Journal of the American Medical Directors Association最新文献

{"title":"Kinematic Insights Into Older Adult Fall-Related Head Impacts: Boundary Conditions and Injury Risk","authors":"Nicole E.-P. Stark PhD ,&nbsp;Ethan S. Henley ,&nbsp;Brianna A. Reilly ,&nbsp;Damon R. Kuehl MD ,&nbsp;Steve Rowson PhD","doi":"10.1016/j.jamda.2025.105545","DOIUrl":"10.1016/j.jamda.2025.105545","url":null,"abstract":"<div><h3>Objectives</h3><div>To quantify real-world impact conditions of falls, which cause 50% to 90% of older adult traumatic brain injuries, and reconstruct them using dummy headforms to analyze kinematics and injury outcomes.</div></div><div><h3>Design</h3><div>Mixed-methods: Observational and experimental.</div></div><div><h3>Setting and Participants</h3><div>An open-access dataset of 118 videos of head impacts at long-term care facilities was used.</div></div><div><h3>Methods</h3><div>Videos were analyzed to determine head impact occurrence, and for each video with a head impact, fall characteristics were recorded. Perpendicular view fall videos were analyzed using validated model-based image-matching software to track head impact velocities. From the tracked videos, falls were reconstructed with a Hybrid III headform mounted on an inverted pendulum to capture impact kinematics.</div></div><div><h3>Results</h3><div>Of the 118 fall videos with head impacts, we tracked 29 videos, finding a normal velocity of 1.76 ± 1.02 m/s and a tangential velocity of 1.27 ± 0.95 m/s. Twenty-three of these impacts were reconstructed, producing peak linear acceleration (PLA) 50.2 ± 36.4 g and peak rotational acceleration (PRA) 2.91 ± 2.16 krad/s². Impacts that occurred against the floor had a 38% higher PLA and a 25% higher PRA compared with wall impacts. Compared with backward and forward falls, lateral falls resulted in 46 and 52 g higher PLA and 3.12 and 4.66 krad/s² higher PRA, respectively.</div></div><div><h3>Conclusions and Implication</h3><div>Fall direction and impact surface influenced head impact accelerations, with certain fall configurations, such as lateral falls against tile, posing a greater risk for traumatic brain injuries. These findings provide critical insights into the biomechanics of older adult head impact falls and highlight the need for targeted fall prevention strategies, such as interventions that reduce the occurrence of lateral falls. In addition, this work offers foundational data for designing protective equipment, including headgear and energy-absorbing flooring, optimized for these specific kinematics.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105545"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634151","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":"Effects of Hand Strength and Walking Speed Combined and in Isolation on the Prediction of Cognitive Decline and Dementia in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis.","authors":"Xiaojie Xie, Deli Li, Meng Zhou, Zhaojun Wang, Xueyan Zhang","doi":"10.1016/j.jamda.2025.105576","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105576","url":null,"abstract":"<p><strong>Objective: </strong>This review aims to further elucidate the relationship between reduced walking speed and grip function and cognitive decline.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Settings and participants: </strong>Adults without dementia.</p><p><strong>Methods: </strong>Six English databases were searched from inception to January 2025. Longitudinal studies that simultaneously investigate the relationship between a decline in grip strength or walking speed and cognitive impairment or dementia were eligible. The meta-analysis was conducted using Stata 17.0. The Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used to assess the quality of evidence in the included studies.</p><p><strong>Results: </strong>A total of 2779 articles were identified through the search strategy. After removing duplicate titles and completing screening, 10 studies were included. Random effects analysis revealed that decreases in physical function (walking speed: hazard ratio [HR], 1.34; 95% CI, 1.13-1.60) and grip strength: HR, 1.30; 95% CI, 1.14-1.49) were significantly associated with decreases in cognitive ability, and this correlation became even more pronounced when pace and grip strength were assessed jointly (HR, 2.72; 95% CI, 1.20-6.17). The results of the subgroup analysis revealed that the study location, follow-up time, cognitive assessment method, sex ratio of the subjects, and other factors affected the results of the study.</p><p><strong>Conclusions and implications: </strong>This study suggests that grip strength and walking speed are important predictors of cognitive decline and dementia, and highlights the significance of the comprehensive assessment. Early intervention before middle-aged and older adults enter the clinical stage of dementia is needed, which requires standardized and rigorous assessment.The sequential relationships between hand strength and walking speed in relation to different developmental stages of dementia, as well as how they can be integrated with objective indicators to facilitate diagnosis, need to be further investigated.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105576"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743109","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 Effectiveness of Tai Chi Assisted by Virtual Environments for Chronic Musculoskeletal Pain.","authors":"Rui Wang, Hao-Yu Wang","doi":"10.1016/j.jamda.2025.105570","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105570","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105570"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743117","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 Use at the End of Life Among US Nursing Home Residents.","authors":"Maki Karakida, Yaoting Li, Hye-Young Jung, Mark Aaron Unruh, Christie Lee Luo, Phyllis Johnson, Jiani Yu","doi":"10.1016/j.jamda.2025.105574","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105574","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105574"},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743114","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":"Reply to the Letter to the Editor Regarding: \"Clinical Efficacy of Virtual Reality Cave Automatic Virtual Environments (CAVE) for Chronic Musculoskeletal Pain in Older Adults: A Randomized Controlled Trial\".","authors":"Regina Wing Shan Sit, Hermione Hin Man Lo","doi":"10.1016/j.jamda.2025.105571","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105571","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105571"},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743112","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":"What do Professionals Think of Specific Care Recommendations for Vascular Cognitive Impairment? A Delphi Study With Health Care Professionals","authors":"Sara A.J. van de Schraaf MSc ,&nbsp;Hanneke F.M. Rhodius-Meester MD, PhD ,&nbsp;Majon Muller MD, PhD ,&nbsp;Johanna M.A. Visser-Meily MD, PhD ,&nbsp;Marjolein E. de Vugt PhD ,&nbsp;Eefje M. Sizoo MD, PhD ,&nbsp;Cees M.P.M. Hertogh MD, PhD","doi":"10.1016/j.jamda.2025.105546","DOIUrl":"10.1016/j.jamda.2025.105546","url":null,"abstract":"<div><h3>Objectives</h3><div>Vascular cognitive impairment (VCI) is an umbrella term covering all cognitive impairment from mild cognitive deficits to dementia due to vascular etiologies. VCI is highly prevalent within dementia and stroke care pathways, but specific recommendations for care for people with VCI are lacking. Therefore, we formulated specific recommendations for care for people with VCI and tested these in a panel of health care professionals.</div></div><div><h3>Design</h3><div>Modified Delphi study.</div></div><div><h3>Setting and Participants</h3><div>Purposefully sampled health care professionals in the dementia and stroke fields.</div></div><div><h3>Methods</h3><div>Based on Dutch care standards for dementia and stroke and previous studies, the research team formulated 27 statements. In 3 rounds, participants were asked on a 4-point Likert scale how much they agreed with statements. They could elaborate on their answer in open fields. After each round, level of agreement was calculated. Subsequently, it was evaluated whether consensus was reached. Qualitative data guided potential modifications to the statements and was analyzed for overarching themes in argumentation.</div></div><div><h3>Results</h3><div>Thirty-four participants (primary and secondary care physicians, nurses, psychologists, occupational therapists, and case managers in dementia care) were included in the expert panel. Of the formulated statements, 23 were accepted after 3 rounds. Accepted statements included recommendations on recognition and management of specific symptoms, awareness of care opportunities in and collaboration between care pathways and networks, and the importance of timely care. Some nuancing comments were raised on feasibility and specificity of the recommendations.</div></div><div><h3>Conclusions and Implications</h3><div>Experts agreed on multiple specific recommendations for VCI care across the patient journey, balancing specific and targeted care with further integration of the different care networks. Despite some concerns on feasibility and the balance between disease-centered and person-centered care, the expert-agreed statements can provide guidance in striving toward tailored care and aid in bringing together stroke and dementia networks for people with VCI.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105546"},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal, Bidirectional Association between Gait Speed and Cognitive Function in Community-Dwelling Older Adults without Dementia","authors":"Ying-Hao Su MD ,&nbsp;Jeng-Min Chiou PhD ,&nbsp;Chengshi Shiu PhD ,&nbsp;Jen-Hau Chen MD, MPH, PhD ,&nbsp;Yen-Ching Chen ScD","doi":"10.1016/j.jamda.2025.105544","DOIUrl":"10.1016/j.jamda.2025.105544","url":null,"abstract":"<div><h3>Objectives</h3><div>The causal relationship between slow gait speed and poor cognition is uncertain due to potential reverse causality. This study aimed to examine the reciprocal relationship between gait speed and global as well as domain-specific cognitive functions in older adults.</div></div><div><h3>Design</h3><div>Prospective cohort study (2013–2022) including 4 repeated measures.</div></div><div><h3>Settings and Participants</h3><div>Community-dwelling and adults without dementia aged ≥65 recruited at baseline.</div></div><div><h3>Methods</h3><div>Biennial evaluations included assessments of 4-m usual walking speed, global cognition using the Taiwanese version of the Montreal Cognitive Assessment (MoCA), and cognitive domains (memory, executive function, verbal fluency, and attention) using a battery of neuropsychological tests. Cross-lagged models and linear mixed models were used to examine the bidirectional association between gait speed and cognitive functions with adjustment for potential confounders.</div></div><div><h3>Results</h3><div>At baseline, 511 participants were enrolled, and 459 individuals with a mean age of 74.5 years were ultimately analyzed. A 1-SD decrease in gait speed was associated with a 0.07–0.09 SD decrease in subsequent global cognition [<span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 1→2}: 0.07, standard error (SE): 0.03; <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 2→3}: 0.09, SE: 0.04; <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 3→4}: 0.09, SE: 0.04; all <em>P</em> &lt; .05]. Similarly, a 1-SD decrease in global cognition was associated with a 0.18 to 0.19 SD decrease in subsequent gait speed (<span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 1→2}: 0.18, SE: 0.05; <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 2→3}: 0.18, SE: 0.06; <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> _{Wave 3→4}: 0.19, SE: 0.07; all <em>P</em> &lt; .001). In addition, slower gait speed was associated with poor memory, verbal fluency, and executive function, and vice versa. The results of linear mixed models were consistent with the findings obtained from cross-lagged models.</div></div><div><h3>Conclusions and Implications</h3><div>This study found a reciprocal association between gait speed and global or domain-specific cognition. Regularly screening gait speed and cognitive function enables the early detection of declines in physical function and cognition.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105544"},"PeriodicalIF":4.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Anticholinergic Burden of Patients Hospitalized for Hip Fracture Reveals a Target for Deprescribing","authors":"Aidan P. McAnena BS ,&nbsp;Andrew R. Zullo PharmD, PhD ,&nbsp;Richa Joshi MBA, MS ,&nbsp;Lori A. Daiello PharmD, ScM ,&nbsp;Sarah D. Berry MD, MPH","doi":"10.1016/j.jamda.2025.105537","DOIUrl":"10.1016/j.jamda.2025.105537","url":null,"abstract":"<div><h3>Objectives</h3><div>Anticholinergic medications can produce harmful side effects, such as ataxia and delirium, in older adults. Older adults with hip fractures are particularly vulnerable, yet they are often prescribed these medications. This study aimed to evaluate the anticholinergic burden (ACB) before and after hospitalization for hip fracture, to identify potential targets for deprescribing.</div></div><div><h3>Design</h3><div>This is an observational retrospective cohort study. Patients with hip fractures between 2012 and 2018 were identified from Medicare Provider Analysis data. Medications were identified from Medicare Part D claims at the time of fracture and from Omnicare claims 100 days post-discharge. The analysis focused on individuals with high pre-fracture ACB scores (≥3), as they had potential for deprescribing.</div></div><div><h3>Setting and Participants</h3><div>The study included individuals aged 66+ hospitalized for hip fractures who received post-acute care in Omnicare-contracted skilled nursing facilities.</div></div><div><h3>Methods</h3><div>Pre- and post-fracture ACB scores were calculated using the ACB scale. Patients were stratified by post-fracture ACB changes (increase, decrease, or no change). Demographics and comorbidities were described using means and percentages. The top 10 most prescribed anticholinergic medications with ACB score 2 or 3 were identified, and prescription rates were compared before and after fracture.</div></div><div><h3>Results</h3><div>Of 351,286 eligible patients, 138,966 (40%) had a high pre-fracture ACB score. The mean age was 83.5 years, and 78.9% were female. Post fracture, 42.6% of patients with a high ACB experienced a decrease in ACB, 9.9% had an increase, and 47.5% saw no change. Commonly prescribed anticholinergics included overactive bladder agents, antipsychotics, antidepressants, antihistamines, and opioids.</div></div><div><h3>Conclusions and Implications</h3><div>Forty percent of patients had a high ACB at fracture, and fewer than half experienced a decrease in ACB after fracture. Antipsychotics were overprescribed, and many patients remained on ineffective overactive bladder agents. There is a need for standardized deprescribing practices for patients with hip fractures in post-acute care settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105537"},"PeriodicalIF":4.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586057","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":"Racial and Ethnic Disparities in Accessing High-Quality Home Health Care among Older Adults with and Without Dementia","authors":"Chenjuan Ma PhD, MSN ,&nbsp;Bei Wu PhD ,&nbsp;Abraham A. Brody PhD, RN","doi":"10.1016/j.jamda.2025.105539","DOIUrl":"10.1016/j.jamda.2025.105539","url":null,"abstract":"<div><h3>Objectives</h3><div>Home health care (HHC) plays a pivotal role in serving millions of US adults aging in place. Although the HHC population is growing rapidly in both size and diversity, driven by an aging US population and a changing demographic profile, there are increasing concerns of equity in HHC, particularly regarding how vulnerable populations are affected under current HHC practices. The purpose of this study was to examine the variations in accessing high-quality HHC in racial and ethnic minority groups and persons living with dementia.</div></div><div><h3>Design</h3><div>Cross-sectional, secondary analysis.</div></div><div><h3>Setting and Participants</h3><div>Older adults who received HHC in 2016 from agencies with a star rating of overall care quality from the Home Health Compare program.</div></div><div><h3>Methods</h3><div>Start of care data from the 2016 HHC Outcome and Assessment Information Set was linked to Master Beneficiary Summary File, Home Health Compare, and Provider of Services file to address the aim. Multinomial regressions were used in analysis when risk-adjusting for individual and agency characteristics.</div></div><div><h3>Results</h3><div>Our risk-adjusted estimates, based on data from 574,682 older adults aged ≥65 years served by 8634 HHC agencies nationwide (2290 offering high-quality care, 4023 providing moderate-quality care, and 2321 delivering low-quality care), revealed significant disparities. Non-Hispanic Blacks (relative risk ratio, 0.62; 95% CI, 0.61–0.64) and Hispanics (relative risk ratio, 0.72; 95% CI, 0.70–0.74) were significantly less likely to receive care from high-quality agencies. Additionally, having dementia exacerbated disparities in accessing high-quality HHC between racial and ethnic minorities and white Americans.</div></div><div><h3>Conclusions and Implications</h3><div>Racial and ethnic minority individuals face significant disadvantages in accessing high-quality HHC, with persons living with dementia from these groups being the most disadvantaged. Further research is warranted to investigate the referral and admission processes for HHC. Our findings highlight the need for actions from clinicians and policymakers to tackle potential biases in the aforementioned care processes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105539"},"PeriodicalIF":4.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586076","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":"Identifying Patient, Care Partner, and Clinician Needs for Functional Recovery Following Hospitalization When Dementia is Present","authors":"Allison M. Gustavson PT, DPT, PhD ,&nbsp;Emily M. Hudson MS ,&nbsp;Jennifer P. Wisdom PhD ,&nbsp;Alicia B. Woodward-Abel MPH ,&nbsp;Rashelle Hoffman PT, DPT, PhD ,&nbsp;Matthew J. Miller PT, DPT, PhD ,&nbsp;Howard A. Fink MD, MPH ,&nbsp;Joseph E. Gaugler PhD ,&nbsp;Hildi J. Hagedorn PhD","doi":"10.1016/j.jamda.2025.105534","DOIUrl":"10.1016/j.jamda.2025.105534","url":null,"abstract":"<div><h3>Objectives</h3><div>Persons with dementia are frequently hospitalized, which threatens their ability to return to and live at home. Current post-acute paradigms tend to default to short-term rehabilitation in a nursing home. Still, alternative post-acute care models are crucial for veterans with dementia to recover at home. This study aims to identify the needs of veterans with dementia, care partners, and rehabilitation clinicians in relation to home-based models of care to inform the implementation and adaptation of models to the post-acute context.</div></div><div><h3>Design</h3><div>Qualitative study.</div></div><div><h3>Setting and Participants</h3><div>Participants included veterans with dementia with recent history of hospitalization, care partners, and rehabilitation clinicians.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted across 3 groups (veterans with dementia, care partners, and rehabilitation clinicians) and analyzed using a rapid qualitative approach guided by the Practical, Robust Implementation and Sustainability Model (PRISM).</div></div><div><h3>Results</h3><div>Participants included 11 veterans with dementia, 13 care partners, and 23 rehabilitation clinicians. We identified 3 themes from the interviews: (1) collaborative decision making and planning are crucial to high-quality care, (2) follow-through is necessary to ensure needs are met when transitioning from hospital to home, and (3) alternative care options, including technology use, are important when optimizing transitions of care.</div></div><div><h3>Conclusion and Implications</h3><div>Alternative options for home care after hospital discharge may enhance patient-and family-centered outcomes. Future research must identify evidence-based models that can be collaboratively adapted or developed to provide effective, safe, and feasible post-acute care to optimize independence in the home and quality of life.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105534"},"PeriodicalIF":4.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573306","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}