Journal of the American Medical Directors Association最新文献

{"title":"Improving Access to Intermediate Care Through Flexibility: Simulation Study.","authors":"Ismail Aydemir, Casper G van Loon, René Bekker, Bianca M Buurman, Rob D van der Mei","doi":"10.1016/j.jamda.2025.105899","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105899","url":null,"abstract":"<p><strong>Objective: </strong>Growing demand for intermediate care, combined with nurse shortages, is increasing the pressure on the accessibility of these services. This study uses simulation as an innovative approach to assess the effectiveness of policy interventions on waiting times and hospital admissions, aiming to identify strategies that better meet rising care demands and improve accessibility.</p><p><strong>Design: </strong>A discrete-event simulation study modeling patient flows in intermediate care facilities.</p><p><strong>Setting and participants: </strong>The simulation model incorporates insights from health care professionals to represent patient flows, admissions, bed capacities, and operational constraints across both intermediate care and hospital settings.</p><p><strong>Methods: </strong>The simulation model incorporates patient arrivals, admissions, and discharges within intermediate care. The study evaluates the impact of the following interventions on patient flow and accessibility: bed pooling between care types, flexible admission hours and transfer times, and the use of emergency beds.</p><p><strong>Results: </strong>Partial bed pooling (10%) between high-complex and geriatric rehabilitation beds reduces waiting times by more than 1 day (a 25% to 42% reduction). Currently, average waiting times are approximately 2 days for low-complex care, and around 4 days for both high-complex care and geriatric rehabilitation. Expanding admission hours, particularly with 24/7 availability, decreases waiting times and hospital congestion. Eliminating emergency beds increases hospital admissions by 18%. By implementing multiple interventions, such as bed pooling and 24/7 admissions, accessibility shows the greatest improvement, with waiting times for high-complex patients reduced by more than 2 days (a 60% reduction) and decreased hospital admissions by 60%.</p><p><strong>Conclusion and implications: </strong>This study illustrates that access to intermediate care can be improved through bed pooling, flexible admission hours and transfer times, and the use of emergency beds, without the need to expand bed capacity. The results demonstrate that these interventions can optimize patient flow, reduce hospital admissions, and enhance overall system efficiency. Furthermore, the study demonstrates that simulation models are valuable tools for exploring policy and system changes within intermediate care settings.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105899"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275063","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":"Glucagon-Like Peptide-1 Receptor Agonists and Dementia Risk Reduction in Older Adults With Type 2 Diabetes: A Retrospective Cohort Study.","authors":"Jheng-Yan Wu, Yu-Min Lin, Wan-Hsuan Hsu, Ting-Hui Liu, Ya-Wen Tsai, Po-Yu Huang, Min-Hsiang Chuang, Tsung Yu, Chih-Cheng Lai","doi":"10.1016/j.jamda.2025.105901","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105901","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on dementia risk compared with dipeptidyl peptidase-4 inhibitors (DPP-4is) among older adults with type 2 diabetes (T2D).</p><p><strong>Design: </strong>Retrospective cohort study using an active-comparator, new-user design with propensity score matching.</p><p><strong>Setting and participants: </strong>Data were obtained from the TriNetX Global Collaborative Network, which includes electronic health records from 134 health care organizations worldwide. Participants were adults aged ≥65 years with T2D who initiated GLP-1RA or DPP-4i therapy between January 2017 and November 2024.</p><p><strong>Methods: </strong>Eligible participants were matched 1:1 on baseline characteristics using propensity score matching (PSM). The primary outcome was incident dementia. Secondary outcomes included prescriptions for dementia-related drugs, Alzheimer's disease, and vascular dementia. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, and subgroup and sensitivity analyses were performed.</p><p><strong>Results: </strong>After PSM, 82,689 patients were included in each treatment group. GLP-1RA use was associated with a lower risk of dementia compared with DPP-4i (HR, 0.58; 95% CI, 0.55-0.61; P < .0001). Stratified analyses revealed consistent risk reductions across age, sex, and GLP-1RA type. In addition, GLP-1RA was also associated with lower risks of dementia-related drug prescriptions (HR, 0.76; 95% CI, 0.70-0.81), Alzheimer's disease (HR, 0.62; 95% CI, 0.56-0.70), and vascular dementia (HR, 0.62; 95% CI, 0.55-0.70). Sensitivity analyses supported the robustness of these findings.</p><p><strong>Conclusions and implications: </strong>GLP-1RA use in older adults with T2D is associated with a significantly lower risk of dementia compared with DPP-4i. These findings suggest the potential neuroprotective benefits of GLP-1RAs and highlight their importance in managing T2D with a view toward reducing dementia risk. Further studies are warranted to explore the underlying mechanisms and validate these observations in randomized controlled trials.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105901"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275074","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":"Trends in Assisted Living and Memory Care Supply From 2019 to 2023","authors":"Eric Jutkowitz PhD ,&nbsp;Gauri Gadkari MS ,&nbsp;Erh-Chi Hsu MPH, RN ,&nbsp;Ozcan Tunalilar PhD ,&nbsp;Lindsey Smith PhD ,&nbsp;Cassandra L. Hua PhD ,&nbsp;Jennifer N. Bunker MPH ,&nbsp;Kali S. Thomas PhD","doi":"10.1016/j.jamda.2025.105890","DOIUrl":"10.1016/j.jamda.2025.105890","url":null,"abstract":"<div><h3>Objectives</h3><div>Describe geographic variation from 2019 to 2023 in assisted living (AL) and memory care supply, and its correlation with county-level characteristics.</div></div><div><h3>Design</h3><div>Descriptive study of the supply of AL and memory care.</div></div><div><h3>Setting and Participants</h3><div>Licensed AL communities in the United States operating in 2019 and 2023.</div></div><div><h3>Methods</h3><div>Data come from a national list of licensed ALs and the US Census Bureau's American Community Survey. The primary outcomes of interest were AL supply and memory care supply (beds per 1000 adults aged 65+ at the county level). We descriptively evaluated county characteristics by AL supply in 2019 and the change in AL supply from 2019 to 2023.</div></div><div><h3>Results</h3><div>In 2023, counties with the highest AL and memory care supply were more likely to have greater wealth, higher educational attainment, and were urban. Between 2019 and 2023, 43% of counties had a decrease in AL supply, 35% of counties had no change in AL supply, and 22% of counties had an increase in AL supply. Counties with a decrease or no change in AL supply compared with increase in AL supply had a larger proportion of the population aged 65+ years, lower median household income, and were more rural. Between 2019 and 2023, 29% of counties had a decrease in memory care supply, 37% had no change in memory care supply, and 34% had an increase in memory care supply. Counties with unchanged or a decrease in memory care supply had lower educational attainment, more poverty, lower home values, and were more rural.</div></div><div><h3>Conclusions and Implications</h3><div>We found low overall availability of AL and memory care supply and decreases in their supply in rural and socioeconomically disadvantaged counties. It is important to incentivize ALs, including memory care, to operate in underserved areas to ensure equitable access to these important long-term care settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 12","pages":"Article 105890"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191677","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":"Validation and Comparison of 4 Fall Risk Assessment Tools for Older Adults in Chinese Nursing Homes: A Prospective Cohort Study","authors":"Lu Shao BN, RN ,&nbsp;Zhong Wang BN, RN ,&nbsp;Xiang Qi PhD, RN ,&nbsp;Jing Wang PhD, RN ,&nbsp;Hongtao Cheng BN, RN ,&nbsp;Xichenhui Qiu PhD, RN ,&nbsp;Ting Xu BN, RN ,&nbsp;Jun-E Zhang PhD, RN ,&nbsp;Bei Wu PhD","doi":"10.1016/j.jamda.2025.105882","DOIUrl":"10.1016/j.jamda.2025.105882","url":null,"abstract":"<div><h3>Objectives</h3><div>This study evaluates and compares the predictive performance of 4 widely used fall risk assessment tools—Morse Fall Scale (MFS), St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Hendrich II Fall Risk Model (Hendrich II), and Timed Up and Go Test (TUGT)—in Chinese nursing homes, with a focus on optimizing cutoff values for better applicability.</div></div><div><h3>Design</h3><div>A prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>The study was conducted in 4 nursing homes in China, including 866 older adults capable of providing informed consent and completing verbal communication.</div></div><div><h3>Methods</h3><div>Participants were assessed using the 4 fall risk tools, and their fall events were recorded over 6 months. Predictive performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve. Calibration curves were generated to assess the agreement between predicted and observed fall probabilities.</div></div><div><h3>Results</h3><div>Using the original cutoff values, the MFS (≥45) and TUGT (≥12 seconds) both showed high sensitivity (0.889 and 0.933, respectively) but low specificity (0.284 and 0.261, respectively). In contrast, the STRATIFY (≥2) and Hendrich II (≥5) exhibited high specificity (0.964 and 0.827, respectively) but low sensitivity (0.117 and 0.328, respectively). After optimization, the MFS (≥65) improved specificity (0.592) with moderate sensitivity (0.689), the STRATIFY (≥1) increased sensitivity (0.856) while reducing specificity to 0.407, the Hendrich II (≥2) achieved specificity of 0.519 with sensitivity of 0.739, and the TUGT (≥26.6 seconds) maintained high sensitivity (0.739) but had a specificity of 0.622. The TUGT demonstrated the strongest overall predictive accuracy (area under the receiver operating characteristic curve, 0.722).</div></div><div><h3>Conclusions and Implications</h3><div>All tools showed limitations in balancing sensitivity and specificity. Adjusting thresholds improved performance but did not yield optimal results. The findings highlight the importance of tailoring fall risk assessments to specific populations with thresholds adjusted to optimize performance. Future research should explore integrating clinical assessments with data-driven predictive models to enhance fall risk evaluation in long-term care settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 12","pages":"Article 105882"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191972","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":"Exploring Safety Concerns in Assisted Living Communities: A Qualitative Comparison of Resident, Family, and Staff Perspectives.","authors":"Youngmin Cho, Victoria Crowder, Cassandra Dictus, Cloie J Chiong, Wenxin Bian, Jing Wang, Matthias Hoben, Stephanie Chamberlain, Ruth A Anderson, Amy Vogelsmeier, Schwartz Lindsay, Marianne Baernholdt, Dardess Pam, Stephanie Miller, Baiming Zou, Anna S Beeber","doi":"10.1016/j.jamda.2025.105910","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105910","url":null,"abstract":"<p><strong>Objectives: </strong>Safety concerns in assisted living (AL) communities are critical, yet understudied from the perspectives of residents, family caregivers, and staff. This study aimed to explore and compare safety concerns across these 3 groups.</p><p><strong>Design: </strong>This qualitative study conducted structured interviews to identify safety concerns from the perspectives of residents, family caregivers, and staff.</p><p><strong>Setting and participants: </strong>Data were collected from 104 participants in AL communities across the United States, comprising 32 residents, 34 family caregivers, and 38 staff members.</p><p><strong>Methods: </strong>We conducted summative content analysis of interview transcripts, identifying distinct safety concerns and comparing the commonality and discrepancies in safety concerns across the 3 participant groups.</p><p><strong>Results: </strong>We identified 29 safety concerns in AL communities. For the top common safety concern, resident condition-related falls were the most frequently reported concern across all groups. Regarding the discrepancies among the 3 groups, resident and/or family groups expressed concerns about prompt use of assistive devices and technology, communication/relationships, and self-care/independence, whereas staff frequently reported concern with environmental issues causing falls.</p><p><strong>Conclusions and implications: </strong>Safety concerns in AL communities are multifaceted and shared across residents, family caregivers, and staff, with falls and unmet care needs being primary concerns. However, differences identified in this study suggest the need for tailored interventions that address the unique concerns of each group. Improving communication among staff, residents, and families may reduce safety concern mismatches and potentially contribute to a safer AL environment.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105910"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275030","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":"Critical Reflections on the LTC+ Program Evaluation.","authors":"Miguel A Rizzi, Ivan Agra, Hector Hernandez, Marta Blazquez, Sergio Herrera Mateo, Mireia Puig Campmany","doi":"10.1016/j.jamda.2025.105905","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105905","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105905"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275043","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":"Mobility During an Acute Medical Hospitalization: A Prospective Cohort Study.","authors":"Fabian D Liechti, Joachim M Schmidt Leuenberger, Martin L Verra, Carole E Aubert","doi":"10.1016/j.jamda.2025.105915","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105915","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed (1) to describe changes in daily activity proportion, (2) to describe mobility during an acute hospitalization, and (3) to assess their associations with institutionalization and survival within 3 months.</p><p><strong>Design: </strong>Secondary analysis of a randomized controlled trial.</p><p><strong>Setting and participants: </strong>Adult patients hospitalized on general internal medicine wards of a Swiss tertiary hospital (September 2021-April 2023) with an expected hospital stay ≥5 days. Daily activity was continuously measured using accelerometers; mobility was assessed with the de Morton Mobility Index at least twice before discharge.</p><p><strong>Methods: </strong>Predictors of change in daily activity proportion and mobility from admission to discharge were identified using logistic regression. Longitudinal changes during hospitalization were analyzed using adjusted linear mixed-effects models.</p><p><strong>Results: </strong>A total of 162 participants were included. Daily activity proportion increased between admission and discharge in 51 of 137 patients (37%) with valid recordings. Repeated measures showed a small linear increase in activity over time, and daily activity proportion was associated with baseline de Morton Mobility Index scores (per 10-point increase: β = 0.005; 95% CI, 0.004-0.005; P < .001). Mobility improved in 81 of 126 patients (64%) between admission and discharge. Higher baseline Barthel Index for Activities of Daily Living scores and absence of mobility aids were associated with higher mobility levels (P < .001). In longitudinal analysis, mobility improved primarily during the first week but stagnated or declined thereafter, particularly among older patients. Increased daily activity proportion was associated with a higher likelihood of living at home 3 months after discharge; mobility was not. Neither was associated with survival.</p><p><strong>Conclusions and implications: </strong>Daily activity and mobility change differed during hospitalization and are associated with distinct outcomes. The observed plateau in mobility after 1 week of hospitalization suggests a critical window for targeted interventions, particularly in older patients with prolonged stays.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105915"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275083","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 Body Weight Changes Over 1 Year With the Incidence of Functional Disability and All-Cause Mortality in Older Adults: The Shizuoka Kokuho Database Study.","authors":"Yasuharu Tabara, Aya-Shoji Asahina, Yoko Sato","doi":"10.1016/j.jamda.2025.105904","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105904","url":null,"abstract":"<p><strong>Objective: </strong>Body weight changes have been reported to increase mortality risk in older adults. However, the prognostic significance of short-term weight changes (during 1 year), particularly for functional disability, is unclear. We aimed to clarify the association between 1-year changes in body weight and the incidence of functional disability and all-cause mortality in older adults.</p><p><strong>Design: </strong>Observational study.</p><p><strong>Setting and participants: </strong>Longitudinal analysis of the prefecture-wide health and care insurance data, including annual health checkup data, including 117,927 Japanese adults aged ≥65 and ≤90 years who had undergone annual health checkups for 2 consecutive years.</p><p><strong>Methods: </strong>Baseline clinical characteristics, including 1-year changes in body weight, were obtained from the health checkup data. Incidence of functional disability and all-cause mortality was obtained from the insurance data.</p><p><strong>Results: </strong>There were 27,719 and 17,002 incident cases of functional disability and all-cause mortality during the mean follow-up periods of 7.3 and 8.0 years, respectively. We observed a U-shaped relationship between 1-year changes in body weight and both outcomes, with a weight loss of ≥2 kg or a weight gain of ≥3 kg showing a significant association. These associations were consistent for the younger (<75 years) and older age groups, regardless of the baseline body mass index. When underweight (body mass index <19 kg/m²), obesity (≥30 kg/m²), weight loss (≥2 kg), and weight gain (≥3 kg) were included in the same model, these factors were independently associated with both outcomes.</p><p><strong>Conclusion and implications: </strong>A weight loss of ≥2 kg or weight gain of ≥3 kg during 1 year was significantly associated with the incidence of functional disability and all-cause mortality in older adults. Careful attention should be paid to unintentional changes in body weight in older adults even if the degree of body weight change is small.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105904"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275096","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":"Comment on \"Identifying Patient, Care Partner, and Clinician Needs for Functional Recovery Following Hospitalization When Dementia Is Present\".","authors":"Ayako Watanabe, Tatsuhiko Nanri, Daisuke Koga, Sakurako Kusano, Kota Minami","doi":"10.1016/j.jamda.2025.105907","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105907","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105907"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274999","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":"Caregiver Neighborhood Vulnerability and Visitation Responses to an Environmental Shock in Nursing Homes.","authors":"Yan Wang, Ziyi Guo, Todd Manini","doi":"10.1016/j.jamda.2025.105902","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105902","url":null,"abstract":"<p><strong>Objectives: </strong>To study the association between climate vulnerability in caregiver neighborhoods on nursing home (NH) visitation changes during and following Hurricane Ian (2022).</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting and participants: </strong>Caregiver neighborhoods defined through data-driven estimation of catchment areas among 480 Florida-based NHs certified by the Centers for Medicare and Medicaid Services.</p><p><strong>Methods: </strong>The analysis outcome was the percent NH visitation change during Hurricane Ian compared with weekly average visitation over 8 weeks before. Caregiver neighborhoods were defined from recurrent visitations occurring every 2 weeks over 2 months prior. The Climate Vulnerability Index was used to evaluate the environmental, social, economic, and infrastructural factors shaping community adaptation to climate change. Associations between neighborhoods' domain vulnerabilities and percentages of visitation change in response to Hurricane Ian were analyzed separately using quantile regression models adjusted by NH quality rating and hurricane exposure.</p><p><strong>Results: </strong>Visitations declined an average of 16.3% (SD = 36.3%) during and immediately following Hurricane Ian. Vulnerabilities in infrastructure, health, and environment exhibited a significant positive trend across visitation change quantiles, indicating that greater vulnerability was associated with larger reductions in visitations. For example, the 10th quantile (68.7% visitation loss, β = -2.296; 95% CI, -3.51 to -1.08]) and the 25th quantile (31.4% visitation loss, coef. = -0.771; 95% CI, -1.52 to -0.19]) were associated with infrastructure vulnerability. Health and environmental vulnerability showed similar significant effects at the lower quantiles of visitation change. Adjustments for covariates had minimal effects on these relationships.</p><p><strong>Conclusions and implications: </strong>Hurricane Ian resulted in a significant loss in caregiver visitations to the NH. This loss is partly explained by climate vulnerability of neighborhoods in which caregivers reside. These findings are relevant to NH administrators, policymakers, and government officials involved in planning and mitigation strategies. Enhancing neighborhood infrastructure to support caregivers may promote continued care during extreme weather events.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105902"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275040","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}