Journal of the American Medical Directors Association最新文献

{"title":"Solution to Improve State Health Outcomes and Access to Care for Medicare Beneficiaries: Full Practice of APRNs","authors":"Alisha Harvey Johnson PhD, RN ,&nbsp;Isabella Zaniletti PhD, MA ,&nbsp;Julie Miller DNP, MBA, FNP-BC, NEA-BC ,&nbsp;Lori L. Popejoy PhD, RN ,&nbsp;Marilyn J. Rantz PhD, RN","doi":"10.1016/j.jamda.2025.105585","DOIUrl":"10.1016/j.jamda.2025.105585","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the influence of advanced practice registered nurse (APRN) restrictive practice laws on the number of APRNs providing services in various care settings, acute, primary, nursing home (long stay), and skilled nursing facility (short stay); understand the relationship between restrictive practice and number of Medicare beneficiary services across settings; and to understand the relationship between restrictive practice and overall quality of health care as indicated by Commonwealth Report state health rankings.</div></div><div><h3>Design</h3><div>One large federal data set and 2 national annual reports with state rankings from 2022 were used in this comparative, descriptive study.</div></div><div><h3>Settings and Participants</h3><div>We summarized number of services × APRN × 1000 patients by state practice restriction (full, reduced, or restricted) and setting of care.</div></div><div><h3>Methods</h3><div>We evaluated interstate variability and reported states that performed significantly above or below the overall median across all settings. Last, we fitted a linear regression model to explore the association of number of services × APRN × 1000 beneficiaries with Commonwealth Report health ranking.</div></div><div><h3>Results</h3><div>APRNs in full-practice states provide significantly more services than in reduced or restricted, regardless of care setting. After adjusting for practice restriction and care setting, no significant association was found between the number of services × APRN × 1000 beneficiaries and the state overall health ranking (regression coefficient <em>β</em> = 0.003, <em>P</em> = .736).</div><div>However, practice restriction was found to be highly significant, with full-practice states indicating overall better health (<em>P</em> &lt; .001), regardless of setting.</div></div><div><h3>Conclusions and Implications</h3><div>Commonwealth Health ranking was found to be highly significant, with full-practice states indicating overall better health, 16 to 18 rankings better than reduced or restricted practice (<em>P</em> = .001), remaining consistent across all settings of care. Restrictive practice laws reduce access to care. It is time states with restrictive and reduced practice reexamine their APRN practice laws to enable Medicare beneficiaries increased access to care and improve overall health outcomes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105585"},"PeriodicalIF":4.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865122","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":"Excessive Burden of Hyperglycemia Along With Hypoglycemia in Long-Term Care Facilities Identified by Continuous Glucose Monitoring","authors":"Medha N. Munshi MD ,&nbsp;Christine Slyne BA ,&nbsp;Atif Adam MD ,&nbsp;Noa Krakoff BS ,&nbsp;Haley Brabant BS ,&nbsp;Molly Savory BS ,&nbsp;Jennifer Maurer DNP ,&nbsp;Elena Toschi MD","doi":"10.1016/j.jamda.2025.105590","DOIUrl":"10.1016/j.jamda.2025.105590","url":null,"abstract":"<div><h3>Objectives</h3><div>Recommendations for diabetes care in long-term care facilities (LTC) focus on the avoidance of hypoglycemia and symptomatic hyperglycemia. Using continuous glucose monitoring (CGM), we evaluated the current state of glycemia in LTC residents with multiple comorbidities.</div></div><div><h3>Design</h3><div>Cross-sectional prospective observational study.</div></div><div><h3>Settings and Participants</h3><div>Participants with diabetes on 1 or more glucose-lowering medications residing in 1 of 8 LTC facilities in Ohio and Michigan.</div></div><div><h3>Methods</h3><div>A masked Dexcom G6 pro CGM was placed for 10 days on LTC residents. Clinical and demographic information was collected from medical records.</div></div><div><h3>Results</h3><div>Sixty-five residents [median age 68 years (range 44–84 years), 51% female, 100% with type 2 diabetes] completed the study. Overall, 68% of the cohort used insulin and 64% were on non-insulin agents (11% on sulfonylurea). The mean A1c of the cohort was 7.2% ± 1.5%. CGM data showed 26% of the cohort with ≥1% time spent in hypoglycemia (time &lt;70 mg/dL). A larger burden of severe hyperglycemia (sensor glucose &gt;250 mg/dL) was seen, with 52% of the cohort spending &gt;10% time, 37% spending &gt;25%, and 18% spending &gt;50% time in severe hyperglycemia. The cohort had a median of 13 comorbid conditions, taking 19 medications daily, with 86% having functional disabilities and 63% reporting a recent fall. Fifty-four percent of the cohort had a body mass index (BMI) &gt;30 kg/m² and 22% had a BMI &gt;40 kg/m².</div></div><div><h3>Conclusions and Implications</h3><div>In this multimorbid cohort of residents with diabetes living in LTC facilities, we identified a high burden of both hypoglycemia and severe hyperglycemia, despite optimal control of A1c. More consistent use of CGM may help to identify glycemic excursions and actionable glucose patterns to improve therapeutic decision-making by clinicians.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105590"},"PeriodicalIF":4.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869037","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":"Polypharmacy and Mild Cognitive Impairment in Older Adults: A 3-year Study of DO-HEALTH","authors":"Caroline de Godoi Rezende Costa Molino PhD ,&nbsp;Konstantin Baumann MD ,&nbsp;Stephanie Gaengler PhD ,&nbsp;Tatjana Meyer-Heim MD ,&nbsp;Angélique Sadlon MD, PhD ,&nbsp;Gregor Freystaetter MD ,&nbsp;Reto W. Kressig MD ,&nbsp;Andreas Egli MD ,&nbsp;Heike A. Bischoff-Ferrari MD, DrPH","doi":"10.1016/j.jamda.2025.105586","DOIUrl":"10.1016/j.jamda.2025.105586","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between polypharmacy and mild cognitive impairment (MCI) at baseline and over 3 years in community-dwelling older adults.</div></div><div><h3>Design</h3><div>Observational analysis of the DO-HEALTH trial.</div></div><div><h3>Setting and Participants</h3><div>Community-dwelling adults aged ≥70 years with good cognitive function and without major diseases at baseline.</div></div><div><h3>Methods</h3><div>Main exposure was polypharmacy at baseline (≥5 medications). The outcome was MCI (Montreal Cognitive Assessment [MoCA] score &lt;26), assessed at baseline and years 1, 2, and 3. Logistic regression and generalized estimating equations (GEEs) for repeated binary outcomes were used for the cross-sectional and longitudinal analysis, respectively. Minimally adjusted models included age, sex, prior fall, study site, body mass index, and education. Fully adjusted models additionally adjusted for mental health and multimorbidity. GEE models also accounted for time and DO-HEALTH treatment effects. Sensitivity analysis used a stricter MCI definition (MoCA &lt; 24).</div></div><div><h3>Results</h3><div>A total of 2153 participants completed MoCA at baseline. Baseline MCI prevalence was higher in participants with polypharmacy compared with those with no polypharmacy (MCI &lt; 26: 53.5% vs 46.5%; MCI &lt; 24: 34.9% vs 17.2%). Polypharmacy was associated with greater MCI odds at baseline in the minimally adjusted models (MoCA &lt; 26: odds ratio [OR], 1.32; 95% CI, 1.05–1.66; MoCA &lt; 24: OR, 1.37; 95% CI, 1.06–1.79). Over 3 years, polypharmacy was associated with increased MCI odds in the minimally adjusted models (MoCA &lt; 26: OR, 1.28; 95% CI, 1.08–1.52; MoCA &lt; 24: OR, 1.33; 95% CI, 1.07–1.65). Notably, these associations were somewhat attenuated and nonsignificant after controlling for mental health and multimorbidity.</div></div><div><h3>Conclusion and Implications</h3><div>Our findings suggest that MCI is more prevalent in older adults with polypharmacy compared with those without polypharmacy. Although polypharmacy was associated with MCI at baseline and over 3 years, these associations were attenuated by mental health and multimorbidity, suggesting that mental health and multimorbidity contribute to both polypharmacy and MCI.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105586"},"PeriodicalIF":4.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811589","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 Dementia and Early Rehabilitation in Older Inpatients With Internal Medical Conditions.","authors":"Naho Kawasaki, Atsushi Miyawaki, Yuya Kimura, Yuichiro Matsuo, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1016/j.jamda.2025.105595","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105595","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105595"},"PeriodicalIF":4.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975056","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":"Barriers and Facilitators to Successful Outbreak Management of Viral Respiratory Tract Infections in Long-Term Care Facilities: A Qualitative Interview Study","authors":"Iris R. van der Horst Msc ,&nbsp;Daisy Kolk PhD ,&nbsp;Meriam Janssen PhD ,&nbsp;Sascha R. Bolt PhD ,&nbsp;Martin Smalbrugge PhD, MD ,&nbsp;Sarah Janus PhD ,&nbsp;Cees M.P.M. Hertog PhD, MD","doi":"10.1016/j.jamda.2025.105575","DOIUrl":"10.1016/j.jamda.2025.105575","url":null,"abstract":"<div><h3>Objectives</h3><div>Effective management of COVID-19 and influenza outbreaks in nursing homes (NHs) depends on preparation by the NH organization and the rightful execution of infection prevention and control (IPC) measures by NH staff. To be better prepared for future outbreaks and pandemics, we need a better understanding of barriers and facilitators to the execution of measures. This study aims to investigate which barriers and facilitators were perceived by Dutch NH staff during the execution of IPC measures to control outbreaks of COVID-19 and influenza in the COVID-19 pandemic end stage.</div></div><div><h3>Design</h3><div>Qualitative interview study.</div></div><div><h3>Setting</h3><div>Nursing homes where COVID-19 and/or influenza outbreaks (defined as at least 2 confirmed cases on an NH unit) occurred between February 2023 and April 2023.</div></div><div><h3>Methods</h3><div>We monitored 24 COVID-19 and influenza outbreaks in 14 Dutch NH organizations in the pandemic end stage. Purposive sampling was used to select a variety of outbreaks for more extensive monitoring, including qualitative interviews with NH staff involved in the management of the outbreak. During the interviews, participants reflected on the management of monitored outbreaks as well as previous outbreaks. Interview transcripts were thematically analyzed to identify determinants of IPC strategy execution.</div></div><div><h3>Results</h3><div>Determinants of IPC execution were clustered according to themes: motivations and attitudes; appropriateness of measures; guidance and cooperation of NH staff; communication; knowledge and skills; architectural features of the NH location; and availability of resources.</div></div><div><h3>Conclusions and Implications</h3><div>The current study provides in-depth insight into which determinants facilitated and impeded IPC execution during COVID-19 and influenza outbreaks pandemic end stage. These findings may help NHs to better prepare for the management of future outbreaks and pandemics, and provide insights into what determinants to consider for developing IPC strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105575"},"PeriodicalIF":4.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753290","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":"Social Engagement is Associated with Location-based Digital Markers on a Dementia Care Unit","authors":"Leia C. Shum MASc ,&nbsp;Elham Khodabandehloo PhD ,&nbsp;Tamim Faruk MASc ,&nbsp;Twinkle Arora PhD ,&nbsp;Caitlin McArthur PhD ,&nbsp;Charlene H. Chu PhD ,&nbsp;Katherine S. McGilton PhD ,&nbsp;Alastair J. Flint MB ,&nbsp;Shehroz S. Khan PhD ,&nbsp;Andrea Iaboni MD, DPhil","doi":"10.1016/j.jamda.2025.105548","DOIUrl":"10.1016/j.jamda.2025.105548","url":null,"abstract":"<div><h3>Objective</h3><div>Social engagement is an important contributor to quality of life and the overall health of people with dementia. There is an opportunity to develop an objective measure of social engagement by capturing factors such as the number and duration of social contacts, time in social settings, and social network metrics. The aim of this study was to examine the longitudinal relationship between clinical assessment of social engagement and digital markers of social behavior and networks derived from a clinical real-time location system (RTLS).</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting and Participants</h3><div>Thirty-seven patients on a short-stay specialized dementia unit for behavioral and psychological symptoms of dementia (60-day average length of stay).</div></div><div><h3>Methods</h3><div>Location data were collected using a wrist-worn clinical RTLS. Features measuring social contact, time in social spaces, and social network analyses were extracted from the location data for each morning and evening shift. The association over time between average weekly features and weekly Revised Index of Social Engagement (RISE) assessment scores was investigated using univariate panel models.</div></div><div><h3>Results</h3><div>There was high variability within and between participants in the RTLS-derived digital markers of social behavior. Seven digital markers of social engagement were statistically associated with weekly RISE scores over time, including time spent in the dining hall, time without co-patient contact, number of contacts longer than 5 minutes in duration, and social network PageRank.</div></div><div><h3>Conclusions and Implications</h3><div>Location data collected in residential care environments can provide insights into patterns of social engagement in people with dementia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105548"},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670153","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 Effects of Commercial Conversational Agents on Older Adults’ Mental Health: A Scoping Review","authors":"Jolene Zi Tong Teo BSN (Hons) ,&nbsp;Si Qi Yoong BSN (Hons) ,&nbsp;Yi Xuan Chan BSN (Hons) ,&nbsp;Ying Jiang PhD","doi":"10.1016/j.jamda.2025.105523","DOIUrl":"10.1016/j.jamda.2025.105523","url":null,"abstract":"<div><h3>Objectives</h3><div>With increasing life expectancy, more older adults are experiencing poor mental health because of the significant life transitions they face. Commercial conversational agents (CAs) are emerging devices that can potentially support older adults' mental well-being. However, limited literature has evaluated the influence of commercial CAs on older adults' mental health. This study aims to examine what is known about the effects of commercial CAs on older adults’ mental health and the associated features.</div></div><div><h3>Design</h3><div>This scoping review was conducted in accordance with Arksey and O'Malley's framework.</div></div><div><h3>Setting and Participants</h3><div>The review primarily focused on community-dwelling older adults aged 60 and above who used any commercial CAs.</div></div><div><h3>Methods</h3><div>Quantitative, qualitative, mixed-method peer-reviewed studies and dissertations were included. Eleven databases were searched for relevant articles published from January 1, 2010, until April 9, 2024. Data extracted included the author(s), year, country, objective, population details, eligibility criteria, study design, commercial CA type, and findings related to research questions. Inductive basic content analysis was used for data synthesis.</div></div><div><h3>Results</h3><div>Twenty-nine articles from 28 studies (n = 1017 older adults) were included. Five categories were synthesized: social wellness, emotional reactions, cognitive stimulation, autonomy, and depression. Common features impacting older adults' mental health were the CAs' conversational capacity and anthropomorphism, voice-activated functions, music, calling and other functions, and technological limitations. There were more positive than adverse effects on older adults’ mental health categories.</div></div><div><h3>Conclusion and Implications</h3><div>Commercial CAs can potentially mitigate mental health in older adults, but the evidence is still very preliminary. Their effects must be verified in randomized controlled trials using objective and validated tools and through mixed-method studies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105523"},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743120","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":"Agreement of Medicare Part D and Minimum Data Set Reported Psychotropic Medication Use in Nursing Homes","authors":"Tianwen Huan MS ,&nbsp;Orna Intrator PhD ,&nbsp;Adam Simning MD, PhD ,&nbsp;Kenneth Boockvar MD ,&nbsp;David C. Grabowski PhD ,&nbsp;Shubing Cai PhD","doi":"10.1016/j.jamda.2025.105538","DOIUrl":"10.1016/j.jamda.2025.105538","url":null,"abstract":"<div><h3>Objectives</h3><div>Little evidence exists on the accuracy of the Minimum Data Set (MDS)–based medication items. We compared quarterly rates of antipsychotic, antidepressant, and hypnotic use between the MDS and Part D Prescription Drug Event file (PDE) in 2018.</div></div><div><h3>Design</h3><div>Cross-sectional comparison.</div></div><div><h3>Setting and Participants</h3><div>All US Medicare- or Medicaid-certified nursing homes were included. Long-stay nursing home residents enrolled in Medicare Part D who were aged ≥65 years with psychiatric disorders or dementia identified in the MDS data (N = 580,340) were included. Two subcohorts included the following: residents with psychiatric disorders and no Alzheimer's disease and related dementias (ADRD), and residents with ADRD.</div></div><div><h3>Methods</h3><div>Psychotropic medication use was assessed using the share of study participants who received the medication in the quarter identified by the MDS. We used Cohen kappa to assess agreement in the share of residents using psychotropic medications during the quarter and used PDE data as a reference to calculate validity parameters.</div></div><div><h3>Results</h3><div>The MDS-reported and PDE-reported antipsychotic (MDS vs PDE: 34.0% vs 34.3%) or antidepressant (MDS vs PDE: 73.4% vs 71.3%) users have high concordance as measured by the kappa value (antipsychotic: 0.9; antidepressant: 0.83). Sensitivity, specificity, positive predictive value, and negative predictive value of MDS data compared with PDE were 96.7%, 92.8%, 96.3%, and 93.6% for antipsychotic, and 84.5%, 96.7%, 91.1%, and 94.0% for antidepressant. Only 3.7% of study participants identified in the MDS data, vs 32.6% of PDE-based users (kappa value: 0.1), used hypnotics. By combining antianxiety medications with hypnotics, the rates of MDS hypnotic or antianxiety users increased to 35.0% (kappa value: 0.74). Sensitivity, specificity, positive predictive value, and negative predictive value were 89.5%, 85.6%, 92.8%, and 79.8%, respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Agreement between the MDS and PDE in antipsychotic and antidepressant use was high, suggesting that the MDS is a valid tool to measure antipsychotic and antidepressant use. Additional work is needed to understand the disagreements between MDS and PDE in hypnotic use.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105538"},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753289","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":"Measuring Physical Activity in Hospital Settings: A Scoping Review of Randomized Controlled Trials","authors":"Christina L. Ekegren PhD ,&nbsp;Lane Meyer DPT ,&nbsp;Michele Callisaya PhD ,&nbsp;Maureen C. Ashe PhD ,&nbsp;Claire Baldwin PhD ,&nbsp;Sze-Ee Soh PhD ,&nbsp;Dawn C. Mackey PhD","doi":"10.1016/j.jamda.2025.105563","DOIUrl":"10.1016/j.jamda.2025.105563","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify physical activity and sedentary behavior outcomes, measurement tools and protocols used, and data integrity in randomized controlled trials (RCTs) of hospital-based movement interventions in middle-aged and older adults.</div></div><div><h3>Design</h3><div>Scoping review of RCTs.</div></div><div><h3>Setting and Participants</h3><div>Adults with a mean or median age ≥50 years admitted to an acute or subacute hospital.</div></div><div><h3>Methods</h3><div>Four databases were searched for RCTs published between 2000 and 2023 evaluating interventions and measuring outcomes related to movement behavior (physical activity and/or sedentary behavior) of adults during an acute or subacute inpatient admission. Data extracted included movement behavior outcomes, measurement tools/devices, measurement protocols, and the integrity of movement data. Data were reported and synthesized using frequencies/percentages and via narrative summaries.</div></div><div><h3>Results</h3><div>After screening (n = 18,018), 34 studies were included. Most studies were conducted in subacute rehabilitation (n = 13) and excluded participants with cognitive impairment (n = 27) and/or mobility impairment (n = 24). A total of 17 different movement behavior outcomes were measured, with step count measured in 22 studies. Most studies (n = 30) measured movement behaviors using a wearable device. There were 43 unique measurement devices/tools used across studies, with significant heterogeneity observed in protocols for their use.</div></div><div><h3>Conclusions and Implications</h3><div>Given the substantial heterogeneity of movement behavior outcomes, and measurement tools and protocols used, there is an urgent need to develop evidence-based guidelines for measuring movement behaviors in hospital-based trials. Without this, synthesis of clinical trial outcomes and subsequent implementation of effective interventions for improving hospital-based movement behaviors will remain lacking.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105563"},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700776","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":"Post-Acute Care Staff Perspectives of Changes since the COVID-19 Pandemic","authors":"Maggie Syme PhD ,&nbsp;Darby M. Simon MS ,&nbsp;Sandra Shi MD ,&nbsp;Cari Levy MD ,&nbsp;Ana-Maria Vranceanu PhD ,&nbsp;Evan Plys PhD","doi":"10.1016/j.jamda.2025.105579","DOIUrl":"10.1016/j.jamda.2025.105579","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105579"},"PeriodicalIF":4.2,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753293","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}