Journal of the American Medical Directors Association最新文献

{"title":"Health Care Use, Care Settings, and Location of Death for People With Schizophrenia in Long-Term Care.","authors":"Katie Dover, Jess G Fiedorowicz, David Kirkwood, Marco Solmi, James M Bolton, Sarina R Isenberg, Wenshan Li, Alyson Mahar, Shirley H Bush, Michael Bonares, Jodi D Edwards, Simon Hatcher, Naheed Dosani, Peter Lawlor, Harvey M Chochinov, Paul Kurdyak, Martin Wellman, Caroline Franck, Alexandre Rochon, Peter Tanuseputro, Colleen Webber","doi":"10.1016/j.jamda.2025.105719","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105719","url":null,"abstract":"<p><strong>Objective: </strong>To determine if health care settings in the last year of life and location of death differ between long-term care (LTC) residents with and without schizophrenia.</p><p><strong>Design: </strong>A retrospective cohort study using health administrative data.</p><p><strong>Setting and participants: </strong>All adults who died in Ontario between January 1, 2010, and December 31, 2019, who were living in LTC homes 1 year before death, and who died of natural causes.</p><p><strong>Methods: </strong>Schizophrenia was ascertained using a validated administrative data algorithm. We used descriptive statistics, negative binomial regression, and logistic regression to compare health characteristics, health care use, and location of death for individuals with and without schizophrenia in the last year of life.</p><p><strong>Results: </strong>Of 135,560 total LTC residents, 5670 (4.2%) had a diagnosis of schizophrenia. LTC residents with schizophrenia died on average 7 years earlier (standardized difference = 0.75) yet were more likely to have no recorded chronic health conditions (standardized difference = 0.19). Those with schizophrenia had significantly higher rates of hospitalizations (adjusted rate ratio = 1.22, 95% confidence interval = 1.17-1.26) and emergency department visits (adjusted rate ratio = 1.14, 95% confidence interval = 1.10-1.18) in the last year of life, adjusted for age, sex, cause of death, and year of death. This finding was observed for both mental health-related and non-mental health-related hospitalizations and emergency department visits. LTC residents with schizophrenia were also more likely to die during a mental health-related (standardized difference = 0.21) or non-mental health-related (standardized difference = 0.15) hospitalization, with lower odds of dying in LTC (adjusted odds ratio, 0.83; 95% confidence interval, 0.78-0.88).</p><p><strong>Conclusions and implications: </strong>LTC residents with schizophrenia have higher rates of acute care use and are more likely to die in hospital compared with residents without schizophrenia. More research is necessary to understand differences in care provisions for LTC residents with schizophrenia and understand how LTC facilities can meet the unique needs of this vulnerable population.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105719"},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310085","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":"Short Physical Performance Battery or Chair Stand: Which Better Predicts Disability Among High-Functioning Older Adults?","authors":"Roberta de Oliveira Máximo, Mariane Marques Luiz, Sara Souza Lima, Andrew Steptoe, Cesar de Oliveira, Tiago da Silva Alexandre","doi":"10.1016/j.jamda.2025.105720","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105720","url":null,"abstract":"<p><strong>Objective: </strong>To compare the Short Physical Performance Battery (SPPB) and Chair Stand Test (CST) in terms of their ability to identify the risk of incident disability in instrumental activities of daily living (IADL) and basic activities of daily living (BADL) over an 8-year follow-up among high-functioning older adults.</p><p><strong>Design: </strong>Longitudinal study.</p><p><strong>Setting and participants: </strong>A sample of 2386 participants from the English Longitudinal Study of Ageing (ELSA) who were free of IADL/BADL disability and had a gait speed greater than 0.8 m/s at baseline.</p><p><strong>Methods: </strong>Receiver operating characteristic curves were used to evaluate the accuracy of the SPPB and CST to identify the risk of incident IADL/BADL disability. Subsequently, the trajectories of incident IADL/BADL disability were analyzed according to the SPPB and CST cutoff points using generalized linear mixed models adjusted for sociodemographic, behavioral, and clinical characteristics.</p><p><strong>Results: </strong>Performance in the SPPB ≤11 points and CST ≥11.5 seconds more accurately identified the risk of incident IADL/BADL disability than SPPB ≤10 points and CST >15 seconds, which are the cutoff points most commonly recommended in the literature to date. Finally, the trajectories of incident IADL/BADL disability were similar for SPPB ≤11 points and CST ≥11.5 seconds.</p><p><strong>Conclusions and implications: </strong>SPPB ≤11 points and CST ≥11.5 seconds more accurately identified the risk of incident IADL/BADL disability than previously recommended cutoff points. As both instruments were similar in predicting trajectories of incident disability, the CST may represent a more practical choice for clinical screening, given its simplicity and shorter administration time.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105720"},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310086","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":"Effectiveness of an Artificial Intelligence-Infused SinDance Exergame for Enhancing Physical Functions and Well-Being in Older Adults: A Pilot Randomized Controlled Trial","authors":"Ying Jiang PhD,&nbsp;Kei Oide BSc (Hons),&nbsp;Yue En Chow BSc (Hons),&nbsp;Changwu Chen MSc,&nbsp;Mandy Zhang MMed(FM), MB BCh BAO,&nbsp;Matthew Chin Heng Chua PhD,&nbsp;Si Qi Yoong BSc (Hons)","doi":"10.1016/j.jamda.2025.105701","DOIUrl":"10.1016/j.jamda.2025.105701","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105701"},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208855","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":"An Embedded Pragmatic Clinical Trial of the Individualized Positive Psychosocial Interaction (IPPI) Program","authors":"Katherine M. Abbott PhD ,&nbsp;Allison R. Heid PhD ,&nbsp;Molly Noble MGS ,&nbsp;Amy Kotterman RDN, LD ,&nbsp;Kathleen Unroe MDMHA, MS ,&nbsp;Kimberly Van Haitsma PhD","doi":"10.1016/j.jamda.2025.105700","DOIUrl":"10.1016/j.jamda.2025.105700","url":null,"abstract":"<div><h3>Objectives</h3><div>We implemented a pilot embedded pragmatic clinical trial of the evidence-based Individualized Positive Psychosocial Interaction (IPPI) program for people living with dementia (PLWD) in nursing homes. We sought to answer the following questions: Can staff consistently deliver IPPIs to enrolled residents over 6 months? How does IPPI completion impact the immediate outcome of resident mood? Can we track the impact of IPPI completion on a distal (3-month and 6-month) pragmatic clinical outcome (ie, symptoms of distress) recorded in the Minimum Dataset (MDS) 3.0?</div></div><div><h3>Design</h3><div>Nursing home staff completed an online training on emotion-focused communication and were trained to deliver IPPIs, which are short (ie, 10-minute) protocol-guided, one-on-one preference-aligned, interactions with PLWD. Staff were instructed to complete 2 IPPIs per week per resident for 6 months.</div></div><div><h3>Setting and Participants</h3><div>130 residents from 7 nursing homes.</div></div><div><h3>Methods</h3><div>Pre- and post-IPPI observed emotion evaluations were completed and MDS 3.0 data were collected for all eligible residents in the nursing home community during the study period. Descriptive statistics and frequencies were computed for rates of IPPI completions, sample descriptives, endorsement of mood change, and symptoms of distress at baseline, 3 months, and 6 months.</div></div><div><h3>Results</h3><div>IPPI participants who did not die or discharge from the nursing home completed on average 45 IPPIs over 6 months. In 59% (n = 2813) of IPPIs, mood immediately improved from negative to neutral/positive or from neutral to positive, whereas in 42% (n = 1994) of cases, mood stayed stable. MDS 3.0 data were able to show change over time in symptoms of distress from baseline to 3 months and 6 months, with most improving during the intervention period.</div></div><div><h3>Conclusions and Implications</h3><div>The IPPI program is an effective person-centered intervention for PLWD in nursing homes. It can be integrated into care and improve resident mood, and symptoms of distress can be tracked in existing clinical data.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105700"},"PeriodicalIF":4.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216173","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":"Association Between Residents’ Perceived Importance of Family Involvement in Overall Care Planning and Rehabilitative Therapy Administration in Nursing Homes","authors":"Syed Naqvi BS,&nbsp;Anthony P. Nunes PhD,&nbsp;Kate L. Lapane PhD","doi":"10.1016/j.jamda.2025.105704","DOIUrl":"10.1016/j.jamda.2025.105704","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examines the association between nursing home residents' perceived importance of family involvement in overall care planning and the administration of physical and occupational therapy.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>The study focused on all newly admitted nursing home residents aged 50 years and older who transferred from acute-care facilities in 2019.</div></div><div><h3>Methods</h3><div>We analyzed data from the Minimum Data Set 3.0 for 2,112,330 residents aged 50+ years in US nursing homes. We assessed family involvement in care planning based on the resident's perceived importance of family involvement in care planning, ranging from “Not important at all” to “very important.” Exclusions were residents in hospice, comatose, or life expectancy of less than 6 months. The outcome was defined as a sum of physical and occupational therapy minutes. Adjusted linear regression models were used.</div></div><div><h3>Results</h3><div>Residents who reported “very important” family involvement were older (mean age 78 years) and received more therapy minutes compared with other groups. Those with a lesser preference for family involvement were younger and had higher body mass index, better continence, and less functional impairment. Fewer therapy minutes were received by residents with less family involvement. Residents who considered family involvement \"Not Important at All\" received 15 fewer minutes of therapy (95% CI, −18 to −13) compared with those who deemed it \"very important\" after adjusting for confounders.</div></div><div><h3>Conclusions and Implications</h3><div>The study highlights a link between family involvement in care planning and increased therapy administration in nursing homes. Residents reporting higher preference for family engagement received more therapy minutes, with this pattern consistent across various demographic and health conditions. This finding underscores the importance of family involvement in receipt of therapy and highlights the need for incorporating family engagement strategies in nursing home care planning to ensure equitable and effective care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105704"},"PeriodicalIF":4.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208853","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":"Association of Shorter Secondary One-Leg Standing Time with Loss of Independence or Death in Community-Dwelling Older Adults in the Aizu Cohort Study (LOHAS)","authors":"Yoji Hirayama MD ,&nbsp;Hajime Yamazaki MD, PhD ,&nbsp;Yusuke Ogawa MD, MPH, PhD ,&nbsp;Yoshie Yamada MD, PhD ,&nbsp;Yosuke Yamamoto MD, PhD","doi":"10.1016/j.jamda.2025.105688","DOIUrl":"10.1016/j.jamda.2025.105688","url":null,"abstract":"<div><h3>Objectives</h3><div>Although a previous report indicated that the primary one-leg standing time (OLST), defined as the longer OLST of both legs, is associated with death, the association between secondary OLSTs (the shorter OLSTs) and death remains unclear. This study investigated the association between secondary OLSTs and the loss of independence (LOI) or death.</div></div><div><h3>Design</h3><div>Population-based cohort study.</div></div><div><h3>Setting and Participants</h3><div>This study was conducted in 2 Japanese municipalities. Between 2008 and 2010, bilateral OLSTs were measured in independent adults aged ≥65 years. In total, 3278 participants were included in the primary analysis.</div></div><div><h3>Methods</h3><div>The outcome was a composite of LOI and death. LOI was defined as the need for complete support in basic activities of daily living, corresponding to care levels 3 to 5 of the Japanese long-term care insurance certification. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) and 95% CIs for the association between secondary OLSTs and LOI or death. We also conducted additional analyses limited to those with normal primary OLSTs (≥30 seconds) and evaluated the independent role of secondary OLST.</div></div><div><h3>Results</h3><div>During follow-up (median: 7.22 years), LOI or death occurred in 452 (13.7%) participants. Shorter secondary OLSTs were associated with LOI or death; the multivariable HR (95% CI) was 2.17 (1.67-2.84) in those with secondary OLSTs of &lt;10 seconds, 1.54 (1.13-2.10) for OLSTs of 10-20 seconds, and 0.88 (0.56-1.37) for OLSTs of 20-30 seconds, compared to those with normal secondary OLSTs (≥30 seconds). These associations remained consistent in additional analyses limited to those with normal primary OLSTs.</div></div><div><h3>Conclusions and Implications</h3><div>Shorter secondary OLSTs are risk factors for LOI or death in older adults, even when the primary OLSTs are within the normal range. Assessing OLSTs on both sides is important for predicting prognostic outcomes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105688"},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132608","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":"Simplifying Sarcopenia Screening: A Community-Based Evaluation of Screening and Assessment Combinations","authors":"Tzu-Hao Tseng MD, PhD ,&nbsp;Ting-En Tseng MD ,&nbsp;Yi-Chien Lu PhD ,&nbsp;Ning-Huei Sie PhD ,&nbsp;Chih-Chien Hung MD ,&nbsp;Chung-Yi Li PhD ,&nbsp;Der-Sheng Han MD, PhD ,&nbsp;Chih-Hsing Wu MD, PhD ,&nbsp;Chen-Yu Wang PhD ,&nbsp;Shau-Huai Fu MD, PhD","doi":"10.1016/j.jamda.2025.105703","DOIUrl":"10.1016/j.jamda.2025.105703","url":null,"abstract":"<div><h3>Objectives</h3><div>Sarcopenia is a serious condition in older individuals, characterized by muscle loss and physical decline. Early detection is crucial but challenging due to subtle symptoms. The Asian Working Group for Sarcopenia (AWGS) 2019 consensus recommends detection for possible sarcopenia, but the effectiveness of the suggested tools varies, and the ideal screening combination remains unclear. This study aims to identify the most suitable screening pathway for early sarcopenia detection in community settings.</div></div><div><h3>Design</h3><div>Prospective cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Participants were recruited from locations offering congregated meal services between October 2018 and November 2019. Eligible participants were community-dwelling residents aged 50 years or older who were capable of completing the full sarcopenia survey.</div></div><div><h3>Methods</h3><div>All assessments recommended in the AWGS 2019 algorithm were conducted. We organized these tests into 12 distinct pathways, each combining a case-finding method with an assessment, either a muscle strength test or a physical performance test. Skeletal muscle mass was measured using bioelectrical impedance analysis. The validity of different combinations was then compared.</div></div><div><h3>Results</h3><div>A total of 567 participants were enrolled in this study. Among the 3 case-finding tools, calf circumference had the highest sensitivity and the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) had the lowest (80% vs 8%). Across the 12 different screening combinations tested, pathways involving calf circumference outperformed those involving the SARC-F or the SARC-F combined with calf circumference (SARC-CalF). Notably, the combination of calf circumference and handgrip strength emerged as the optimal pathway, offering the best sensitivity and satisfactory specificity, along with superior discrimination ability (indicated by receiver operating characteristic analysis) and prediction accuracy (indicated by Brier score).</div></div><div><h3>Conclusions and Implications</h3><div>The combination of calf circumference and handgrip strength is the most effective screening pathway for detecting sarcopenia in community settings. Its performance is even close to conducting all the tests outlined in the AWGS 2019 consensus. This simplified pathway may serve as a practical screening option in community settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105703"},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208857","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":"Did Site-Neutral Payment for Long-Term Care Hospitals Reduce Financial Incentives to Time Discharge?","authors":"Rashmita Basu PhD ,&nbsp;Anil N. Makam MD, MAS","doi":"10.1016/j.jamda.2025.105689","DOIUrl":"10.1016/j.jamda.2025.105689","url":null,"abstract":"<div><h3>Objectives</h3><div>Historically, fee-for-service Medicare reimbursed long-term care hospital (LTCH) stays as a lump-sum payment, which was substantially reduced for discharges before the diagnosis-specific short-stay outlier (SSO) threshold day, leading to large spikes in discharges on the threshold day. The objective of this study was to examine if LTCHs similarly time discharge at the SSO threshold for blended site-neutral payment cases compared with standard payment cases.</div></div><div><h3>Design</h3><div>Cross sectional.</div></div><div><h3>Setting and Participants</h3><div>Cohort of Medicare beneficiaries.</div></div><div><h3>Methods</h3><div>We used the national 100% LTCH Medicare Provider Analysis and Review Limited Data Set for fiscal year 2017 and exploited differences in prior ICU days using a multinomial model adjusting for patient demographics and case-mix. We only included stays where payment status was solely determined by prior ICU days. Our primary outcome was the discharge on the SSO threshold day. The exposure was an indicator variable for ≥3 intensive care unit days in the preceding acute care hospital, where yes equated to standard payment and no was a blended site-neutral case.</div></div><div><h3>Results</h3><div>Among 10,910 LTCH discharges (48% of cases were aged 65-74 years, 52% were female, 25% were non-white, 24% were blended site-neutral cases), we found that despite an approximately 50% reduction in payment increase, the spike in the adjusted probability of discharge on the SSO threshold day vs the day before was similar for blended site-neutral (20% vs 2%) and standard payment cases (16% vs 1%), with an adjusted difference of −3% (95% CI, −5% to 2%).</div></div><div><h3>Conclusions and Implications</h3><div>Unwarranted spikes in discharge on the SSO threshold persisted despite a 50% reduction in the payment increase, a crucial insight for policymakers and payers who seek to avoid incentives to strategically time discharges. LTCH stays should be reimbursed without meaningful payment increases based on length of stay thresholds.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105689"},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191914","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":"Latent Cognitive Profiles and Demographic Determinants in Older Adults without Dementia: A National Cross-Sectional Study","authors":"Jiaying Li PhD,&nbsp;Junxin Li PhD","doi":"10.1016/j.jamda.2025.105697","DOIUrl":"10.1016/j.jamda.2025.105697","url":null,"abstract":"<div><h3>Objectives</h3><div>Traditional cognitive well-being classification in older adults often overlooks domain-specific deficits. We aimed to validate previously identified distinct cognitive profiles among those without dementia and examine demographic predictors to guide tailored interventions for equitable healthy aging.</div></div><div><h3>Designs</h3><div>Cross-sectional study.</div></div><div><h3>Settings/Participants</h3><div>Community-dwelling adults aged ≥65 years without dementia from the National Health and Aging Trends Study (NHATS).</div></div><div><h3>Methods</h3><div>We performed a split-sample validation analysis on the identified latent profile analysis of episodic memory, executive function, orientation, psychomotor function, visual attention, and working memory. Multinomial logistic regression examined demographic predictors of each profile with Holm-Bonferroni correction.</div></div><div><h3>Results</h3><div>After the split-sample validation analysis, we confirmed that 5 latent profiles emerged (n = 2219): profile 1, overall intact (50.5% of all samples); profile 2, isolated moderate orientation impairment (15.6%); profile 3, mild global impairment with preserved orientation (22.0%); profile 4, mild global impairment with significant orientation impairment (5.5%); and profile 5, moderate global impairment (6.2%). Compared with profile 1, profile 2 was exclusively related to aged ≥90 years, with normal income negatively associated. Similarly, profile 3 was linked to ages 85-89 and ≥90 years, as well as Black or Hispanic ethnicity. Profile 4 was positively associated with aged ≥90 years and Black or Hispanic ethnicity, and negatively associated with normal income. Profile 5 was associated with aged ≥90 years and Black or Hispanic ethnicity, whereas normal income and self-rated good or excellent health were negatively associated with profile 5 (all adjusted <em>P</em> &lt; .05).</div></div><div><h3>Conclusions and Implications</h3><div>About half of older adults exhibit domain-specific deficits, suggesting tailored interventions are essential. Profile 5 needs comprehensive strategies, whereas orientation-focused training could benefit profiles 2, 3, and 4. Demographic factors—particularly age, ethnicity, and income—should guide customization to enhance intervention participation and adherence.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105697"},"PeriodicalIF":4.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199491","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":"Has Increased Medicaid Spending on Home- and Community-Based Services Reduced Unmet Needs in Activities of Daily Living Care among Community-Dwelling Older Adults with Dementia? Evidence from 2008 to 2020","authors":"Zijing Cheng PhD ,&nbsp;Hochang B. Lee PhD ,&nbsp;Daniel D. Maeng PhD ,&nbsp;Elaine L. Hill PhD ,&nbsp;Yue Li PhD","doi":"10.1016/j.jamda.2025.105691","DOIUrl":"10.1016/j.jamda.2025.105691","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the potential impact of Medicaid total long-term services and supports (LTSS) expenditures and the proportion allocated to home- and community-based services (HCBS) on unmet needs among community-dwelling older adults with dementia.</div></div><div><h3>Design</h3><div>This is a retrospective study using nationally representative, longitudinal data and quasi-experimental approach.</div></div><div><h3>Setting and Participants</h3><div>A total of 2722 respondent-waves of community-dwelling older adults who participated in at least 1 of the 7 waves of Health and Retirement Study interviews between 2008 and 2020 and were identified as having dementia.</div></div><div><h3>Methods</h3><div>Unmet needs were assessed using a binary variable indicating whether respondents who reported difficulties with activities of daily living (ADL) did not receive the necessary assistance. Generalized linear models (GLMs) with a logit link function and binomial distribution, clustered at the individual level, were used for both bivariate and multivariable analyses. To address potential endogeneity, a 2-stage residual inclusion (2SRI) analysis was conducted using state education expenditures per pupil as an instrumental variable (IV). Additionally, the Durbin-Wu-Hausman (DWH) test was performed to assess endogeneity.</div></div><div><h3>Results</h3><div>Both GLM and IV regressions indicated that an increase in the share of HCBS relative to total Medicaid LTSS expenditures was associated with a significant reduction in unmet ADL needs among dementia individuals (OR_GLM 0.77, 95% CI_GLM 0.59-0.98, <em>P</em>_GLM = 0.03; OR_IV 0.76, 95% CI_IV 0.58-1.00, <em>P</em>_IV = 0.05). However, total Medicaid LTSS expenditures showed no significant association with patient unmet needs in either model. The DWH test for endogeneity supported the GLM estimates, confirming that total Medicaid LTSS expenditure was exogenous (<em>P</em> = .64). Sensitivity analyses excluding the total Medicaid LTSS expenditures yielded consistent estimates and suggested no collinearity between the independent variables.</div></div><div><h3>Conclusions and Implications</h3><div>A higher proportion of Medicaid LTSS expenditures allocated to HCBS can potentially reduce unmet needs for ADL among community-dwelling older adults with dementia, supporting efforts to shift long-term care from institutional to home- and community-based settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105691"},"PeriodicalIF":4.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191915","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}