strong>Conclusions and implications: </strong>Our study identified key factors influencing mood transitions, highlighting pain and aggressive behavior as significant contributors to worsening mood, both of which are modifiable through targeted interventions. The findings suggest substantial opportunities for mood improvement in long-term care settings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105612"},"PeriodicalIF":4.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006201","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":"Household Air Pollution, Physical Activity, and the Risk of Frailty Among Middle-Aged and Older Adults: A Cohort Study","authors":"Xiaosheng Dong PhD ,&nbsp;Xiangren Yi PhD ,&nbsp;Jiaqiang Xiao MD ,&nbsp;Nuo Yi PhD ,&nbsp;Huihui Wang MD ,&nbsp;Xiao Hou PhD ,&nbsp;Chengchao Zhou PhD","doi":"10.1016/j.jamda.2025.105525","DOIUrl":"10.1016/j.jamda.2025.105525","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to explore the relationship among household air pollution, physical activity (PA), and the risk of frailty among middle-aged and older adults.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 10,561 participants from the 2011–2020 China Health and Retirement Longitudinal Study (CHARLS) were included.</div></div><div><h3>Methods</h3><div>PA was assessed using the International Physical Activity Questionnaire (IPAQ), and household air pollution was measured based on cooking and heating. Frailty risk was evaluated using the frailty index (FI). Cox proportional hazards regression models were used for statistical analysis.</div></div><div><h3>Results</h3><div>During the follow-up, 1101 participants developed frailty. After adjusting for all covariates, compared with participants who consistently used solid fuels, transforming solid fuels to cleaner fuels for cooking [hazard ratio (HR), 0.671; 95% CI, 0.560–0.803] and heating (HR, 0.373; 95% CI, 0.292–0.479) reduced the risk of frailty by 32.9% and 62.7%, respectively. Conversely, transforming cleaner fuels to solid fuels for cooking increased the risk of frailty by 27.5% (HR, 1.275; 95% CI, 1.006–1.599). Sufficient PA for 3 to 4 years (HR, 0.658; 95% CI, 0.542–0.798) and for ≥5 years (HR, 0.490; 95% CI, 0.398–0.602) reduced frailty risk by 34.2% and 51.0%, respectively. Both transforming solid household fuels to cleaner household fuels with 3 or more years of sufficient PA and transforming cleaner household fuels to solid household fuels with 3 or more years of sufficient PA were significantly associated with lower frailty risk.</div></div><div><h3>Conclusions and Implications</h3><div>Both transforming solid household fuels to cleaner household fuels and maintaining sufficient PA for 3 or more years were significantly associated with lower risk of frailty. Conversely, transforming cooking-related cleaner fuels to cooking-related solid fuels can increase frailty risk. In addition, 3 or more years of sufficient PA can superimpose the benefits of transforming solid household fuels to cleaner household fuels, offsetting the negative effects of transforming cleaner household fuels to solid household fuels.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105525"},"PeriodicalIF":4.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537364","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 MPH, MS,&nbsp;Yaoting Li MS,&nbsp;Hye-Young Jung PhD,&nbsp;Mark Aaron Unruh PhD,&nbsp;Christie Lee Luo MPH,&nbsp;Phyllis Johnson MBA,&nbsp;Jiani Yu PhD","doi":"10.1016/j.jamda.2025.105574","DOIUrl":"10.1016/j.jamda.2025.105574","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105574"},"PeriodicalIF":4.2,"publicationDate":"2025-04-28","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":"Solution to Improve State Health Outcomes and Access to Care for Medicare Beneficiaries: Full Practice of APRNs","authors":"Alisha Harvey Johnson PhD, RN ,&nbsp;Isabella Zaniletti PhD, MA ,&nbsp;Julie Miller DNP, MBA, FNP-BC, NEA-BC ,&nbsp;Lori L. Popejoy PhD, RN ,&nbsp;Marilyn J. Rantz PhD, RN","doi":"10.1016/j.jamda.2025.105585","DOIUrl":"10.1016/j.jamda.2025.105585","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the influence of advanced practice registered nurse (APRN) restrictive practice laws on the number of APRNs providing services in various care settings, acute, primary, nursing home (long stay), and skilled nursing facility (short stay); understand the relationship between restrictive practice and number of Medicare beneficiary services across settings; and to understand the relationship between restrictive practice and overall quality of health care as indicated by Commonwealth Report state health rankings.</div></div><div><h3>Design</h3><div>One large federal data set and 2 national annual reports with state rankings from 2022 were used in this comparative, descriptive study.</div></div><div><h3>Settings and Participants</h3><div>We summarized number of services × APRN × 1000 patients by state practice restriction (full, reduced, or restricted) and setting of care.</div></div><div><h3>Methods</h3><div>We evaluated interstate variability and reported states that performed significantly above or below the overall median across all settings. Last, we fitted a linear regression model to explore the association of number of services × APRN × 1000 beneficiaries with Commonwealth Report health ranking.</div></div><div><h3>Results</h3><div>APRNs in full-practice states provide significantly more services than in reduced or restricted, regardless of care setting. After adjusting for practice restriction and care setting, no significant association was found between the number of services × APRN × 1000 beneficiaries and the state overall health ranking (regression coefficient <em>β</em> = 0.003, <em>P</em> = .736).</div><div>However, practice restriction was found to be highly significant, with full-practice states indicating overall better health (<em>P</em> &lt; .001), regardless of setting.</div></div><div><h3>Conclusions and Implications</h3><div>Commonwealth Health ranking was found to be highly significant, with full-practice states indicating overall better health, 16 to 18 rankings better than reduced or restricted practice (<em>P</em> = .001), remaining consistent across all settings of care. Restrictive practice laws reduce access to care. It is time states with restrictive and reduced practice reexamine their APRN practice laws to enable Medicare beneficiaries increased access to care and improve overall health outcomes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105585"},"PeriodicalIF":4.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865122","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":"Excessive Burden of Hyperglycemia Along With Hypoglycemia in Long-Term Care Facilities Identified by Continuous Glucose Monitoring","authors":"Medha N. Munshi MD ,&nbsp;Christine Slyne BA ,&nbsp;Atif Adam MD ,&nbsp;Noa Krakoff BS ,&nbsp;Haley Brabant BS ,&nbsp;Molly Savory BS ,&nbsp;Jennifer Maurer DNP ,&nbsp;Elena Toschi MD","doi":"10.1016/j.jamda.2025.105590","DOIUrl":"10.1016/j.jamda.2025.105590","url":null,"abstract":"<div><h3>Objectives</h3><div>Recommendations for diabetes care in long-term care facilities (LTC) focus on the avoidance of hypoglycemia and symptomatic hyperglycemia. Using continuous glucose monitoring (CGM), we evaluated the current state of glycemia in LTC residents with multiple comorbidities.</div></div><div><h3>Design</h3><div>Cross-sectional prospective observational study.</div></div><div><h3>Settings and Participants</h3><div>Participants with diabetes on 1 or more glucose-lowering medications residing in 1 of 8 LTC facilities in Ohio and Michigan.</div></div><div><h3>Methods</h3><div>A masked Dexcom G6 pro CGM was placed for 10 days on LTC residents. Clinical and demographic information was collected from medical records.</div></div><div><h3>Results</h3><div>Sixty-five residents [median age 68 years (range 44–84 years), 51% female, 100% with type 2 diabetes] completed the study. Overall, 68% of the cohort used insulin and 64% were on non-insulin agents (11% on sulfonylurea). The mean A1c of the cohort was 7.2% ± 1.5%. CGM data showed 26% of the cohort with ≥1% time spent in hypoglycemia (time &lt;70 mg/dL). A larger burden of severe hyperglycemia (sensor glucose &gt;250 mg/dL) was seen, with 52% of the cohort spending &gt;10% time, 37% spending &gt;25%, and 18% spending &gt;50% time in severe hyperglycemia. The cohort had a median of 13 comorbid conditions, taking 19 medications daily, with 86% having functional disabilities and 63% reporting a recent fall. Fifty-four percent of the cohort had a body mass index (BMI) &gt;30 kg/m² and 22% had a BMI &gt;40 kg/m².</div></div><div><h3>Conclusions and Implications</h3><div>In this multimorbid cohort of residents with diabetes living in LTC facilities, we identified a high burden of both hypoglycemia and severe hyperglycemia, despite optimal control of A1c. More consistent use of CGM may help to identify glycemic excursions and actionable glucose patterns to improve therapeutic decision-making by clinicians.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105590"},"PeriodicalIF":4.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869037","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":"Polypharmacy and Mild Cognitive Impairment in Older Adults: A 3-year Study of DO-HEALTH","authors":"Caroline de Godoi Rezende Costa Molino PhD ,&nbsp;Konstantin Baumann MD ,&nbsp;Stephanie Gaengler PhD ,&nbsp;Tatjana Meyer-Heim MD ,&nbsp;Angélique Sadlon MD, PhD ,&nbsp;Gregor Freystaetter MD ,&nbsp;Reto W. Kressig MD ,&nbsp;Andreas Egli MD ,&nbsp;Heike A. Bischoff-Ferrari MD, DrPH","doi":"10.1016/j.jamda.2025.105586","DOIUrl":"10.1016/j.jamda.2025.105586","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between polypharmacy and mild cognitive impairment (MCI) at baseline and over 3 years in community-dwelling older adults.</div></div><div><h3>Design</h3><div>Observational analysis of the DO-HEALTH trial.</div></div><div><h3>Setting and Participants</h3><div>Community-dwelling adults aged ≥70 years with good cognitive function and without major diseases at baseline.</div></div><div><h3>Methods</h3><div>Main exposure was polypharmacy at baseline (≥5 medications). The outcome was MCI (Montreal Cognitive Assessment [MoCA] score &lt;26), assessed at baseline and years 1, 2, and 3. Logistic regression and generalized estimating equations (GEEs) for repeated binary outcomes were used for the cross-sectional and longitudinal analysis, respectively. Minimally adjusted models included age, sex, prior fall, study site, body mass index, and education. Fully adjusted models additionally adjusted for mental health and multimorbidity. GEE models also accounted for time and DO-HEALTH treatment effects. Sensitivity analysis used a stricter MCI definition (MoCA &lt; 24).</div></div><div><h3>Results</h3><div>A total of 2153 participants completed MoCA at baseline. Baseline MCI prevalence was higher in participants with polypharmacy compared with those with no polypharmacy (MCI &lt; 26: 53.5% vs 46.5%; MCI &lt; 24: 34.9% vs 17.2%). Polypharmacy was associated with greater MCI odds at baseline in the minimally adjusted models (MoCA &lt; 26: odds ratio [OR], 1.32; 95% CI, 1.05–1.66; MoCA &lt; 24: OR, 1.37; 95% CI, 1.06–1.79). Over 3 years, polypharmacy was associated with increased MCI odds in the minimally adjusted models (MoCA &lt; 26: OR, 1.28; 95% CI, 1.08–1.52; MoCA &lt; 24: OR, 1.33; 95% CI, 1.07–1.65). Notably, these associations were somewhat attenuated and nonsignificant after controlling for mental health and multimorbidity.</div></div><div><h3>Conclusion and Implications</h3><div>Our findings suggest that MCI is more prevalent in older adults with polypharmacy compared with those without polypharmacy. Although polypharmacy was associated with MCI at baseline and over 3 years, these associations were attenuated by mental health and multimorbidity, suggesting that mental health and multimorbidity contribute to both polypharmacy and MCI.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105586"},"PeriodicalIF":4.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811589","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}