Journal of the American Medical Directors Association最新文献

{"title":"Gender Differences in Frailty Progression and Recovery in Older Adults in Long-Term Care.","authors":"Hadis Mozaffari, Hilary Low, Kaitlin Harding, Xiaowei Song","doi":"10.1016/j.jamda.2025.105756","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105756","url":null,"abstract":"<p><strong>Objectives: </strong>To examine gender differences in frailty transitions in relation to predictive factors and outcomes.</p><p><strong>Design: </strong>Retrospective analysis of long-term care data.</p><p><strong>Setting and participants: </strong>Older adults (men = 10,683; women = 18,976; ≥65 years of age) were assessed annually over 3 years.</p><p><strong>Methods: </strong>A deficit accumulation frailty index was constructed using 43 health measures. Trajectories among the 4 frailty states and mortality were evaluated by comparing women and men. Probabilities of frailty transitions and odds of death were evaluated using Poisson and logistic regression. Covariates included baseline frailty, age, admission year, education, and marital status.</p><p><strong>Results: </strong>The 3-year mortality rate was 29% in women and 37% in men; each additional health deficit at baseline increased the odds of mortality by 13% in both genders. Among survivors, frailty trajectories were dominated by stabilization (46%), whereas 16% showed an improvement and 38% showed a decline. An increase in deficits at baseline was associated with a 58% increase in deficits after 3 years for women (67%, 57%, and 47% in 1, 2, and 3 years, respectively), with similar trends observed for men. Age advancement increased deficit counts by 3% in women and 4% in men, and the odds of death increased by 4% in women and 6% in men. Residents with high school or more education showed a greater risk of health decline in 1 year (23% in women, 35% in men). Being married increased the risk of health decline for 73% in women and 72% in men.</p><p><strong>Conclusions and implications: </strong>Frailty affected health changes and mortality; those who were less frail were more likely to maintain/improve. Education and marriage had gender-specific effects on health changes. These findings enlighten management strategies targeting frailty and demographic profiles.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105756"},"PeriodicalIF":4.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618703","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":"Diagnoses Associated With Hospitalization of Nursing Home Residents With Severe Functional Impairment and Terminal Illness.","authors":"Joseph G Ouslander, Gabriella Engstrom, Zhiyou Yang, Bernardo Reyes, Ruth Tappen, Peter J Huckfeldt","doi":"10.1016/j.jamda.2025.105739","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105739","url":null,"abstract":"<p><strong>Background: </strong>Hospitalizations and emergency department (ED) visits can be uncomfortable and burdensome for severely impaired and terminally ill nursing home (NH) residents. Very few studies have examined specific diagnoses associated with these events.</p><p><strong>Methods: </strong>This is a secondary analysis of a trial that implemented a 12-month quality improvement program to reduce potentially avoidable hospitalizations (PAH) and ED visits of NH residents. The Minimum Data Set (MDS) was used to define residents with severe impairment of cognitive and physical functioning and those with terminal illness. Medicare claims data were used to identify hospital diagnoses for all cause hospitalizations (ACH), PAH, ED visits without hospitalization, and potentially avoidable ED visits.</p><p><strong>Results: </strong>Among 6011 severely impaired residents of the 264 NHs, 34% had one or more ACHs, of which one-third met the criteria for PAH, and 18% had at least one ED visit without hospitalization, of which 70% met the criteria for potentially avoidable. Among 5810 residents identified as terminally ill, 14% had at least one ACH, of which 31% were PAH, and 8% had at least one ED visit, of which 80% met the criteria for potentially avoidable. The most common diagnoses associated with PAH were pneumonia and other infections, shortness of breath/respiratory failure, and altered mental status. In the severely impaired group, problems with feeding tubes were the most common diagnoses associated with potentially avoidable ED visits, and in the terminally ill group, it was fall-related trauma.</p><p><strong>Conclusions and implications: </strong>ACH and ED visits without hospitalization are common among severely impaired and terminally ill NH residents. About one in three ACH in both groups met the criteria for PAH, and 70%-80% of ED visits met the criteria for potentially avoidable. Understanding the specific diagnoses associated with these potentially avoidable events can help target educational and quality improvement efforts to reduce their frequency, risk of hospital acquired complications, morbidity, and costs.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105739"},"PeriodicalIF":4.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608660","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":"Unpaid Caregiver Characteristics Associated With Retirement From the Labor Force: A Matched Case-Control Study Using CLSA Data.","authors":"Derek R Manis, Wenshan Li, Reiko Okamoto, Stacey Fisher, Colleen Webber, Vanessa Taler, Douglas G Manuel, Amy T Hsu","doi":"10.1016/j.jamda.2025.105742","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105742","url":null,"abstract":"<p><strong>Objective: </strong>To examine the caregiving factors, sociodemographic characteristics, and self-reported health of caregivers who retired from the labor force to provide full-time, unpaid care to their care recipient.</p><p><strong>Design: </strong>Matched case-control study.</p><p><strong>Setting and participants: </strong>Caregiver respondents from the Canadian Longitudinal Study on Aging baseline (2011-2015), follow-up 1 (2015-2018), and follow-up 2 (2018-2021) cycles. Caregiver respondents who indicated that they retired from the labor force to provide full-time care were matched 1:1 without replacement to caregiver respondents who did not retire to provide full-time care on birth year (±1 year), sex assigned at birth, and region of Canada.</p><p><strong>Methods: </strong>Caregiving-related variables (eg, type of care and intensity, care recipient's sex, relationship to the caregiver, co-residence status), sociodemographic variables (eg, income, immigration, race, sexual orientation, marital status), and self-reported health were examined. Conditional logistic regression was used to model adjusted associations with being a caregiver who retired from the labor force to provide full-time care.</p><p><strong>Results: </strong>There were 336 caregivers who retired to provide full-time care and were matched to 336 caregivers who did not retire to provide full-time care (mean age 70 years, 73% female; N = 672). Factors related to caregiving burden and type were strongly associated with retirement from the labor force to provide full-time care, whereas caregivers' self-reported physical and mental health and household income were not associated with the decision to retire.</p><p><strong>Conclusions and implications: </strong>Caregivers' decisions to retire from the labor force were mostly driven by their care recipients' care needs. These findings may suggest the need for flexible workplace policies that accommodate varied caregiving responsibilities to support caregivers. Increasing access to congregate residential and respite care may be another strategy that could reduce caregiver burden and retirement from the labor force.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105742"},"PeriodicalIF":4.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608594","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":"Happy by Nature: Nature Connection as a Source of Psychological Well-Being in Assisted Living Facilities.","authors":"Annika Kolster, Ulla L Aalto, Timo Partonen, Hannu Kautiainen, Laura J Rautiainen, Anu Jansson, Jill S Litt, Montse Masó-Aguado, Kaisu H Pitkälä","doi":"10.1016/j.jamda.2025.105740","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105740","url":null,"abstract":"<p><strong>Objectives: </strong>Contact with nature is a source of resilience and well-being, and nature-based interventions (NBIs) potentially support older adults' health and self-efficacy. Health-related outcomes of NBIs depend not only on the surroundings and activity, but also on the perceived nature connection. Although NBIs are implemented in assisted living facilities (ALFs), the nature connection has not been investigated in this setting. This study explores how individual nature connection is associated with psychological well-being among residents in ALFs, and how this is affected by mobility.</p><p><strong>Design: </strong>Descriptive cross-sectional survey study.</p><p><strong>Setting and participants: </strong>A total of 854 residents (≥55 years of age) in 25 ALFs in the metropolitan area of Helsinki, Finland, were included in this study.</p><p><strong>Methods: </strong>Demographics, diagnoses, and medications were confirmed from medical records, whereas mobility and psychological well-being were assessed using self-reported measures. Responders graded the importance of different ways to interact with nature. The score on the 12-item Gerontological Nature Connection Scale (GNCS) was used for assessment of nature connection.</p><p><strong>Results: </strong>Participants' mean age was 83 years, multimorbidity was common, and 54% were diagnosed with dementia. The GNCS score was associated with psychological well-being, especially with life satisfaction, feeling needed, and zest for life. Exploratory factor analysis recognized variation in ways to interact with nature, describing the dimensions of (1) nature in mind, (2) outdoor accessibility, and (3) nature apprehension. Accessing the outdoors was important, and furthermore, for participants with poor mobility, a higher GNCS score was related to better psychological well-being.</p><p><strong>Conclusions and implications: </strong>Nature connection supports psychological well-being, especially when mobility is poor. Our findings support the development of NBIs in the care of older adults as part of the evolving field of nature-based social prescribing. Understanding individual needs is essential for effective and safe interventions.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105740"},"PeriodicalIF":4.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608662","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":"Telehealth Adoption and Barriers Across Post-Acute and Long-Term Care Settings: Insights From a Clinician Survey.","authors":"Zhimeng Yan, Jiani Yu","doi":"10.1016/j.jamda.2025.105743","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105743","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105743"},"PeriodicalIF":4.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608665","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":"Quality Indicators to Monitor Care in Long-Term Care Facilities: A Scoping Review.","authors":"Gillian E Caughey, Miia Rahja, Rangika Fernando, Maria C Inacio","doi":"10.1016/j.jamda.2025.105747","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105747","url":null,"abstract":"<p><strong>Objective: </strong>To identify and synthesize quality indicators (QIs) used to routinely monitor and assess the quality and safety of care received by residents of long-term care facilities (LTCFs).</p><p><strong>Design: </strong>A scoping literature review.</p><p><strong>Setting and participants: </strong>Older people ≥65 years of age residing in LTCFs.</p><p><strong>Methods: </strong>Academic and gray literature searches were done to identify publicly available QIs, routinely used at the population level and reported since 2012. Synthesis by domains, QI type (structure, process, and outcome), and dimension of quality (efficiency, effectiveness, patient-centeredness, timeliness, equity, and safety). The data used to develop the QIs, risk adjustments, and population- and reporting-related characteristics were also summarized.</p><p><strong>Results: </strong>A total of 327 QIs from 18 programs across 13 countries were identified. Of the identified QIs, 68.2% (n = 223) were outcome QIs, 30.0% (n = 98) were process QIs, and 1.8% (n = 6) were structure QIs. Almost 80% (79.2%; n = 259) of the QIs were related to the dimensions of safety and effectiveness. The most common domains across the 18 QI programs included falls/fractures/injuries, medication-related, and pressure injury, with 14 programs (77.8%) covering each of these areas. Standardized clinical data (n = 235) was the most common data source used for QI estimation. Public reporting was available at various levels ranging from the national to facility level.</p><p><strong>Conclusions and implications: </strong>International QIs to monitor and evaluate the quality of care in LTCFs focus on safe and effective care, essential in supporting residents to maintain well-being and quality of life. The findings from this review highlight the need for wider adoption of a comprehensive holistic suite of QIs to support person-centered care, reflective of all dimensions of care quality including equity, to drive improvements in LTCFs worldwide.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105747"},"PeriodicalIF":4.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608664","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":"Author's Response to the Letter to the Editor Entitled: “The Real-World Context of Long-Term Care Data”","authors":"Daniel Eduardo da Cunha Leme PhD,&nbsp;Amanda Mofina PhD,&nbsp;John Hirdes PhD","doi":"10.1016/j.jamda.2025.105588","DOIUrl":"10.1016/j.jamda.2025.105588","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105588"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811587","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 Real-World Context of Long-Term Care Data","authors":"Laura Block BS, BSN, RN,&nbsp;Dann J. Hekman MS,&nbsp;Donovan T. Maust MD, MS,&nbsp;Tonya J. Roberts PhD, RN, FGSA,&nbsp;Andrea Gilmore-Bykovskyi PhD, RN","doi":"10.1016/j.jamda.2025.105587","DOIUrl":"10.1016/j.jamda.2025.105587","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105587"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811592","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":"Individual- and Facility-Level Factors Related to Quality-of-Life Transitions in Older Adults in Residential Facilities: A Systematic Review","authors":"Arisa Kawashima PhD ,&nbsp;Xueying Jin PhD ,&nbsp;Ayane Komatsu PhD ,&nbsp;Sakino Niwa MS ,&nbsp;Hiroyuki Shimada PhD ,&nbsp;Hidenori Arai MD, PhD ,&nbsp;Tami Saito PhD","doi":"10.1016/j.jamda.2025.105721","DOIUrl":"10.1016/j.jamda.2025.105721","url":null,"abstract":"<div><h3>Objectives</h3><div>To elucidate factors related to the transitions of quality of life (QoL) and well-being in older adults living in residential facilities.</div></div><div><h3>Design</h3><div>We undertook a systematic review and narrative synthesis.</div></div><div><h3>Setting and Participants</h3><div>The participants were individuals aged ≥60 years living in various types of residential facilities.</div></div><div><h3>Methods</h3><div>We conducted a search in PubMed and Embase (Ovid) using free-text words and Medical Subject Heading terms on December 1, 2024. We included longitudinal studies published after 2000 that quantitatively assessed QoL and/or well-being at ≥2 time points. Studies published before 2000, non–English-language papers, and interventional or qualitative studies were excluded. The title, abstract, and full-text assessments were performed by multiple independent reviewers based on eligibility criteria. The Study Quality Assessment Tool for observational cohort and cross-sectional studies was used to assess methodologic quality.</div></div><div><h3>Results</h3><div>Of the 7705 papers initially identified, 18 studies involving 122,057 participants were included. These studies, predominantly multicenter studies and studies conducted in the United States, revealed that QoL and well-being tended to decline gradually after admission. Key factors associated with maintaining and enhancing QoL and well-being included facility-level factors (eg, age-friendly architectural environments, social support and activities) and individual aspects (eg, cognitive function, activities of daily living, urinary continence). The variation in outcome measures precluded a meta-analysis.</div></div><div><h3>Conclusions and Implications</h3><div>We identified both facility- and individual-level factors associated with changes related to QoL and well-being in older adults living in residential facilities. The importance of modifiable facility-level factors should be reconsidered in ensuring quality care for older residents.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105721"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484803","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":"Directions & Connections","authors":"","doi":"10.1016/S1525-8610(25)00304-4","DOIUrl":"10.1016/S1525-8610(25)00304-4","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105787"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595483","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}