Journal of the American Medical Directors Association最新文献

{"title":"Black-White Differences in Long-Term Services and Supports (LTSS) Deserts: Implications for Unmet Care Needs","authors":"Chanee D. Fabius PhD ,&nbsp;Kali S. Thomas PhD ,&nbsp;Jennifer C. Cornman PhD ,&nbsp;Vicki A. Freedman PhD","doi":"10.1016/j.jamda.2025.105758","DOIUrl":"10.1016/j.jamda.2025.105758","url":null,"abstract":"<div><h3>Objectives</h3><div>Little is known about the impacts of living in a long-term services and supports (LTSS) “desert,” where there are few community-based care options. We sought to understand whether racial disparities exist in LTSS availability and variety and associations with unmet care needs for non-Hispanic White and Black older adults.</div></div><div><h3>Design</h3><div>Cross-sectional study of national survey data linked to contextual LTSS market measures.</div></div><div><h3>Setting and Participants</h3><div>Non-Hispanic White (n = 1751) and Black (n = 603) adults aged 70 and older with activity limitations from the 2019 National Health and Aging Trends Study (NHATS).</div></div><div><h3>Methods</h3><div>The outcome of interest is any adverse consequence as the result of unmet care needs for household, self-care, or mobility activities. We estimate multivariable logistic regression models adjusting for a novel measure reflecting LTSS availability and variety (fertile, typical, desert), consisting of the number of home health agencies, residential care/assisted living beds, and adult day care providers in a county per 100,000 older adults.</div></div><div><h3>Results</h3><div>Relative to White older adults, Black older adults more often experienced adverse consequences due to unmet need (35.0% vs 27.6%, <em>P</em> &lt; .03). Although not statistically significant, older Black adults were more likely to live in an LTSS desert (<em>P</em> &lt; .058). In fully adjusted within-group multivariable logistic regression models, living in an LTSS desert was associated with greater odds of experiencing adverse consequences due to unmet need among White, but not Black, older adults (adjusted odds ratio, 1.50; 95% CI, 0.95–2.36). For both White and Black older adults, single older adults and those receiving unpaid or paid community-based care were more likely to experience adverse consequences due to unmet need.</div></div><div><h3>Conclusions and Implications</h3><div>Findings underscore differences in how LTSS availability and variety relate to unmet care needs for Black and White older adults. Future research should examine these associations in other racial and ethnic minoritized groups.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105758"},"PeriodicalIF":4.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in Distressed Behavior in Dementia During the COVID-19 Pandemic in Veterans Affairs Community Living Centers","authors":"Thomas A. Bayer MD, ScM ,&nbsp;Frank DeVone ScM ,&nbsp;Mriganka Singh MD ,&nbsp;Ciera Leeder MD, MSc ,&nbsp;Alexander Garbin DPT, PhD ,&nbsp;Christopher Halladay ScM ,&nbsp;Kevin McConeghy PharmD, PhD ,&nbsp;Stefan Gravenstein MD, MPH ,&nbsp;James L. Rudolph MD, MS","doi":"10.1016/j.jamda.2025.105752","DOIUrl":"10.1016/j.jamda.2025.105752","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare distressed behavior in Veterans with Alzheimer disease and related dementias (ADRD) residing in Veterans Affairs (VA) Community Living Centers (CLCs) during the COVID-19 pandemic to previous years.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Veterans with ADRD and without baseline distressed behavior residing in CLCs in March 2020 (Early-COVID) and March 2018 or March 2019 (Pre-COVID).</div></div><div><h3>Methods</h3><div>We measured distressed behavior with the Distressed Behaviors in Dementia Indicator. Using a Cox regression, we compared the 180-day hazard of distressed behavior in the Early-COVID group to that in the Pre-COVID group.</div></div><div><h3>Results</h3><div>Of 4383 sampled Veterans, 1190 (27%) had recently taken an antipsychotic medication. In the Pre-COVID (n = 2795) and Early-COVID groups (n = 1588), new distressed behavior occurred in 629 (22.5%) and 313 (19.7%) Veterans, respectively. The adjusted hazard ratio (HR) of new distressed behavior was 0.82 (95% CI 0.71-0.95) for Early-COVID compared with Pre-COVID. Antipsychotic medication was associated with new distressed behavior (HR 1.61, 95% CI 1.40-1.86).</div></div><div><h3>Conclusions and Implications</h3><div>New distressed behavior decreased during the first 6 months of the COVID-19 pandemic compared with the previous 2 years. The observed association between antipsychotic medication use and distressed behavior may reflect clinical recognition and treatment of a predisposition toward distressed behavior. Recorded changes in distressed behavior in Veterans with dementia residing in CLCs opposed the trend of decreased well-being in residents of non-VA nursing homes, but changes in resident assessment fidelity during the Early-COVID period could have confounded the study.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105752"},"PeriodicalIF":4.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Decision Making in Dysphagia Rehabilitation for Older Adults in Chronic Care: A Cross-Sectional Study","authors":"Kohei Yamaguchi DDS, PhD,&nbsp;Sayaka Komori DDS,&nbsp;Ryosuke Yanagida DDS, PhD,&nbsp;Kanako Yoshimi DDS, PhD,&nbsp;Kazuharu Nakagawa DDS, PhD,&nbsp;Haruka Tohara DDS, PhD","doi":"10.1016/j.jamda.2025.105751","DOIUrl":"10.1016/j.jamda.2025.105751","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore factors associated with decision making regarding training, environmental adjustments, and dental interventions in dysphagia rehabilitation for care-dependent older adults in the chronic care phase.</div></div><div><h3>Design</h3><div>Exploratory cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Care-dependent older adults receiving dysphagia rehabilitation via dental home care between 2018 and 2023 in the Kanto region of Japan.</div></div><div><h3>Methods</h3><div>Data were retrospectively collected from clinical records. Key variables included types of intervention received, age, sex, Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale, and Charlson Comorbidity Index. Patients were classified into 3 clusters using <em>k</em>-means clustering based on age, frailty, FOIS score, and residential environment. Group comparisons were performed to evaluate differences in intervention strategies and duration.</div></div><div><h3>Results</h3><div>A total of 242 patients (mean age: 83.3 years; 38.4% male) were included. Training was implemented in 56.6% of patients, environmental adjustments in 90.1% (eg, posture adjustment: 30.7%, eating and food guidance: 89.4%), and dental interventions in 26.4%. Cluster analysis showed that younger, tube-fed patients, many of whom were living at home, were more likely to receive training (<em>P</em> &lt; .001) and had longer intervention durations (<em>P</em> &lt; .001), whereas older patients more often received compensatory strategies (<em>P</em> = .471).</div></div><div><h3>Conclusions and Implications</h3><div>In chronic-phase dysphagia rehabilitation, training is not always prioritized. Intervention choices appear to be influenced by patient characteristics, such as age, oral intake status, and other clinical conditions. Environmental adjustments were the most common intervention, highlighting the importance of compensatory strategies in care-dependent older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105751"},"PeriodicalIF":4.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618705","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":"A Need for a Time-Out: A Consensus Statement From the Post-Acute and Long-Term Care Medical Association (PALTmed) on the Use of Urine Polymerase Chain Reaction Testing for Urinary Tract Infections","authors":"Jessica Zering PharmD ,&nbsp;Ghinwa Dumyati MD ,&nbsp;Nicole Osevala MD ,&nbsp;Muhammad Salman Ashraf MBBS ,&nbsp;PALTmed","doi":"10.1016/j.jamda.2025.105746","DOIUrl":"10.1016/j.jamda.2025.105746","url":null,"abstract":"<div><div>Identification and appropriate treatment of urinary tract infections (UTIs) is challenging in post-acute and long-term care (PALTC) settings. Urine polymerase chain reaction (PCR) has emerged as a rapid diagnostic alternative to standard urine culture, gaining increasing adoption in nursing homes despite limited guidance on its appropriate use. In response to concerns regarding clinical utility, a small workgroup composed of members of the Infection Advisory Subcommittee convened in 2024 to develop a consensus statement on urine PCR testing in PALTC settings. A comprehensive literature review identified several issues. Urine PCR demonstrated a high sensitivity for organism detection, including those of unclear clinical significance. This may lead to UTI overdiagnosis. Discrepancies between gene resistance data and phenotypical antibiotic susceptibilities may result in inaccurate antibiotic selection, with a lack of established treatment thresholds further complicating decision-making processes. Moreover, the cost of urine PCR testing is significantly higher than standard urine culture and much of the supporting literature is biased due to industry funding. Most importantly, no objective studies have demonstrated improved patient outcomes associated with the use of urine PCR. Based on these findings, we recommend against the routine use of urine PCR testing for UTI diagnosis in patients who are in PALTC settings. Its widespread use will likely drive unnecessary antibiotic use, increasing the risk of antimicrobial resistance and its associated harms. Further research is needed to firmly define the population of patients who are in PALTC settings who would benefit from urine PCR testing.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105746"},"PeriodicalIF":4.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618650","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":"Potentially High-Risk Antipsychotic Use in People With Dementia: A National Data Linkage Study.","authors":"Hieu T Le, Edward C Y Lau, Mohammad Afshar Ali, Christine Y Lu, Sarah N Hilmer, Yun-Hee Jeon, Lee-Fay Low, Tuan A Nguyen, Edwin C K Tan","doi":"10.1016/j.jamda.2025.105750","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105750","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the prevalence of and sociodemographic factors associated with potentially high-risk antipsychotic use in people living with dementia in Australia.</p><p><strong>Design: </strong>Retrospective cross-sectional study using national linked data from the 2021 Census and the Pharmaceutical Benefits Scheme.</p><p><strong>Setting and participants: </strong>All people ≥65 years of age who responded to the 2021 Census, self-reported a diagnosis of dementia and/or were dispensed an acetylcholinesterase inhibitor or memantine, and purchased ≥1 antipsychotic subsidized by the Pharmaceutical Benefits Scheme between August 1, 2021, and October 31, 2021, were included.</p><p><strong>Methods: </strong>Four measures of potentially high-risk antipsychotic use were assessed: possible drug-drug interactions, possible drug-disease interactions (DDSIs) (ie, stroke or diabetes), concomitant psychotropic medication (CPM), and prolonged duration of use (ie, ≥4 prescriptions in the 6 months from August 1, 2021). Factors associated with each measure were identified by logistic regression models.</p><p><strong>Results: </strong>Of the 22,710 individuals using at least 1 antipsychotic, 9947 (43.8%) were using risperidone. A total of 19,576 people (86.2%) had ≥1 measure of high-risk use. The most common measure was CPM (n = 17,560, 77.3%), followed by drug-drug interaction (n = 7059, 31.1%), DDSI (n = 5125, 22.6%), and prolonged duration of use (n = 2129, 9.4%). The factors of ≥75 years of age, higher educational attainment, and living in a remote area were associated with lower odds of having ≥1 measure, whereas multimorbidity was associated with increased likelihood. Residing in nonprivate dwellings and having multiple prescribers were associated with higher odds of having multiple measures, except for DDSI. Culturally and linguistically diverse populations had higher odds of DDSI but lower odds of CPM.</p><p><strong>Conclusions and implications: </strong>Achieving quality use of antipsychotics in individuals with dementia remains challenging, with almost 9 of 10 antipsychotic users having at least 1 measure of high-risk use. Future research should investigate strategies to optimize antipsychotic use in people living with dementia and target subgroups at higher risk.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105750"},"PeriodicalIF":4.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682770","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 Exercise-Based Interventions on Depressive Symptoms in Older Adults: A Systematic Review and Network Meta-Analysis","authors":"Kexin Huang MD ,&nbsp;Guangwei Zhang MD ,&nbsp;Hayley Gains MSc ,&nbsp;Rendong He MD ,&nbsp;Yongliang Jiao MD ,&nbsp;Yong Jia PhD ,&nbsp;Li Chen PhD","doi":"10.1016/j.jamda.2025.105583","DOIUrl":"10.1016/j.jamda.2025.105583","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To compare and rank the effectiveness of exercise-based interventions for improving depressive symptoms in older adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Systematic review with a network meta-analysis of randomized controlled trials.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting and Participants&lt;/h3&gt;&lt;div&gt;Older adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Eleven databases were systematically searched from inception to March 16, 2024, and the search was last updated August 21, 2024. Randomized controlled trials which examined the effectiveness of exercise-based interventions for older adults were included. Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Random effect network meta-analysis within a frequentist framework was conducted for the primary analyses. A protocol for this systematic review was registered in the International Prospective Register of Systematic Review (registration number CRD42024542830).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 65 studies with 5536 participants were included in the network meta-analysis. Compared with waitlist controls and active controls, positive effects on depression symptoms were found for exercises (standardized mean difference [SMD], −0.69; 95% CI, 0.90 to −0.48; &lt;em&gt;P&lt;/em&gt; &lt; .001; SMD, −0.42; 95% CI, 0.48 to −0.36; &lt;em&gt;P&lt;/em&gt; &lt; .001). Pairwise analysis indicated that there were statistically significant differences between exercise types: neuromotor exercise vs waitlist control (SMD, −0.82; 95% CI, 1.57 to −0.07), aerobic exercise vs active control (SMD, −0.67; 95% CI, 1.05 to −0.28), flexibility exercise vs active control (SMD, −0.76; 95% CI, 1.46 to −0.06), neuromotor exercise vs active control (SMD, −0.86; 95% CI, 1.34 to −0.38), and multicomponent exercise vs active control (SMD, −0.58; 95% CI, 1.03 to −0.14). However, there were no statistically significant differences between exercise types: flexibility exercise vs waitlist control, aerobic exercise vs waitlist control, multicomponent exercise vs waitlist control, resistance vs waitlist control, resistance vs active control, and any 2 comparisons of the 5 exercise types. Neuromotor exercise training appeared to have the highest probability of being the most effective exercise type in improving depressive symptoms with a surface under cumulative ranking (SUCRA) value of 82.7%, followed by flexibility exercise (SUCRA, 71.8%; mean rank, 2.7), aerobic exercise (SUCRA, 66.4%; mean rank, 3.0), multicomponent exercise (SUCRA, 58.5%; mean rank, 3.5), and resistance exercise (SUCRA, 42.4%; mean rank, 4.5). Results appeared robust to publication bias; however, 2 studies met the Cochrane criteria for high risk of bias. The confidence in accordance with Confidence in Network Meta-Analysis was very low to moderate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and Implications&lt;/h3&gt;&lt;div&gt;Exercise-based interventions have proven to be an effective treatment for depressive symptoms, with ne","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105583"},"PeriodicalIF":4.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795881","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 Efficacy of Health Promotion Interventions for Mild Frailty Older Adults: A Systematic Review.","authors":"Yue Li, Jie Yun, Xie Cen, Liping Wang, Ruiting Yang, Danni Lu, Dianhe Liu","doi":"10.1016/j.jamda.2025.105755","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105755","url":null,"abstract":"<p><strong>Objectives: </strong>The growing population of prefrail older adults is increasingly becoming a priority in health care services within aging nations. This study was designed to assess the effect of health-promoting interventions on clinical efficacy in prefrail older adult populations and to undertake a preliminary exploration of their associated cost-effectiveness.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Setting and participants: </strong>Prefrail older people ≥60 years of age who conform to 1 or 2 of the criteria within Fried's frailty phenotype, in any setting.</p><p><strong>Methods: </strong>A comprehensive search of 7 databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, CNKI, and Wanfang) was conducted from database inception through March 2025. Inclusion criteria encompassed randomized controlled trials investigating multidimensional health outcomes for older adults with prefrailty. Dual independent processes were implemented for both data extraction and methodologic quality assessment using the Cochrane risk of bias tool.</p><p><strong>Results: </strong>This review included 7 randomized controlled trials (N = 1323) with intervention periods spanning 3 to 26 months. Health promotion strategies comprised 3 main categories: multicomponent exercise, theory-driven approaches, and multidisciplinary interventions. Despite variations in outcome measurements, the study results preliminarily suggest that health-promoting interventions have demonstrated a certain degree of positive impact on both the health status and cost-effectiveness of prefrail older adults.</p><p><strong>Conclusions and implications: </strong>Health promotion interventions can improve clinical outcome indicators for prefrail older adults and possess potential advantages in terms of cost-effectiveness. However, the benefits largely depend on the type and duration of the intervention. When assessing these factors together, home-based health promotion interventions seem to be a particularly beneficial strategy, offering both cost efficiency and meaningful improvements in prefrailty status.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105755"},"PeriodicalIF":4.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682771","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 Combined Effects of Chronic Pain and Different Types of Isolation on the Incidence of Disability in Community-Dwelling Older Adults: Prospective Cohort Study","authors":"Soichiro Matsuda PhD,&nbsp;Takehiko Doi PhD,&nbsp;Sho Nakakubo PhD,&nbsp;Fumio Sakimoto PhD,&nbsp;Hiroyuki Shimada PhD","doi":"10.1016/j.jamda.2025.105748","DOIUrl":"10.1016/j.jamda.2025.105748","url":null,"abstract":"<div><h3>Objectives</h3><div>Social isolation is a critical public health issue that increases pain sensitivity and exacerbates chronic pain, leading to further social limitations. However, the risk of disability when these factors overlap remains unclear. This study hypothesized that the coexistence of social isolation and chronic pain would elevate disability incidence among community-dwelling older adults.</div></div><div><h3>Design</h3><div>A prospective cohort study.</div></div><div><h3>Settings and Participants</h3><div>This study included 4709 community-dwelling older adults (73.8 ± 5.4 years of age, male: n = 2053) without baseline disability.</div></div><div><h3>Methods</h3><div>Chronic pain, isolation due to lack of social support, and isolation due to lack of social participation were assessed at baseline. Disability incidence was examined during a 24-month follow-up.</div></div><div><h3>Results</h3><div>In the adjusted Cox proportional hazards model, participants experiencing both chronic pain and isolation due to lack of social support provision had a significantly higher risk of disability incidence than those without chronic pain or isolation [hazard ratio (HR), 2.69; 95% CI, 1.78–4.05; <em>P</em> &lt; .001]. Similarly, participants experiencing both chronic pain and isolation due to lack of social participation had a significantly higher risk of disability incidence than those without chronic pain or isolation (HR, 2.97; 95% CI, 2.00–4.40; <em>P</em> &lt; .001). In addition, chronic pain and isolation due to lack of social participation had an additive effect after adjustment (relative excess risk due to interaction, 0.68; 95% CI, 0.00–1.36).</div></div><div><h3>Conclusion and Implications</h3><div>The overlap of chronic pain and isolation due to lack of social participation had an additive effect on disability incidence over 24 months. These findings highlight the importance of preventing the combination of chronic pain and social isolation to mitigate disability risk.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105748"},"PeriodicalIF":4.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608666","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":"Family Caregiver Availability and Capacity Associated With Home Health Service Types for Patients With Dementia","authors":"Julia G. Burgdorf PhD ,&nbsp;Jennifer L. Wolff PhD ,&nbsp;Yolanda Barrón MS ,&nbsp;Halima Amjad MD, MPH, PhD","doi":"10.1016/j.jamda.2025.105744","DOIUrl":"10.1016/j.jamda.2025.105744","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the relationship between unmet needs for family caregiver support, defined as lack of caregiver availability or capacity, and home health care (HH) service types delivered to patients with dementia.</div></div><div><h3>Design</h3><div>Cross-sectional study of national claims and assessment data.</div></div><div><h3>Setting and Participants</h3><div>325,148 older adults (aged ≥65 years) with diagnosed dementia receiving Medicare-funded HH in 2018.</div></div><div><h3>Methods</h3><div>Service types were measured from Medicare claims and refers to patient receipt of each of 6 service types covered during HH: nursing, physical therapy, occupational therapy, speech therapy, social work, and personal care aide. We fit multivariable logistic regression models estimating the odds of receiving each service type as a function of unmet caregiving needs and patient and HH agency characteristics, while clustering at the HH agency level.</div></div><div><h3>Results</h3><div>In adjusted models, lack of caregiver availability to help with medical, functional, or instrumental tasks was associated with higher odds of receiving skilled nursing [adjusted odds ratio (aOR) 1.63, 95% CI 1.47-1.81], aide (aOR 1.61, 95% CI 1.54-1.68), and social work (aOR 2.71, 95% CI 2.56-2.86), respectively. Lack of caregiver capacity to help with medical, functional, or instrumental tasks was associated with higher odds of receiving skilled nursing (aOR 1.29, 95% CI1.20-1.39), physical therapy (aOR 1.74, 95% CI1.68-1.81), and social work (aOR 1.24, 95% CI 1.17-1.28), respectively.</div></div><div><h3>Conclusions and Implications</h3><div>We observed significant associations between unmet needs for caregiving support and HH service delivery for patients with dementia. Expanding HH quality measurement and risk adjustment data elements to include measures of caregiver availability and capacity are necessary steps toward supporting HH providers' efforts to meet patients’ needs regardless of their caregiving context.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105744"},"PeriodicalIF":4.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608661","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":"Comparison of Asynchronous Telepsychiatry vs Synchronous Telepsychiatry (CATELEST) in Skilled Nursing Facilities: A Randomized Controlled Noninferiority Clinical Trial.","authors":"Glen L Xiong, Ana-Maria Iosif, Alvaro D Gonzalezk, Alice Fisherk, MarieChristi Candido, Michelle M Burke, Debra R Kahn, Peter Yellowlees","doi":"10.1016/j.jamda.2025.105753","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105753","url":null,"abstract":"<p><strong>Objective: </strong>Comparison of asynchronous telepsychiatry (ATP) with traditional synchronous telepsychiatry (STP) in skilled nursing facilities (SNFs) in California, United States.</p><p><strong>Design: </strong>Patient-level randomized, controlled noninferiority trial.</p><p><strong>Setting and participants: </strong>A total of 235 residents aged ≥18 years from 9 SNFs were referred for psychiatric symptom or medication evaluations.</p><p><strong>Methods: </strong>Patients were individually randomized to receive ATP or STP. Visits were conducted at baseline and 1, 2, 3, 6, and 12 months. The primary outcome was change in psychiatric symptom severity from baseline to 6 months, using the clinician-rated Clinical Global Impressions (CGI) Severity of Illness scale, with a predetermined noninferiority margin of 0.5 points. Secondary analyses examined medication reduction recommendations. Data were analyzed using generalized linear mixed-effects models.</p><p><strong>Results: </strong>Both groups showed improvement in symptoms. At 6 months, the intention-to-treat analysis (113 ATP, 109 STP) showed an adjusted CGI change of -0.47 (95% CI -0.64 to -0.29) for ATP and -0.68 (95% CI -0.86 to -0.49) for STP, with a between-group difference of 0.21 (95% CI -0.04 to 0.47), supporting noninferiority. The per-protocol analysis (79 ATP, 68 STP) showed an adjusted CGI change of -0.47 (95% CI -0.67 to -0.28) for ATP and -0.74 (95% CI -0.96 to -0.53) for STP, with a difference of 0.27 (95% CI -0.02 to 0.56). Because the upper bound of the confidence interval (0.56) exceeded the noninferiority margin (0.5), the per-protocol analysis did not support the noninferiority hypothesis. Overall rates of antipsychotic and antidepressant reduction recommendations were similar (P = .35 and P = .12, respectively).</p><p><strong>Conclusions and implications: </strong>ATP was noninferior to STP in the intention-to-treat analysis but not in the per-protocol analysis, possibly due to the reduced sample size. ATP has significant implications for improving access to mental health care for patients within SNFs. Larger replication studies are warranted to validate and further refine these findings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105753"},"PeriodicalIF":4.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675097","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}