Journal of the American Medical Directors Association最新文献

{"title":"Transportation Services in Society for Individuals Living With Dementia in Long-Term Care Facilities: A Scoping Review","authors":"Soojeong Han PhD, AGNP, RN,&nbsp;Simon P. Navarro MA, RN, CCRN, TCRN,&nbsp;Gregory L. Alexander PhD, RN, FAAN, FACMI, FIASI","doi":"10.1016/j.jamda.2025.105745","DOIUrl":"10.1016/j.jamda.2025.105745","url":null,"abstract":"<div><h3>Objectives</h3><div>Significant numbers of adults with dementia require long-term care services. For example, around 750,000 people who live in nursing homes have a diagnosis of dementia. Transportation insecurity for the long-term care facility population has not received sufficient attention. This scoping review aims to explore the literature on nonemergency medical transportation for long-term care facility residents with dementia and identify research gaps related to transportation challenges faced by this vulnerable population.</div></div><div><h3>Design</h3><div>A scoping review.</div></div><div><h3>Setting and Participants</h3><div>This review included research studies published in peer-reviewed journals regarding transportation services for long-term care facility residents with dementia.</div></div><div><h3>Methods</h3><div>Arksey and O'Malley's framework and PRISMA-ScR checklist were followed. The search was performed in 5 databases, including PubMed, CINAHL, PsycINFO, Scopus, and Embase. Titles, abstracts, and full-text articles were independently reviewed by 2 reviewers, and all discrepancies were resolved by a consensus discussion.</div></div><div><h3>Results</h3><div>Of the 1405 publications screened, 5 studies met the inclusion criteria for analysis and synthesis for this review. The need for adequate transportation services was expressed by caregivers, health care professionals, and individuals with dementia. Dementia-specific challenges and other transportation insecurity issues related to social determinants of health, such as finance and rural and urban contexts, were disclosed. Surprisingly, no studies explored transportation insecurity as a primary focus for individuals with dementia in long-term care facilities, representing a significant literature gap.</div></div><div><h3>Conclusions and Implications</h3><div>The findings of this review address critical literature gaps related to transportation challenges faced by long-term care facility residents with dementia and provide evidence to guide and develop transportation service systems as well as potential interventions for long-term care residents, especially those with dementia. Further explorations and experiments are needed to establish long-term care facilities with dementia-friendly features, which enhance accessibility and quality of life for these residents.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 9","pages":"Article 105745"},"PeriodicalIF":4.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short Physical Performance Battery or Chair Stand: Which Better Predicts Disability Among High-Functioning Older Adults?","authors":"Roberta de Oliveira Máximo PhD ,&nbsp;Mariane Marques Luiz PhD ,&nbsp;Sara Souza Lima MSc ,&nbsp;Andrew Steptoe PhD ,&nbsp;Cesar de Oliveira PhD ,&nbsp;Tiago da Silva Alexandre PhD","doi":"10.1016/j.jamda.2025.105720","DOIUrl":"10.1016/j.jamda.2025.105720","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the Short Physical Performance Battery (SPPB) and Chair Stand Test (CST) in terms of their ability to identify the risk of incident disability in instrumental activities of daily living (IADL) and basic activities of daily living (BADL) over an 8-year follow-up among high-functioning older adults.</div></div><div><h3>Design</h3><div>Longitudinal study.</div></div><div><h3>Setting and Participants</h3><div>A sample of 2386 participants from the English Longitudinal Study of Ageing (ELSA) who were free of IADL/BADL disability and had a gait speed greater than 0.8 m/s at baseline.</div></div><div><h3>Methods</h3><div>Receiver operating characteristic curves were used to evaluate the accuracy of the SPPB and CST to identify the risk of incident IADL/BADL disability. Subsequently, the trajectories of incident IADL/BADL disability were analyzed according to the SPPB and CST cutoff points using generalized linear mixed models adjusted for sociodemographic, behavioral, and clinical characteristics.</div></div><div><h3>Results</h3><div>Performance in the SPPB ≤11 points and CST ≥11.5 seconds more accurately identified the risk of incident IADL/BADL disability than SPPB ≤10 points and CST &gt;15 seconds, which are the cutoff points most commonly recommended in the literature to date. Finally, the trajectories of incident IADL/BADL disability were similar for SPPB ≤11 points and CST ≥11.5 seconds.</div></div><div><h3>Conclusions and Implications</h3><div>SPPB ≤11 points and CST ≥11.5 seconds more accurately identified the risk of incident IADL/BADL disability than previously recommended cutoff points. As both instruments were similar in predicting trajectories of incident disability, the CST may represent a more practical choice for clinical screening, given its simplicity and shorter administration time.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105720"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Burnout and Work-Life Satisfaction Among Nurse Practitioner and Physician Members of the Virginia Long-Term Care Clinician Network.","authors":"Kristin M MacDonald, Christian Bergman, Laura Finch, Kimberly Ivey, Leland Bert Waters","doi":"10.1016/j.jamda.2025.105778","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105778","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105778"},"PeriodicalIF":4.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Low Calf Circumference and Incident Sarcopenia in Community-Dwelling Older Adults: A 3-Year Prospective Cohort Study.","authors":"Li Huang, Taiping Lin, Hui Wang, Dongmei Xie, Ning Ge, Jirong Yue","doi":"10.1016/j.jamda.2025.105741","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105741","url":null,"abstract":"<p><strong>Objectives: </strong>Calf circumference (CC) is a widely acknowledged indicator of skeletal muscle mass within the current consensus among experts. Nevertheless, the relationship between low calf circumference and new-onset sarcopenia remains unclear within the realm of prospective cohort studies.</p><p><strong>Design: </strong>A 3-year prospective cohort study.</p><p><strong>Setting and participants: </strong>A total of 934 community-dwelling participants >60 years of age and devoid of sarcopenia at baseline were enrolled in this study.</p><p><strong>Methods: </strong>This 3-year prospective cohort investigation recruited participants and data from the West China Health and Aging Trend Study (WCHAT). Sarcopenia criteria for inclusion were established in accordance with the 2019 Asian Working Group on Sarcopenia guidelines: moderately low CC was defined as CC < 34 cm for males and CC < 33 cm for females, and severe diminution of CC was defined as CC < 31 cm for both sexes. Poisson regression models were used to explore the association between low CC status and sarcopenia incidence.</p><p><strong>Results: </strong>A total of 791 participants completed the 3-year follow-up survey, and 81 (10.24%) developed new-onset sarcopenia. After adjustment for a comprehensive array of potential confounders, moderately low CC was significantly associated with incident sarcopenia (adjusted RR, 3.94; 95% CI, 2.40-6.48). In contrast, participants with severely low CC had a higher risk of sarcopenia incidence (adjusted RR, 5.51; 95% CI, 2.30-13.20).</p><p><strong>Conclusions and implications: </strong>Within this prospective cohort analysis, low CC emerged as a new independent risk factor for incident sarcopenia over 3 years, with a concomitant escalation in risk observed with severe diminution of CC.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105741"},"PeriodicalIF":4.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659507","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 Effect of Medicaid Managed Long-Term Services and Supports Spending on Nursing Home Care Quality in the United States.","authors":"Jennifer L Choi, Michael Lepore, Alison M Trinkoff, Catherine E Cooke, T Joseph Mattingly","doi":"10.1016/j.jamda.2025.105772","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105772","url":null,"abstract":"<p><strong>Objectives: </strong>The number of US states operating Medicaid managed long-term services and supports (MLTSS) programs grew from 8 to 24 between 2004 and 2019, driven by the challenges of an aging population. Significant heterogeneity exists across states in program features, structure, and spending. This study examined whether spending dimensions, specifically capitation rates and market coverage rates (the proportion of Medicaid nursing home expenditures distributed through managed care), influence the quality of care in nursing homes within MLTSS states.</p><p><strong>Design: </strong>Secondary analysis of data on MLTSS program spending constructed by the authors, merged with publicly available cross-sectional nursing home data from LTCFocus and the Centers for Medicare and Medicaid Services.</p><p><strong>Setting and participants: </strong>The sample included 2169 nursing homes operating in 6 states (Arizona, Delaware, Florida, Iowa, New Jersey, and Tennessee) with mandatory and statewide MLTSS programs as of fiscal year 2019.</p><p><strong>Methods: </strong>A multiple regression model was estimated to examine the relationship between nursing home quality outcomes and state-level spending measures, controlling for key nursing home, county, and state control measures. Sensitivity analyses included additional controls for metropolitan statistical area indicators and wage indices.</p><p><strong>Results: </strong>Higher capitation rates consistently contributed to improved quality of care, as evidenced by increased staffing hours, lower proportions of long-stay residents with increased daily activity needs, loss of bladder control, and urinary tract infections. In contrast, the associations between coverage rates and care quality measures remained inconclusive.</p><p><strong>Conclusions and implications: </strong>This study highlights how capitation rates positively influence care quality in nursing homes within the MLTSS context. The findings provide valuable insights for policymakers, health care administrators, and managed care organizations seeking to optimize care quality in MLTSS programs.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105772"},"PeriodicalIF":4.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637416","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":"Trajectories After In-Hospital Delirium: Long-Term Changes in Frailty and Cognition After COVID-19","authors":"Julia Minnema MSc ,&nbsp;Lisanne Tap MD, PhD ,&nbsp;Evertine J. Abbink PhD ,&nbsp;Floor J.A. van Deudekom MD, PhD ,&nbsp;Miriam C. Faes MD, PhD ,&nbsp;Jeannette Peters PhD ,&nbsp;Simon P. Mooijaart MD, PhD ,&nbsp;Barbara C. van Munster MD, PhD ,&nbsp;Bas F.M. van Raaij MD ,&nbsp;Sarah H.M. Robben MD, PhD ,&nbsp;Francesco Mattace-Raso MD, PhD ,&nbsp;Harmke A. Polinder-Bos MD, PhD ,&nbsp;COVID-OLD Consortium, CliniCo Consortium, and COOP Consortium","doi":"10.1016/j.jamda.2025.105591","DOIUrl":"10.1016/j.jamda.2025.105591","url":null,"abstract":"<div><h3>Objectives</h3><div>Delirium is a common complication in older patients hospitalized with COVID-19 and is associated with short-term functional and cognitive decline. This study evaluated whether in-hospital delirium is associated with long-term mortality and changes in frailty and cognition.</div></div><div><h3>Design</h3><div>This study is part of 2 retrospective and prospective Dutch multicenter cohort studies: the COVID-OLD and the CliniCo study.</div></div><div><h3>Setting and Participants</h3><div>Patients aged ≥70 years who survived hospitalization for COVID-19 were included in this study. Patients were hospitalized during the first (March-May 2020) and second wave (September 2020-December 2020) of the COVID-19 pandemic. Follow-up data were collected by phone approximately 2 years after hospital discharge.</div></div><div><h3>Methods</h3><div>In-hospital delirium was assessed using the Delirium Observation Screening Scale. Multivariable linear regression models were used to investigate the association between in-hospital delirium, and change in Clinical Frailty Scale, and change in cognition (Informant Questionnaire on Cognitive Decline in Elderly). Multivariable logistic regression models were used to investigate the association between in-hospital delirium and mortality at follow-up.</div></div><div><h3>Results</h3><div>At hospital discharge, 1663 patients were alive. Of those patients, 272 died before follow-up, 955 did not participate in the follow-up, and 436 patients participated in the follow-up. Of the follow-up cohort (median age, 75 years; interquartile range, 73-80; 65.4% men), 14.2% had in-hospital delirium. Delirium was not associated with long-term changes in Clinical Frailty Scale (β = 0.36; 95% CI, −0.11 to 0.82) or with mortality (OR, 1.29; 95% CI, 0.80-2.08). Patients with delirium more frequently suffered from long-term cognitive decline than patients without delirium (β = 2.45; 95% CI, 1.19-3.71).</div></div><div><h3>Conclusions and Implications</h3><div>Delirium was associated with long-term cognitive decline, but not with increased levels of frailty or mortality at follow-up. Follow-up consultations especially after delirium might be needed to assess possible cognitive decline.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105591"},"PeriodicalIF":4.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026877","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":"Clinical Pathways for Diagnosing Neurocognitive Disorders: Insights From Process Mining a Memory Clinic Cohort.","authors":"Claudio Singh Solorzano, Stefania Orini, Cristina Festari, Simona Buscarnera, Francesco Rossato, Michela Pievani, Matteo Cotta Ramusino, Federico Massa, Roberto Gatta, Giovanni Battista Frisoni","doi":"10.1016/j.jamda.2025.105774","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105774","url":null,"abstract":"<p><strong>Objectives: </strong>Process mining (PM) has only recently been used in medicine. Its implementation in the dementia field could be valuable, considering the epidemiologic breadth of the condition and its economic implications. This proof-of-concept study aims to apply PM in the context of dementia to provide a realistic picture of patients' diagnostic pathways in a memory clinic.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting and participants: </strong>A total of 539 medical charts were reviewed to obtain sociodemographic data and type and timing of diagnostic evaluations (eg, clinical or neuropsychological visits, imaging scans, and fluid biomarker analyses).</p><p><strong>Methods: </strong>We used a PM approach to create a process map from the clinical events and visualize the most common diagnostic pathways in the total cohort and subcohort of patients. PM techniques represent the temporal and dynamic sequence of clinical events in the patients' journeys, overcoming the traditional frequency analyses focused only on aggregate statistics and event distributions.</p><p><strong>Results: </strong>The results showed that the diagnosis was typically reached during the third clinical visit, following the results of instrumental examinations (ie, morphologic imaging, routine blood and neuropsychological examinations) and a first-line diagnostic biomarker. In mild cognitive impairment (MCI) and mild dementia (DEM) subcohorts, cerebrospinal fluid analyses are the most frequently used first-line biomarkers to ascertain a suspicion of Alzheimer disease (23%). Differential PM analyses revealed that the DEM subcohort underwent morphologic imaging before accessing the memory clinic more often than the MCI subcohort (P < .05).</p><p><strong>Conclusions and implications: </strong>This preliminary use of PM algorithms in memory clinics shows promising results in visualizing and measuring real-world diagnostic pathways.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105774"},"PeriodicalIF":4.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637413","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":"Usage and Costs of Regular Acetaminophen (Paracetamol) in Canadian Long-Term Care Facilities","authors":"Roni Y. Kraut MD, MSc ,&nbsp;Xueyi Chen PhD ,&nbsp;Scott R. Garrison MD, PhD ,&nbsp;Erik Youngson MMath ,&nbsp;Cheryl A. Sadowski PharmD ,&nbsp;Christian Ono ,&nbsp;Andrea Gruneir PhD","doi":"10.1016/j.jamda.2025.105722","DOIUrl":"10.1016/j.jamda.2025.105722","url":null,"abstract":"<div><h3>Objectives</h3><div>Evidence suggests that the use of regular acetaminophen (paracetamol) in long-term care (LTC) is a low-value intervention, that it does not improve pain or quality of life, and that it has the potential for adverse effects. Our objective was to assess the usage of regular acetaminophen in Canadian LTC facilities as well as the costs associated with its use.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Canadian LTC facilities serviced by a national LTC pharmacy provider in 2022.</div></div><div><h3>Methods</h3><div>Descriptive statistics were used to characterize prevalence, dosing, dispensation frequency, type, and costs of regular acetaminophen dispensations (cost of tablets, carbon emissions, and nursing dispensation time).</div></div><div><h3>Results</h3><div>The data set included 49,419 residents (median age: 86, women: 65%) from British Columbia (5.5%), Alberta (7.1%), Manitoba (23.0%), and Ontario (64.4%). The mean prevalence of regular acetaminophen dispensations was 45.7%. Among residents dispensed regular acetaminophen, 85% of residents were dispensed &gt;1000 mg of acetaminophen/day, the mean defined daily dose per 1000 residents per 1 day was 317 [standard deviation (SD) 56], 59.3% were dispensed acetaminophen ≥3 times per day, and dispensations were approximately evenly split between 325- and 500-mg tablets. The 27.8 million tablets of acetaminophen dispensed in 2022 cost $870,000; had a carbon footprint of 54.8 tonnes of carbon dioxide equivalents (CO₂e); and required 191,000 nursing hours, the equivalent of 92 nurses working full-time for 1 year.</div></div><div><h3>Conclusion and Implications</h3><div>Regular acetaminophen use is highly prevalent in LTC and has substantial costs. It would be advantageous to re-examine acetaminophen use in LTC facilities.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105722"},"PeriodicalIF":4.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484806","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":"Development and Validation of the Care Risk Perception Scale (CRPS) for Caregivers of Older Adults With Dementia in Long-Term Care Facilities.","authors":"Liqin Wei, Lihui Pu, Mengying Qiu, Jiayi Zhu, Shuai Yuan, Xiaofeng Xie, Fengying Zhang","doi":"10.1016/j.jamda.2025.105759","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105759","url":null,"abstract":"<p><strong>Objectives: </strong>Global aging has increased the demand for long-term care facilities (LTCFs) for older adults with dementia. This challenge is further exacerbated by systemic barriers such as insufficient infrastructure and a shortage of trained caregivers within LTCFs. These limitations heighten care risks for vulnerable populations and underscore the urgent need for tools to evaluate caregivers' risk perceptions-a critical determinant of safety practices. This study developed and validated the Care Risk Perception Scale (CRPS), a specialized instrument designed to assess caregivers' perceived risk associated with dementia care and inform targeted interventions in LTCFs.</p><p><strong>Design: </strong>A mixed-method design was used, including literature review, 2 rounds of Delphi expert consultation (n = 22), and psychometric validation with 501 caregivers in LTCFs.</p><p><strong>Setting and participants: </strong>Participants were caregivers of older adults with dementia in LTCFs in Sichuan Province, China. Inclusion criteria required at least 3 months of caregiving experience and cognitive competence, March-September 2024.</p><p><strong>Methods: </strong>A mixed-method design was used: (1) literature review and 2 Delphi rounds (22 experts) generated a preliminary scale; (2) psychometric validation involved 501 caregivers from 150 Chinese LTCFs, including item analysis, exploratory factor analysis (n = 200), and confirmatory factor analysis (n = 301).</p><p><strong>Results: </strong>The final CRPS contains 23 items across 4 dimensions: institutional, environmental, psychological support, and competency risks. The scale demonstrated strong reliability (Cronbach's α = 0.882 overall; 0.753-0.905 for subscales) and validity (content validity = 0.928). Exploratory factor analysis extracted 4 factors explaining 69.78% variance (Kaiser-Meyer-Olkin = 0.888, Bartlett's χ² = 3753.073, P < .001). Confirmatory factor analysis confirmed model fit (χ²/df = 2.725, Comparative Fit Index = 0.928, Root Mean Square Error of Approximation = 0.075). Split-half reliability was 0.457 (P < .001), and test-retest reliability was 0.714 (P < .001).</p><p><strong>Conclusions and implications: </strong>The CRPS is a scientifically robust tool to assess care risk perceptions in LTCFs. By identifying caregivers' risk awareness gaps, it supports targeted interventions and policy reforms for standardized safety audits to enhance dementia care quality and safety.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105759"},"PeriodicalIF":4.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626645","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":"Subcontracting, Employment Characteristics, and COVID-19 Infections Among Staff and Residents of Nursing Homes in Canada.","authors":"Valentina Antonipillai, Rochelle Garner, Edward Ng, Mary Crea-Arsenio, Andrea Baumann","doi":"10.1016/j.jamda.2025.105749","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105749","url":null,"abstract":"<p><strong>Objectives: </strong>Staffing challenges in nursing homes (NHs) have led to an increased reliance on subcontracted direct care workers from third-party agencies to provide essential care for older adults. This study assesses the associations between subcontracting, employment characteristics, and COVID-19 infections among direct care staff and residents in NHs.</p><p><strong>Design: </strong>Retrospective observational study using 2 cycles of cross-sectional data from the Nursing and Residential Care Facilities Survey, administered across provinces in Canada during the pandemic, in 2020 and 2021.</p><p><strong>Setting and participants: </strong>NHs (n = 823) that responded to both Nursing and Residential Care Facilities Survey cycles.</p><p><strong>Methods: </strong>The mean number of COVID-19 cases, prevalence rates, and average number of subcontracted direct care workers (registered nurses, registered practical nurses, and personal support workers) were calculated per NH. Associations between subcontracting status, employment characteristics, and COVID-19 infections among NH direct care staff and residents were examined using multivariate negative binomial regression analyses. Employment characteristics included NH ownership type, size, hours of care per resident day, and working conditions, including experiences of staff shortages.</p><p><strong>Results: </strong>Approximately 30% of NHs subcontracted direct care workers from agencies, contributing to 14% of total annual hours of direct care work. On average, the prevalence of staff and resident COVID-19 infections significantly varied by subcontracting status. NHs that subcontracted workers had 1.6 and 1.9 times greater rates of COVID-19 infections among staff and residents, respectively, after controlling for covariates.</p><p><strong>Conclusions and implications: </strong>This study found higher rates of COVID-19 infection in staff and residents of NHs that subcontracted direct care workers compared with those that did not. Increased direct care worker absenteeism, for-profit status, and size were also predictors of staff and resident infections. Future research is needed to identify and assess procedures for subcontracting agency workers that limit infection and improve quality of care.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105749"},"PeriodicalIF":4.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618717","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}