Journal of the American Medical Directors Association最新文献

{"title":"Should Frailty Be Subdivided in Definition and Assessment?","authors":"Ryota Sakurai, Satoshi Seino, Koichiro Wasano","doi":"10.1016/j.jamda.2025.105692","DOIUrl":"10.1016/j.jamda.2025.105692","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105692"},"PeriodicalIF":4.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191916","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":"Antithrombotic Therapy and Mortality Risk in Older Adults with Hip Fractures","authors":"Karin Vleeshouwers MD ,&nbsp;Janneke J.C. Bastings MD ,&nbsp;Renée Brüggemann MD, PhD ,&nbsp;Melanie J. de Jong MSc ,&nbsp;Mark van den Boogaart MD ,&nbsp;Martijn Poeze MD, PhD ,&nbsp;Nick van Es MD, PhD ,&nbsp;Nordin M.J. Hanssen MD, PhD ,&nbsp;Steffie Brouns MD, PhD ,&nbsp;Fabienne Magdelijns MD, PhD ,&nbsp;Bart Spaetgens MD, PhD","doi":"10.1016/j.jamda.2025.105690","DOIUrl":"10.1016/j.jamda.2025.105690","url":null,"abstract":"<div><h3>Objectives</h3><div>Antithrombotic therapy, including antiplatelet therapy, direct oral anticoagulants (DOACs), and vitamin K antagonists (VKAs), is increasingly prescribed. These therapies pose complex challenges in patients with hip fracture due to risks of bleeding, risks of thromboembolism, and their potential role as markers of frailty. However, limited real-world evidence exists regarding their risks and benefits in this population. This retrospective cohort study examines the association between antithrombotic therapy and mortality in older patients with hip fracture.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Patients with hip fracture admitted to a level 1 trauma center between January 2021 and December 2022.</div></div><div><h3>Methods</h3><div>Data on clinical characteristics, antithrombotic therapy, and outcomes were collected from health records. Mortality was analyzed using Kaplan-Meier curves and Cox proportional hazards regression, adjusting for age, sex, comorbidity, functional status, surgery, kidney function, body mass index, and nursing home residency. Secondary outcomes included transfusion rates and thromboembolic events.</div></div><div><h3>Results</h3><div>Among 526 patients (median age, 82 years; 69% female), 1-year mortality rates were 14.3% for no antithrombotic therapy, 21.0% for antiplatelet therapy, 26.4% for DOACs, and 48.9% for VKAs. At 2 years, mortality rates increased to 20.9%, 30.4%, 32.1%, and 61.7%, respectively (log-rank <em>P</em> &lt; .001). In the fully adjusted model, the mortality risks associated with antiplatelet therapy [hazard ratio (HR), 0.71; 95% CI, 0.45-1.12] and DOACs (HR, 0.99; 95% CI, 0.54-1.81) were no longer significant compared with patients without antithrombotic therapy, whereas VKAs remained significantly associated with increased mortality (HR, 2.17; 95% CI, 1.22-3.83). Secondary outcomes revealed that all antithrombotic therapies were linked to delayed surgery and higher transfusion rates. However, neither delayed surgery nor transfusions independently predicted mortality.</div></div><div><h3>Conclusions and Implications</h3><div>VKA use is associated with significantly higher mortality in older patients with hip fracture and may identify a subset at substantial risk of poor outcomes. These findings underscore the need for careful assessment and management of VKA users and further research to confirm these observations.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105690"},"PeriodicalIF":4.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191913","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":"Mechanisms Leading to Sedentary Behaviors among Older Adults in Chinese Residential Care Homes: The Capability, Opportunity, Motivation-Behavior Model Guided Structural Equation Modeling","authors":"Sihan Dong BSN ,&nbsp;Min Wang PhD ,&nbsp;Su Hwan Kim PhD ,&nbsp;Zhaodong Chen ,&nbsp;Xiangning Hu ,&nbsp;Peiyao Li ,&nbsp;Xueying Liu BSN ,&nbsp;Mengjiao Xu BSN ,&nbsp;Xiuling Yang PhD ,&nbsp;Yuting Song PhD","doi":"10.1016/j.jamda.2025.105629","DOIUrl":"10.1016/j.jamda.2025.105629","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate sedentary behaviors among older adults in residential care homes and explore potential mechanisms leading to sedentary behaviors based on the Capability, Opportunity, and Motivation to Behavior (COM-B) model.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>We collected data from 329 residents who lived in 11 residential care homes in China.</div></div><div><h3>Method</h3><div>We collected self-reported survey data on resident demographics, sedentary behavior, activities of daily living (ADLs), social support, exercise self-efficacy, and depressive symptoms. Mean and standard deviation were used to describe the sedentary behavior of older adults in care homes. We drew on the COM-B model and constructed a structural equation model to assess the interrelationships of ADLs, social support, exercise self-efficacy, depressive symptoms, and sedentary behavior.</div></div><div><h3>Result</h3><div>The average daily sedentary time of older adults in our sample was 11.4 hours (SD = 2.6). Social support not only directly influenced sedentary behavior of older adults in care homes (β = 0.042; <em>P</em> = .039; 95% CI, −0.054 to −0.031]), but also indirectly through exercise self-efficacy (β = 0.003; <em>P</em> &lt; .001; 95% CI, −0.023 to −0.011]) and depressive symptoms (β = 0.003; <em>P</em> &lt; .001; 95% CI, −0.018 to −0.006) affected sedentary behaviors. ADLs indirectly affected sedentary behaviors through exercise self-efficacy (β = 0.029; <em>P</em> &lt; .001; 95% CI, −0.220 to −0.107) and depressive symptoms (β = 0.099; <em>P</em> &lt; .001; 95% CI, −0.161 to −0.053).</div></div><div><h3>Conclusions and Implications</h3><div>The high levels of sedentary behaviors among our sample of residents warrant awareness among long-term care staff and managers. Potential strategies for reducing sedentary behaviors include promoting social support, enhancing exercise self-efficacy, and managing depressive symptoms.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105629"},"PeriodicalIF":4.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086439","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":"Transforming Transitional Care: Early Hospital Discharge through the Care at Home Program","authors":"Shawn M. Doss BA ,&nbsp;Brad Bergum MS ,&nbsp;Lauren Hopkins MPH ,&nbsp;Ricaurte Solis DO ,&nbsp;Matthew Lyon MD","doi":"10.1016/j.jamda.2025.105681","DOIUrl":"10.1016/j.jamda.2025.105681","url":null,"abstract":"<div><h3>Objectives</h3><div>Every year, thousands of patients face the challenging transition from hospital to home, resulting in high readmission rates and excessive resource use. Our telemedicine-based Care at Home (CaH) program, which facilitates early discharge, was assessed for its impact on 30-day readmissions, length of hospital stay (LoS), and total charges.</div></div><div><h3>Design</h3><div>Retrospective cohort study comparing standard inpatient care with the CaH program, which features telemedicine support and continuous monitoring provided by nurses, paramedics, and physicians after early hospital discharge. This program prioritizes patients at higher risk for readmission.</div></div><div><h3>Setting and Participants</h3><div>Data were derived from 2866 hospital admissions covering select diagnostic-related groups (DRGs) between January and December 2023. Of these, 215 patients were enrolled in CaH and 2651 received standard inpatient care.</div></div><div><h3>Methods</h3><div>We analyzed 30-day readmission rates, LoS, and total charges. Categorical variables were evaluated using χ² tests, and the Mann-Whitney <em>U</em> (MWU) test was applied for skewed continuous variables. A Cox proportional hazards model assessed time to readmission, using a 1.15 noninferiority margin.</div></div><div><h3>Results</h3><div>The 30-day readmission rate was 11.2% in the CaH group and 12.8% in the control group (<em>P</em> = .57). Hazard ratios (HRs) favored CaH but exceeded the 1.15 noninferiority margin (adjusted HR, 0.82; 95% CI, 0.54–1.24; <em>P</em> = .35). CaH did achieve significantly lower LoS (mean 4.7 vs 7.7 days; MWU <em>P</em> &lt; .001) and total charges (mean $54,491 vs $84,245; MWU <em>P</em> &lt; .001). DRG-specific analyses revealed variable readmission outcomes but consistent reductions in LoS and costs across most DRGs for patients in CAH.</div></div><div><h3>Conclusions and Implications</h3><div>CaH yielded comparable 30-day readmission rates while significantly lowering LoS and total costs, although it did not achieve the predefined noninferiority margin. Potential selection bias and differences in patient acuity may have influenced these findings. Further research should focus on refining patient selection, developing condition-specific protocols, and examining broader applications of telemedicine-driven early discharge models.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105681"},"PeriodicalIF":4.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094179","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":"Dementia Care Training Interventions for Residential Aged Care Workers: An Umbrella Review","authors":"Lauren Bruce DPsych (Health),&nbsp;Marta Woolford PhD,&nbsp;Hannah Gulline MPH,&nbsp;Danielle Berkovic PhD,&nbsp;Darshini Ayton PhD","doi":"10.1016/j.jamda.2025.105627","DOIUrl":"10.1016/j.jamda.2025.105627","url":null,"abstract":"<div><h3>Objectives</h3><div>Staff working in residential aged care (RAC) play a vital role in delivering quality care to residents with dementia. This umbrella review aimed to summarize reviews that examined dementia training interventions for RAC staff and their effects, to inform the development of training for an Australian aged care organization.</div></div><div><h3>Design</h3><div>Umbrella review.</div></div><div><h3>Settings and participants</h3><div>RAC workers and older adults with dementia living in RAC.</div></div><div><h3>Methods</h3><div>An umbrella review was adopted to summarize a wide range of education and training interventions efficiently. A systematic search was conducted to identify systematic, literature, or scoping reviews that adopted a systematic or documented search strategy; included primary studies that assessed training or educational interventions for paid staff in RAC; and focused specifically on dementia care.</div></div><div><h3>Results</h3><div>Twenty-seven reviews met inclusion criteria. Dementia training for RAC workers included a diverse range of topics, frameworks, or approaches to care. Clinical and direct care staff were the participants of training across most interventions. Core training components focused on (1) managing behavioral and psychological symptoms of dementia, (2) providing person-centered care, and (3) building communication skills. Training was often couched within multifaceted dementia interventions. More successful training extended beyond didactic teaching methods and engaged staff across multiple training sessions. Although a range of staff and resident outcomes were examined, the diversity of outcomes assessed and study designs made it difficult to compare across reviews.</div></div><div><h3>Conclusion and Implications</h3><div>Given the prevalence of dementia in older people living in RAC, equipping the workforce with the core knowledge and skills in how to care for a person with dementia is vital for the delivery of quality of care and resident quality of life.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105627"},"PeriodicalIF":4.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031694","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":"Does the Veterans Health Administration Purchase High-Quality Home Health Care?","authors":"Katherine A. Kennedy PhD ,&nbsp;Frank DeVone ScM ,&nbsp;Portia Y. Cornell PhD ,&nbsp;Pedro Gozalo PhD ,&nbsp;Kali S. Thomas PhD ,&nbsp;Stefan Gravenstein MD, MPH ,&nbsp;Kate H. Magid MPH ,&nbsp;Tracy Mroz PhD ,&nbsp;Christine D. Jones MD, MS","doi":"10.1016/j.jamda.2025.105684","DOIUrl":"10.1016/j.jamda.2025.105684","url":null,"abstract":"<div><h3>Objectives</h3><div>Veterans are frequently referred for skilled home health care (HHC) after hospital discharge. We examined access to high-quality VA-contracted home health agencies (HHAs) for Veterans following a VA medical center (VAMC) hospitalization and by rural or urban residence.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting and Participants</h3><div>We used national VA data from April 2015 to September 2019 and included all Veterans discharged from a VAMC hospitalization who received skilled HHC paid for by VA.</div></div><div><h3>Methods</h3><div>We assigned every eligible discharge a choice set of VA-contracted HHAs serving the Veteran's county and a choice set of all HHAs serving the Veteran's county. We calculated a quality ratio (QR): the percentage of high-quality VA-contracted (4- or 5-star) HHAs relative to all high-quality HHAs serving the county reported in Home Health Compare. We then aggregated the QR by VAMC. High QRs (average QR and 95% CI &gt;1) indicate VA contracts with higher-quality HHAs, relative to all HHAs serving the county. Neutral QRs (positive or negative average QR and 95% CI includes 1) indicate no difference in quality. Low QRs (average QR and 95% CI &lt;1) indicate a lower-quality network. We examined bootstrapped QRs by VAMCs, including the subset serving mostly rural Veterans.</div></div><div><h3>Results</h3><div>We identified 60,406 VA-paid HHC episodes for 42,010 Veterans discharged from 113 VAMCs. Although 61.1% of VAMCs had high QRs, only 27.3% of the 33 VAMCs serving rural Veterans had high QRs. Rural-residing Veterans had lower proportions of high QRs than urban Veterans (46.3% vs 64.0%) and nearly double the proportion of neutral QRs (31.5% vs 16.2%), but similar proportions of low QRs (22.2% vs 19.1%).</div></div><div><h3>Conclusions and Implications</h3><div>Overall, VA-contracted HHAs were of higher quality compared to available HHAs serving Veterans’ counties. Although VAMCs serving mostly rural Veterans provided less access to higher-quality HHAs, this effect was driven by more access to neutral quality HHAs in rural counties, not by differentially contracting with lower-quality HHAs.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105684"},"PeriodicalIF":4.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142860","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":"Cross-National Evidence on Risk of Death Associated with Loneliness: A Survival Analysis of 1-Year All-Cause Mortality among Older Adult Home Care Recipients in Canada, Finland, and Aotearoa | New Zealand","authors":"Bonaventure A. Egbujie PhD ,&nbsp;Gustavo Betini PhD ,&nbsp;Sandra Ochwat MSc ,&nbsp;Reem T. Mulla PhD ,&nbsp;Jokke Häsä PhD ,&nbsp;Johanna Edgren PhD ,&nbsp;Mari Aaltonen PhD ,&nbsp;Irihapeti Bullmore RN ,&nbsp;Gary Cheung PhD ,&nbsp;Hamish A. Jamieson PhD ,&nbsp;Philip Schluter PhD ,&nbsp;John P. Hirdes PhD","doi":"10.1016/j.jamda.2025.105687","DOIUrl":"10.1016/j.jamda.2025.105687","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine all-cause 1-year risk of mortality associated with loneliness for home care recipients after adjusting for potential confounders.</div></div><div><h3>Design</h3><div>Survival analyses with parallel designs using interRAI Home Care assessments and mortality.</div></div><div><h3>Settings and Participants</h3><div>Home care recipients in 3 countries—Canada, Finland, and Aotearoa | New Zealand (ANZ)—who were 65 years and older were selected for this retrospective analysis.</div></div><div><h3>Methods</h3><div>We fit a multivariable Cox regression model to obtain the adjusted proportional hazards of 1-year mortality among home care recipients for each of the 3 countries.</div></div><div><h3>Results</h3><div>A total of 178,610, 35,073, and 169,703 home care recipients in Canada, Finland, and ANZ respectively, were included in the study. The respective baseline rates of loneliness in the 3 countries were 15.9%, 20.5%, and 24.4% of recipients. In multivariate Cox regression analysis, being lonely was independently associated with a lower likelihood of mortality among home care recipients, with hazard ratios of 0.82 (95% CI 0.78-0.86) in Canada, 0.85 (95% CI 0.79-0.92) in Finland, and 0.77 (95% CI 0.74-0.81) in ANZ.</div></div><div><h3>Conclusions and Implications</h3><div>Loneliness is pervasive in home care settings across the 3 countries; however, its association with mortality differs from reports for the general population. Loneliness was not associated with an increased risk of death after adjusting for health-related covariates. The causal order between changes in health, loneliness, and mortality is unclear. For example, loneliness may be a consequence of those health changes rather than their cause. Hence, temporal order needs better delineation. Health care systems should treat loneliness as an important mental health priority irrespective of a possible relationship with physical health.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105687"},"PeriodicalIF":4.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132609","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":"Factors Influencing Change in Frailty Status in Retirement Village Residents","authors":"Katherine Bloomfield MBChB ,&nbsp;Zhenqiang Wu PhD ,&nbsp;Annie Tatton RGON ,&nbsp;Cheryl Calvert NZRNComp ,&nbsp;Joanna Hikaka PhD ,&nbsp;Michal Boyd ND ,&nbsp;Dale Bramley MPH, MBA ,&nbsp;Martin J. Connolly MD","doi":"10.1016/j.jamda.2025.105626","DOIUrl":"10.1016/j.jamda.2025.105626","url":null,"abstract":"<div><h3>Objectives</h3><div>Older people residing in retirement villages (RVs) (elsewhere called continuing care retirement communities) are thought to live in a relatively age-friendly environment. Many RVs have facilities and resources for health care and home-based supports and opportunities for physical activity and social engagement. Living within such environments may influence changes in frailty.</div></div><div><h3>Design</h3><div>Longitudinal cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 578 residents from 33 RVs.</div></div><div><h3>Methods</h3><div>Resident international Resident Assessment Instrument data, used to develop the frailty index, and village-level data (by survey) were collected at baseline. Participants were reassessed with the international Resident Assessment Instrument 2.5 years later. Analysis of factors associated with worsening frailty or death was performed with multivariable logistic regression.</div></div><div><h3>Results</h3><div>At follow-up, 47 participants had died, and a further frailty index was calculated in 478 participants. Within the entire cohort, 289 (55.0%) stayed within the same frailty category, 23 (4.4%) improved, and 166 (31.6%) worsened in frailty status during a mean of 2.5 years. Aged &gt;90 years at baseline [odds ratio (OR), 3.34; 95% CI, 1.61-6.93; <em>P</em> = .001], poor/fair quality of life (OR, 2.94; 95% CI, 1.35-6.40; <em>P</em> = .007), participation in social activities of long-standing interest in the last 30 days (comparator within 3 days: OR, 1.99; 95% CI, 1.06-3.71; <em>P</em> = .03), and villages owned by not-for-profit organizations (OR, 1.71; 95% CI, 1.06-2.77; <em>P</em> = .03) were associated with higher odds of worsening frailty status or death. There was a borderline significant association with not visiting a dentist in the past 12 months (OR, 1.43; 95% CI, 0.98-2.08; <em>P</em> = .07), with significance found on sensitivity analysis (OR, 1.57; 95% CI, 1.08-2.26; <em>P</em> = .02).</div></div><div><h3>Conclusions and Implications</h3><div>In older adults residing in presumed age-friendly communities, individual and RV-level factors were associated with worsening frailty or death, some of which are modifiable. Further research addressing differences between RV ownership models and how this influences frailty is needed. Understanding how the wider social and physical environment influences frailty is essential for designing frailty prevention strategies at the neighborhood level and in the creation of frailty-friendly and preventative environments.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105626"},"PeriodicalIF":4.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032725","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 Interventions for Reducing Sedentary Behavior in Older Adults Living in Long-Term Care Facilities: A Systematic Review and Meta-Analysis","authors":"Erika Karkauskiene MD ,&nbsp;Rima Solianik PhD ,&nbsp;Mark A. Tully PhD ,&nbsp;Maria Giné-Garriga PhD, PT ,&nbsp;Cristina Font-Jutglà PhD ,&nbsp;Anna Escribà Salvans PhD ,&nbsp;Vilma Dudoniene PhD, PT ,&nbsp;Marius Brazaitis PhD ,&nbsp;Javier Jerez-Roig PhD, PT","doi":"10.1016/j.jamda.2025.105685","DOIUrl":"10.1016/j.jamda.2025.105685","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the effectiveness of interventions aimed at reducing sedentary behavior (SB) and/or increasing physical activity (PA) among adults aged ≥60 years residing in long-term care facilities (LTCFs).</div></div><div><h3>Design</h3><div>Systematic review of randomized controlled trials (RCTs) and pre-post interventional studies targeting SB reduction and/or increase in PA, following PRISMA guidelines.</div></div><div><h3>Setting and Participants</h3><div>Six studies conducted in LTCFs across Europe and North America, involving 403 participants aged ≥60 years.</div></div><div><h3>Methods</h3><div>We searched 7 databases (Cochrane Library, PubMed, Scopus, PEDro, ScienceDirect, <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, and Google Scholar) up until January 2025 and screened reference lists for additional articles. Two independent reviewers screened titles, abstracts, and full texts, resulting in the inclusion of 6 studies: 3 pre-post interventional studies and 3 RCTs. The primary outcome was time spent in SB, measured via device or self-report, whereas secondary outcomes included quality of life, depression, physical health (physical function, cardiovascular and metabolic health, adverse events), and social isolation.</div></div><div><h3>Results</h3><div>One RCT found that the intervention reduced SB compared to usual care, whereas the other studies reported nonsignificant improvements. Notably, interventions focused on SB rather than PA showed potential positive effects on reducing sedentary time. However, limitations such as small sample sizes, heterogeneity, and risk of bias were common, highlighting the need for further research.</div></div><div><h3>Conclusions and Implications</h3><div>In conclusion, this review emphasizes the uncertainty surrounding the effectiveness of SB reduction interventions in LTCFs. Future research should refine methodologies, standardize interventions and outcome measures, and build a stronger evidence base to guide intervention development and improve well-being in LTCF residents. Findings also suggest that SB-focused strategies may be more effective than PA-based ones alone and could inform policy and practice development in LTCFs.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105685"},"PeriodicalIF":4.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142861","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":"CMS Quality Star Ratings for Nursing Homes Change Frequently: A Descriptive Analysis of Trends From 2009 to 2020","authors":"Tory H. Hogan PhD ,&nbsp;Nicholas R. Maurer MD, MPH ,&nbsp;Pejmon Noghrehchi MHM ,&nbsp;Larry R. Hearld PhD, MSA, MBA","doi":"10.1016/j.jamda.2025.105631","DOIUrl":"10.1016/j.jamda.2025.105631","url":null,"abstract":"<div><h3>Objectives</h3><div>Nursing Home Compare star ratings are closely watched by hospital delivery systems, policymakers, and consumers as measures of care quality. However, very little is known about the degree to which nursing homes can or do move between star ratings, what we refer to as performance mobility. This study addresses a gap in the literature by examining mobility trends in overall nursing home star ratings.</div></div><div><h3>Design</h3><div>Descriptive analysis.</div></div><div><h3>Setting and Participants</h3><div>We reviewed 2,016,985 monthly ratings for 16,568 unique US Medicare–certified nursing homes.</div></div><div><h3>Methods</h3><div>Using Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data, we constructed a database of the overall monthly star ratings for each nursing home in the United States from January 2009 through February 2020. We began by trending the proportion of nursing homes receiving each rating over time before proceeding to 3 focused analyses on mobility, including (1) the frequency of mobility, (2) the median transition time for each mobility combination, and (3) trends in single-unit changes in rating.</div></div><div><h3>Results</h3><div>From 2009 to 2020, we observed a general upward trend in overall ratings despite stricter quality requirements, and frequent mobility—both upward and downward—between ratings: 40.32% of 1-star nursing homes later received a 5-star rating, whereas 27.97% of 5-star nursing homes later received a 1-star rating. When these changes between extremes occurred, they took an average of &lt;5 years.</div></div><div><h3>Conclusions and Implications</h3><div>Our findings suggest that nursing home 5-star ratings change frequently and quickly. Performance plays a key role in nursing home selection among patients, and our results suggest that further studies should examine the antecedents and impacts of such changes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105631"},"PeriodicalIF":4.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086438","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}