Journal of the American Medical Directors Association最新文献

{"title":"Care Needs and Self-Sufficiency Assessment of Home Care Clients.","authors":"Zain Pasat, Bastiaan Van Grootven, Eline Kooijmans, Jasmin Paulamäki, Luke A Turcotte, John P Hirdes, Andrew P Costa","doi":"10.1016/j.jamda.2025.105572","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105572","url":null,"abstract":"<p><strong>Objectives: </strong>Assessing the changing care needs of home care clients is challenging due to the increasing multimorbidity and heterogeneity of geriatric syndromes, including frailty, functional decline, and cognitive impairment. We described the correlation between subjective judgment of changes in self-sufficiency and measured changes in health status.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting and participants: </strong>A total of 70,369 home care clients ≥65 years of age dwelling in a private residence in Ontario, Canada, with 2 interRAI Home Care assessments conducted between July 2021 and December 2023 were included.</p><p><strong>Methods: </strong>We compared assessor-judged changes to self-sufficiency with changes in functioning, personal support and health service needs, cognition, health instability, and pain between the first and second assessments using validated outcome scales and algorithms derived from the interRAI Home Care. We used contingency tables to assess whether any change in outcome scales was consistent with self-sufficiency. We used matched-pairs rank-biserial correlation to compute effect sizes of the magnitude of change in outcome scales within each assessor-judged stratum. We conducted a sensitivity analysis, stratifying the cohort into assessments completed within and after 6 months.</p><p><strong>Results: </strong>A total of 50.6% of clients were judged by an assessor as having deteriorated in self-sufficiency over the last 90 days. Assessor-judged changes in self-sufficiency were associated with personal support and care needs, health instability, and activities of daily living performance. Worsened self-sufficiency was less associated with pain, whereas improved self-sufficiency was weakly associated with improved cognition.</p><p><strong>Conclusions and implications: </strong>Assessor-judged changes in self-sufficiency strongly correlate with changes in health status and care needs. Subjective clinician summaries of health changes show validity in modifying care plans.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105572"},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743066","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":"\"They Want in\": Nursing Home Administrators' Experiences Managing COVID-19 Pandemic Visitation Restrictions.","authors":"Courtney Hawes, Joan F Brazier, Amy Meehan, Elizabeth White, Jacy Weems, David C Grabowski, Emily A Gadbois","doi":"10.1016/j.jamda.2025.105573","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105573","url":null,"abstract":"<p><strong>Objectives: </strong>To assess how visitation restrictions and protocols were implemented by administrators during the COVID-19 pandemic.</p><p><strong>Design: </strong>This qualitative study consisted of 156 semistructured interviews repeated at 3-month intervals from July 2020 to December 2021.</p><p><strong>Setting and participants: </strong>Interviewers were conducted with administrators of 40 nursing homes across 8 health care markets across the United States.</p><p><strong>Methods: </strong>Interviews were conducted virtually or via phone. Thematic analysis and modified grounded theory were used to identify themes across coded transcripts.</p><p><strong>Results: </strong>Findings demonstrated that in-person visitation restriction was followed by nursing homes using new strategies to maintain relationships between visitors and residents, including virtual visitation and visits through windows. Nursing homes also relied on compassionate care and essential caregivers, allowing family members into nursing homes under certain circumstances; however, visitation was still limited. As in-person visitation began again, nursing homes introduced required screening measures and infection control procedures to prevent the spread of infection. Administrators reported that strategies associated with changes to visitation restrictions received mixed reactions from visitors and residents.</p><p><strong>Conclusions and implications: </strong>Policymakers should clarify future visitation regulations in nursing homes based on insights from administrators while ensuring clear communication and delineation policies for compassionate care and essential caregiver programs. Policymakers and industry experts should reevaluate and clarify the implementation protocols of future visitation mandates among nursing homes based on insights from administrators and ensure clear policies for compassionate care and essential caregiver programs. Additionally, future screening measures should be given additional attention to ensure efficient and productive protocols.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105573"},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743101","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":"Longitudinal, Bidirectional Association between Gait Speed and Cognitive Function in Community-Dwelling Older Adults without Dementia","authors":"Ying-Hao Su MD ,&nbsp;Jeng-Min Chiou PhD ,&nbsp;Chengshi Shiu PhD ,&nbsp;Jen-Hau Chen MD, MPH, PhD ,&nbsp;Yen-Ching Chen ScD","doi":"10.1016/j.jamda.2025.105544","DOIUrl":"10.1016/j.jamda.2025.105544","url":null,"abstract":"<div><h3>Objectives</h3><div>The causal relationship between slow gait speed and poor cognition is uncertain due to potential reverse causality. This study aimed to examine the reciprocal relationship between gait speed and global as well as domain-specific cognitive functions in older adults.</div></div><div><h3>Design</h3><div>Prospective cohort study (2013–2022) including 4 repeated measures.</div></div><div><h3>Settings and Participants</h3><div>Community-dwelling and adults without dementia aged ≥65 recruited at baseline.</div></div><div><h3>Methods</h3><div>Biennial evaluations included assessments of 4-m usual walking speed, global cognition using the Taiwanese version of the Montreal Cognitive Assessment (MoCA), and cognitive domains (memory, executive function, verbal fluency, and attention) using a battery of neuropsychological tests. Cross-lagged models and linear mixed models were used to examine the bidirectional association between gait speed and cognitive functions with adjustment for potential confounders.</div></div><div><h3>Results</h3><div>At baseline, 511 participants were enrolled, and 459 individuals with a mean age of 74.5 years were ultimately analyzed. A 1-SD decrease in gait speed was associated with a 0.07–0.09 SD decrease in subsequent global cognition [<span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 1→2}: 0.07, standard error (SE): 0.03; <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 2→3}: 0.09, SE: 0.04; <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 3→4}: 0.09, SE: 0.04; all <em>P</em> &lt; .05]. Similarly, a 1-SD decrease in global cognition was associated with a 0.18 to 0.19 SD decrease in subsequent gait speed (<span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 1→2}: 0.18, SE: 0.05; <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 2→3}: 0.18, SE: 0.06; <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 3→4}: 0.19, SE: 0.07; all <em>P</em> &lt; .001). In addition, slower gait speed was associated with poor memory, verbal fluency, and executive function, and vice versa. The results of linear mixed models were consistent with the findings obtained from cross-lagged models.</div></div><div><h3>Conclusions and Implications</h3><div>This study found a reciprocal association between gait speed and global or domain-specific cognition. Regularly screening gait speed and cognitive function enables the early detection of declines in physical function and cognition.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105544"},"PeriodicalIF":4.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630528","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":"Individuals With Cognitive Impairment Entering Long-Term Care: Characteristics and Cumulative Incidence of Dementia After Care Entry.","authors":"Andrew P Shoubridge, Maria C Inacio, Tracy Air, Steven L Taylor, Tesfahun C Eshetie, Maria Crotty, Geraint B Rogers, Stephanie L Harrison","doi":"10.1016/j.jamda.2025.105568","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105568","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize individuals entering long-term care facilities (LTCFs) with evidence of cognitive impairment and without a diagnosis of dementia, and to ascertain the cumulative incidence of dementia after care entry.</p><p><strong>Design: </strong>Retrospective cohort study using the Registry of Senior Australians (ROSA) National Historical Cohort.</p><p><strong>Setting and participants: </strong>Individuals aged 65 to 105 years who entered LTCFs between 2009 and 2018, received a cognitive evaluation, and had no recorded dementia diagnosis at the time of care entry.</p><p><strong>Methods: </strong>Cognitive function was determined via the Psychogeriatric Assessment Scales-Cognitive Impairment Scales (PAS-CIS) and defined as none or minimal (PAS-CIS score 0 to <4), mild (4 to <10), or moderate to severe (10 to 21). The cumulative incidence of dementia, determined by aged care assessments, hospitalization, medication, or cause of death, was ascertained for the total cohort and by cognitive impairment status at care entry.</p><p><strong>Results: </strong>In total, 90,122 individuals (median age 85 years; interquartile range [IQR] 81-89; 64.6% female) were studied, of whom 76.6% (n = 69,075) had cognitive impairment, including 51.4% (n = 46,350) with mild and 25.2% (n = 22,725) with moderate to severe impairment. Over a median follow-up of 1.5 years (IQR 0.6-2.9), the cumulative incidence of dementia was 26.8% (95% confidence interval [CI], 26.5-27.1). Stratification by cognitive impairment status showed the cumulative incidence of dementia was 17.4% (95% CI, 16.8-17.9) for none or minimal, 27.3% (95% CI, 26.9-27.8) for mild, and 35.3% (95% CI, 34.7-36.0) for moderate to severe.</p><p><strong>Conclusions and implications: </strong>The cohort of people entering LTCFs with cognitive impairment had a high incidence of dementia diagnosis within 1.5 years after entry. Routine cognitive impairment assessments can inform dementia screening strategies by identifying individuals at higher risk of dementia.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105568"},"PeriodicalIF":4.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730572","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":"Fall Risk-Increasing Drugs and Fall-Related Injuries Among Older Adults in Ontario: A Population-Based Matched Case-Control Study.","authors":"Mahin Delara, Krista M Reich, Wai-Yip Chan, Dallas P Seitz","doi":"10.1016/j.jamda.2025.105567","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105567","url":null,"abstract":"<p><strong>Objectives: </strong>Commonly prescribed medications individually increase the risk of falls. Less is known about the association between multiple fall risk-increasing drug (FRID) use and falls. We examined the association between 12 major FRID classes, alone and in combination and fall-related injuries among older adults in home care (HC) and long-term care (LTC) settings.</p><p><strong>Design: </strong>Matched, case-control study.</p><p><strong>Setting and participants: </strong>HC recipients and LTC residents in Ontario, Canada, from 2008 to 2016.</p><p><strong>Methods: </strong>Cases were matched to controls by sex, age, history of fall, calendar year, and disease risk score. Using multivariable logistic regression, the associations between FRID exposure in the 90 days preceding falls and fall-related injuries that required emergency department or hospitalization were determined with adjusted odds ratios (aORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Exposure to any FRID increased the risk of fall-related injury when compared with non-users in both HC (aOR, 1.34; 95% CI, 1.30-1.40) and LTC (aOR, 1.54; 95% CI, 1.46-1.63) populations. The increased odds of fall-related injuries were evident among most FRID categories, with the highest odds found with dopaminergic agents and antidepressants in both HC and LTC populations. The use of multiple FRIDs was associated with a greater odds of fall-related injury. Exposure to ≥5 FRIDs was associated with an almost twofold higher odds of fall-related injury in HC (aOR, 1.67; 95% CI, 1.57-1.77) and LTC (aOR, 1.92; 95% CI, 1.73-2.13) residents compared with non-users. The findings were similar across multiple subgroups and sensitivity analyses, with higher odds among new users compared with chronic users.</p><p><strong>Conclusions and implications: </strong>Multiple categories of FRIDs are associated with an increased risk of fall-related injuries in older adults. Clinicians should minimize use of these medications and wherever possible. Fall prevention initiatives should incorporate strategies to prioritize deprescription of the highest risk FRIDs.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105567"},"PeriodicalIF":4.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730601","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":"Patterns of Transient and Terminal Transitions in Activities of Daily Living Performance Levels Among Long-Term Care Residents: A Multistate Markov's Model Analysis of Population-Based Longitudinal Data in Canada.","authors":"Bonaventure A Egbujie, Luke A Turcotte, Reem T Mulla, George A Heckman, John P Hirdes","doi":"10.1016/j.jamda.2025.105565","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105565","url":null,"abstract":"<p><strong>Objective: </strong>We examined how long-term care (LTC) home residents transition between different activities of daily living (ADL) performance levels, as well as their eventual terminal clinical outcome transitions.</p><p><strong>Design: </strong>We conducted a longitudinal retrospective analysis of population-based data among institutionalized older adults within 3 Canadian provinces.</p><p><strong>Setting and participants: </strong>LTC home residents within 3 Canadian provinces of Alberta, British Columbia, and Ontario placed between January 2010 and December 2020.</p><p><strong>Methods: </strong>We fit a Markov-chain multistate transition model to the data to obtain transition probabilities, sojourn times, as well as the adjusted odds of each transition.</p><p><strong>Results: </strong>Three distinct transitions were commonly experienced by residents from this analysis. Most LTC residents stayed unchanged in their ADL performance level between 90-day assessments, a substantial proportion transitioned to worse performance level, and only a small proportion improved to a better performance level. Residents spent on average between 21 and 29 months on admission before finally transitioning out of the setting to 1 of 4 terminal states that include mortality, hospitalization, home, or other setting discharges. Within 5 years of admission, between 63% and 72% died, 18% to 19% were hospitalized, and 2% to 4% were discharged back home. The odds of transitioning to different states were strongly affected by factors such as Index of Social Engagement, Cognitive Performance Scale, Changes in Health, End Stage Disease, and Signs and Symptoms score, age, as well as province where the LTC home is located, but varied depending on the admission ADL status.</p><p><strong>Conclusions and implications: </strong>Evidence from this study shows that it does not always have to be one way out for LTC residents. LTC home administrators could use findings from this study to identify residents who could be provided the right intervention to facilitate ADL performance improvement and prevent further decline.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105565"},"PeriodicalIF":4.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730574","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":"Deep Dissecting Hematoma, an Often Misdiagnosed Lesion: Case-Control Analysis of Risk Factors and Wound-Healing Prognosis.","authors":"Marion Frey, Romain Veber, Sara Thietart, Audrey Rouet, Lorène Zerah, Flora Ketz, Juliette Fontaine, Christine Forasassi, Sylvie Meaume, Bastien Genet, Hester Colboc","doi":"10.1016/j.jamda.2025.105569","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105569","url":null,"abstract":"<p><strong>Objectives: </strong>Deep dissecting hematomas (DDHs) represent severe acute wounds, predominantly affecting older patients. This study aimed to identify DDH risk factors and analyze factors associated with good wound-healing prognosis.</p><p><strong>Design: </strong>Retrospective, multicenter, case-control study from January 2016 to March 2022.</p><p><strong>Setting and participants: </strong>A total of 240 patients, 60 cases with DDH and 180 controls with venous or arterial ulcers.</p><p><strong>Methods: </strong>Primary endpoint was analysis of demographic and clinical parameter differences between cases and controls to identify DDH risk factors. Secondary endpoint was analysis of DDH-wound healing to identify factors associated with good prognosis defined as ≥40% healing of the initial wound 1 month after debridement.</p><p><strong>Results: </strong>Cases were mainly female (n = 47, 78%), 63% misdiagnosed, median age: 87 years, and median Cumulative Illness Rating Scale (CIRS) score: 20/56. The low limb was the main DDH localization. Thirty-three (55%) patients had dermatoporosis, 53 (88%) were malnourished, and 51 (85%) had peripheral vascular disease. DDH developed post-trauma in 42 (70%) patients, with 29 (48%) of them resulting from falls. Half of the patients experienced DDH complications: acute anemia (n = 31, 52%) and local infection requiring oral antibiotics (n = 22, 37%). Time to starting appropriate care was significantly longer when the first DDH consultation was outside our expert center. DDH was significantly associated (adjusted OR [95% CI]) with low-molecular-weight heparin (1.95 [5.12-92.1]; P < .001), dermatoporosis (3.75 [1.63-9.04]; P = .002), age (1.09 [1.02-1.17]; P = .02), and CIRS score (1.08 [1.01-1.17]; P = .05). Chemotherapy was significantly associated with delayed wound healing (P = .03) and age (P = .04) and skin grafting within 1 month (P = .003) were significantly associated with good wound healing.</p><p><strong>Conclusions and implications: </strong>This analysis of DDH risk factors based on a case-control study of a large geriatric cohort identified novel results on prognostic factors for DDH healing. Larger prospective studies are needed to extend our findings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105569"},"PeriodicalIF":4.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730599","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":"Commitment and Intention in Employee Turnover: An LTC Sector Study Using TCM and TTM Models.","authors":"Robert F Frediani, Jake Luo, Janis T Eells, Akke N Talsma, Jennifer T Fink","doi":"10.1016/j.jamda.2025.105566","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105566","url":null,"abstract":"<p><strong>Objectives: </strong>Long-term care (LTC) providers are facing a persistent issue of employee turnover. Various sources cite turnover rates of 79% to 124% in 2024. We used the three-component model (TCM) of commitment and the transtheoretical model of change (TTM) to study the correlation between employee commitment and their intention to quit.</p><p><strong>Design: </strong>A correlational statistical analysis of survey results.</p><p><strong>Setting and participants: </strong>We collected survey data from 327 employees from 14 LTC organizations across the state in the summer of 2023.</p><p><strong>Methods: </strong>The researchers worked through a state association to invite their 500+ member organizations to participate in the survey. We used correlational statistics to examine the effects of malleable workplace factors and demographics (independent variables) on employee commitment. We then correlated employee commitment, as an independent variable, to the employee's intention to quit.</p><p><strong>Results: </strong>From the 372 completed surveys, we showed significant correlations between workplace factors and employee commitment. Affective Commitment had the strongest negative correlation with the intention to quit (r = -0.446, P < .01). Employees with higher pay, longer tenure, more working hours per week, and departmental consistency reported higher commitment and lower intention to quit. Employees in the Precontemplation and Maintenance/Termination stages of TTM had the lowest intention to quit, whereas those in Contemplation and Action stages showed a higher likelihood of leaving.</p><p><strong>Conclusions and implications: </strong>Workplace factors affect the employee's level and type of commitment, which then affects their intention to quit. In other words, commitment acts as a measurable and malleable moderator between workplace conditions and an employee's intention to quit. This study offers guidance to employers seeking to affect employee turnover. Further research into LTC facilities could include a more granular analysis of the bidirectional effects of changes in the workplace factors on commitment and employee turnover.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105566"},"PeriodicalIF":4.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730597","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":"High Anticholinergic Burden of Patients Hospitalized for Hip Fracture Reveals a Target for Deprescribing","authors":"Aidan P. McAnena BS ,&nbsp;Andrew R. Zullo PharmD, PhD ,&nbsp;Richa Joshi MBA, MS ,&nbsp;Lori A. Daiello PharmD, ScM ,&nbsp;Sarah D. Berry MD, MPH","doi":"10.1016/j.jamda.2025.105537","DOIUrl":"10.1016/j.jamda.2025.105537","url":null,"abstract":"<div><h3>Objectives</h3><div>Anticholinergic medications can produce harmful side effects, such as ataxia and delirium, in older adults. Older adults with hip fractures are particularly vulnerable, yet they are often prescribed these medications. This study aimed to evaluate the anticholinergic burden (ACB) before and after hospitalization for hip fracture, to identify potential targets for deprescribing.</div></div><div><h3>Design</h3><div>This is an observational retrospective cohort study. Patients with hip fractures between 2012 and 2018 were identified from Medicare Provider Analysis data. Medications were identified from Medicare Part D claims at the time of fracture and from Omnicare claims 100 days post-discharge. The analysis focused on individuals with high pre-fracture ACB scores (≥3), as they had potential for deprescribing.</div></div><div><h3>Setting and Participants</h3><div>The study included individuals aged 66+ hospitalized for hip fractures who received post-acute care in Omnicare-contracted skilled nursing facilities.</div></div><div><h3>Methods</h3><div>Pre- and post-fracture ACB scores were calculated using the ACB scale. Patients were stratified by post-fracture ACB changes (increase, decrease, or no change). Demographics and comorbidities were described using means and percentages. The top 10 most prescribed anticholinergic medications with ACB score 2 or 3 were identified, and prescription rates were compared before and after fracture.</div></div><div><h3>Results</h3><div>Of 351,286 eligible patients, 138,966 (40%) had a high pre-fracture ACB score. The mean age was 83.5 years, and 78.9% were female. Post fracture, 42.6% of patients with a high ACB experienced a decrease in ACB, 9.9% had an increase, and 47.5% saw no change. Commonly prescribed anticholinergics included overactive bladder agents, antipsychotics, antidepressants, antihistamines, and opioids.</div></div><div><h3>Conclusions and Implications</h3><div>Forty percent of patients had a high ACB at fracture, and fewer than half experienced a decrease in ACB after fracture. Antipsychotics were overprescribed, and many patients remained on ineffective overactive bladder agents. There is a need for standardized deprescribing practices for patients with hip fractures in post-acute care settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105537"},"PeriodicalIF":4.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586057","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":"Challenging Yet Rewarding: Staff Experiences in Prolonged Disorders of Consciousness Rehabilitation.","authors":"Manju Sharma-Virk, Willemijn S van Erp, Niek Kok, Jelle van Gurp, Raymond T C M Koopmans, Jan C M Lavrijsen","doi":"10.1016/j.jamda.2025.105564","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105564","url":null,"abstract":"<p><strong>Objectives: </strong>This study explored the experiences and needs of health care professionals providing specialized neurorehabilitation for patients with prolonged disorders of consciousness (PDOC) in post-acute and long-term care settings.</p><p><strong>Design: </strong>A qualitative study within the nationwide PDOC chain-of-care, including early intensive neurorehabilitation (EIN) in one rehabilitation center and prolonged intensive neurorehabilitation (PIN) in 3 specialized nursing homes up to 2 years post-injury.</p><p><strong>Setting and participants: </strong>Fifty-two health care professionals (nurses, physicians, and rehabilitation therapists) aged ≥18 working at either EIN or PIN with at least 1 year working experience in PDOC care were included.</p><p><strong>Methods: </strong>Five discipline-specific focus group discussions, 2 in-depth interviews, and 9 written testimonies were conducted between November 2021 and May 2022. Data were thematically analyzed.</p><p><strong>Results: </strong>Five themes describing rewarding aspects-complexity of work, providing meaningful care to patients, supporting families, multidisciplinary collaborations within teams and care network, works' personal impact, and professional enrichment-and 4 themes describing challenging aspects-confrontation with patients' condition and families' grief, moral distress, complex interaction with families, personal and professional impact-were identified. For sustainability, health care professionals need improved working conditions, specialized training (especially communication skills and resilience trainings), and psychological support to deal with both families' expectations and moral distress. They also urged for better family support systems and improvement in care procedures.</p><p><strong>Conclusion and implications: </strong>This study emphasizes the challenging yet rewarding nature of specialized neurorehabilitation for patients with PDOC and its impact on health care professionals while highlighting their unmet needs. These insights can be implemented to improve existing care programs and establish criteria for institutions delivering this care. Acknowledging burdensome aspects of this work, investment in the well-being of professionals by their employers and policy reforms focused on improved working conditions, specialized training, and psychological support is crucial for sustainable and resilient PDOC care.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105564"},"PeriodicalIF":4.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700771","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}