Journal of the American Medical Directors Association最新文献

{"title":"Remembering a Geriatric Leader in the Post-Acute and Long-Term Care World","authors":"Barbara Resnick PhD, CRNP","doi":"10.1016/j.jamda.2025.105715","DOIUrl":"10.1016/j.jamda.2025.105715","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105715"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595485","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":"PALTmed Events and Product","authors":"","doi":"10.1016/S1525-8610(25)00305-6","DOIUrl":"10.1016/S1525-8610(25)00305-6","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105788"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595484","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":"Palliative Care Needs in Young-Onset Dementia: A Commentary","authors":"Lise Lutgarde Vandaele PhD , Marlise E.A. van Eersel MD, PhD , Raymond T.C.M. Koopmans MD, PhD","doi":"10.1016/j.jamda.2025.105619","DOIUrl":"10.1016/j.jamda.2025.105619","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105619"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595486","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":"General Information","authors":"","doi":"10.1016/S1525-8610(25)00303-2","DOIUrl":"10.1016/S1525-8610(25)00303-2","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105786"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595482","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":"Health Care Use, Care Settings, and Location of Death for People With Schizophrenia in Long-Term Care","authors":"Katie Dover MPH ,&nbsp;Jess G. Fiedorowicz MD, PhD ,&nbsp;David Kirkwood MSc ,&nbsp;Marco Solmi MD, PhD ,&nbsp;James M. Bolton MD ,&nbsp;Sarina R. Isenberg PhD ,&nbsp;Wenshan Li PhD ,&nbsp;Alyson Mahar PhD ,&nbsp;Shirley H. Bush MBBS ,&nbsp;Michael Bonares MD, MSc ,&nbsp;Jodi D. Edwards PhD ,&nbsp;Simon Hatcher MD ,&nbsp;Naheed Dosani MD, BSc ,&nbsp;Peter Lawlor DMed, MMedSc ,&nbsp;Harvey M. Chochinov MD, PhD ,&nbsp;Paul Kurdyak MD, PhD ,&nbsp;Martin Wellman PhD ,&nbsp;Caroline Franck MD, MSc ,&nbsp;Alexandre Rochon MD ,&nbsp;Peter Tanuseputro MD, MHSc ,&nbsp;Colleen Webber PhD","doi":"10.1016/j.jamda.2025.105719","DOIUrl":"10.1016/j.jamda.2025.105719","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if health care settings in the last year of life and location of death differ between long-term care (LTC) residents with and without schizophrenia.</div></div><div><h3>Design</h3><div>A retrospective cohort study using health administrative data.</div></div><div><h3>Setting and Participants</h3><div>All adults who died in Ontario between January 1, 2010, and December 31, 2019, who were living in LTC homes 1 year before death, and who died of natural causes.</div></div><div><h3>Methods</h3><div>Schizophrenia was ascertained using a validated administrative data algorithm. We used descriptive statistics, negative binomial regression, and logistic regression to compare health characteristics, health care use, and location of death for individuals with and without schizophrenia in the last year of life.</div></div><div><h3>Results</h3><div>Of 135,560 total LTC residents, 5670 (4.2%) had a diagnosis of schizophrenia. LTC residents with schizophrenia died on average 7 years earlier (standardized difference = 0.75) yet were more likely to have no recorded chronic health conditions (standardized difference = 0.19). Those with schizophrenia had significantly higher rates of hospitalizations (adjusted rate ratio = 1.22, 95% confidence interval = 1.17–1.26) and emergency department visits (adjusted rate ratio = 1.14, 95% confidence interval = 1.10–1.18) in the last year of life, adjusted for age, sex, cause of death, and year of death. This finding was observed for both mental health–related and non–mental health–related hospitalizations and emergency department visits. LTC residents with schizophrenia were also more likely to die during a mental health–related (standardized difference = 0.21) or non–mental health–related (standardized difference = 0.15) hospitalization, with lower odds of dying in LTC (adjusted odds ratio, 0.83; 95% confidence interval, 0.78–0.88).</div></div><div><h3>Conclusions and Implications</h3><div>LTC residents with schizophrenia have higher rates of acute care use and are more likely to die in hospital compared with residents without schizophrenia. More research is necessary to understand differences in care provisions for LTC residents with schizophrenia and understand how LTC facilities can meet the unique needs of this vulnerable population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105719"},"PeriodicalIF":4.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310085","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":"Nursing Home Staffing Expenditures and Levels are Impaired by High Medicaid Payer-Mix","authors":"John R. Bowblis PhD ,&nbsp;Christopher S. Brunt PhD","doi":"10.1016/j.jamda.2025.105723","DOIUrl":"10.1016/j.jamda.2025.105723","url":null,"abstract":"<div><h3>Objectives</h3><div>Medicaid is the primary payer for most nursing home residents and reimburses below the cost of care, limiting the ability of nursing homes to increase staffing levels. This study examined the association of nursing staff levels and expenditures with Medicaid payer-mix and determined whether these associations varied across different ownership types.</div></div><div><h3>Design</h3><div>Retrospective, cross-sectional analysis using 2023 Medicare Cost Reports and Payroll-Based Journal (PBJ) data for freestanding nursing homes.</div></div><div><h3>Setting and Participants</h3><div>A nationally representative sample of 11,559 nursing homes was analyzed.</div></div><div><h3>Methods</h3><div>Nursing homes were categorized into 5 groups based on Medicaid payer-mix (0%–50%, 51%–65%, 66%–75%, 76%–85%, and 86%+). We measured nursing staff levels and expenditures per resident day, and the proportion of revenue spent on nursing staff. Linear regression models were used to assess associations between Medicaid payer-mix and these outcomes, allowing effects to vary by ownership type.</div></div><div><h3>Results</h3><div>Nursing staff levels decrease as Medicaid payer-mix increases, with total nursing staff hours per resident day declining from 4.08 in the lowest Medicaid group to 3.40 in the highest. Facilities with a higher Medicaid payer-mix also have lower revenues and nursing staff expenditures per resident day but allocate a greater proportion of their revenue to staffing. For example, facilities with 86%+ Medicaid payer-mix spend 41.5% of their revenue on staffing, compared with 36.9% in facilities with less than 50% Medicaid days. Ownership type moderates these associations, with not-for-profits more sensitive to Medicaid payer-mix changes than for-profits.</div></div><div><h3>Conclusions and Implications</h3><div>Nursing homes with a high Medicaid payer-mix face financial constraints that limit staffing levels despite allocating a larger share of revenue to staffing. As policymakers consider staffing mandates, they must address the adequacy of Medicaid reimbursement to support staffing and maintain quality of care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105723"},"PeriodicalIF":4.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484804","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":"Pattern of Antidiabetic Drug Prescription in Older Persons With Type 2 Diabetes: Results From the German DPV Registry","authors":"Andrej Zeyfang MD ,&nbsp;Stefan Gölz MD ,&nbsp;Federica Iraci MD ,&nbsp;Christian Wagner MD ,&nbsp;Christian Scheer MD ,&nbsp;Thomas Kubiak MD ,&nbsp;Latife Bozkurt MD ,&nbsp;Martin Heni MD ,&nbsp;Reinhard W. Holl MD","doi":"10.1016/j.jamda.2025.105724","DOIUrl":"10.1016/j.jamda.2025.105724","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore prescription patterns of SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) in older adults with type 2 diabetes (T2DM), analyzing age and sex differences.</div></div><div><h3>Design</h3><div>Observational retrospective study.</div></div><div><h3>Setting and Participants</h3><div>Data from 103,820 patients aged 60 to 90 years from 518 diabetes centers in Germany, collected between 2017 and 2022 via the DPV registry.</div></div><div><h3>Methods</h3><div>Patients with at least 3 months’ T2DM diagnosis were included. Treatment trends were analyzed using regression models adjusted for age and sex. Repeated measures were aggregated annually.</div></div><div><h3>Results</h3><div>Between 2017 and 2022, SGLT2i use rose from 7.3% to 27.4% and GLP-1RA use from 3.4% to 13.8%. Metformin use increased, while sulfonylureas declined. SGLT2i use was lower in women across all age groups. GLP-1RAs use increased more in younger patients.</div></div><div><h3>Conclusions and Implications</h3><div>Newer antidiabetic drugs are increasingly prescribed in older adults, but notable disparities by age and gender persist. These findings suggest the need to address potential biases and barriers to optimize equitable care in geriatric diabetes management.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105724"},"PeriodicalIF":4.2,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484805","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":"Determinants of Mortality and Causes of Death in Patients With Dementia and Very Severe Challenging Behavior","authors":"Gerrie van Voorden MD ,&nbsp;Richard C. Oude Voshaar MD, PhD ,&nbsp;Raymond T.C.M. Koopmans MD, PhD ,&nbsp;Sytse U. Zuidema MD, PhD ,&nbsp;Alex Verhemel MD ,&nbsp;Anne M.A. van den Brink MD, PhD ,&nbsp;Martin Smalbrugge MD, PhD ,&nbsp;Debby L. Gerritsen PhD","doi":"10.1016/j.jamda.2025.105713","DOIUrl":"10.1016/j.jamda.2025.105713","url":null,"abstract":"<div><h3>Objectives</h3><div>To gain insight into the mortality over time of patients with very severe challenging behavior in dementia when they are temporarily admitted to highly specialized units for treating the behavior.</div></div><div><h3>Design</h3><div>Observational study.</div></div><div><h3>Setting and Participants</h3><div>Eleven highly specialized units throughout the Netherlands participated from December 2020 until December 2022, with a follow-up in September 2023, with 127 patients participating.</div></div><div><h3>Methods</h3><div>General clinical characteristics were collected, such as demographics and cognitive functioning, behavior during the first 2 weeks assessed by the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory Questionnaire (NPI-Q), date of death, and cause of death. Two Cox regression models were estimated, namely prediction models to describe the relationship between some (regular) determinants and mortality over time and association models between behavioral factors and mortality.</div></div><div><h3>Results</h3><div>Of the 127 participants, one-third died during their stay. The most prevalent causes of death were dehydration (often with cachexia) and pneumonia. Mortality over time is best predicted by age (ie, being 80 years or older) and the number of non-psychotropic drugs, as a proxy for somatic disease burden. The 10% of patients scoring highest on the CMAI factor of physically aggressive behavior had a ninefold increased mortality risk during their stay.</div></div><div><h3>Conclusions and Implications</h3><div>A considerable number of patients with very severe challenging behavior in dementia admitted to highly specialized units died during their stay, with a ninefold increased mortality risk over time found in patients with very severe physical aggression. This underlines the need to devote attention to suitable terminal palliative care in clinical practice and research in this patient group.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105713"},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248419","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":"Associations Between Frailty, Illness Severity, and Long-Term Mortality Among Older Adults Admitted to Municipal Acute Care","authors":"Leonor Roa Santervas MD ,&nbsp;Torgeir Bruun Wyller MD, PhD ,&nbsp;Eva Skovlund MSc, PhD ,&nbsp;Espen Saxhaug Kristoffersen MD, PhD ,&nbsp;Rita Romskaug MD, PhD","doi":"10.1016/j.jamda.2025.105718","DOIUrl":"10.1016/j.jamda.2025.105718","url":null,"abstract":"<div><h3>Objectives</h3><div>Important risk factors for mortality include frailty and illness severity. The National Early Warning Score 2 (NEWS2) is widely used to assess acute illness severity and mortality risk, but age and frailty's impact on the association between NEWS2 and mortality is less understood, particularly in nonhospital settings. This study aimed to examine the associations between frailty, NEWS2, and 1-year postdischarge mortality in older adults admitted to the Oslo Municipal In-Patient Acute Care (MipAC) unit.</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting and Participants</h3><div>Patients admitted to the MipAC unit with 1-year follow-up for all-cause mortality.</div></div><div><h3>Methods</h3><div>Frailty was assessed using the Clinical Frailty Scale (CFS). The maximum registered NEWS2 during admission was obtained from patient records. Associations with 1-year mortality were analyzed using a Cox model and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>Among 382 patients (mean age, 84.3 years; 72% female), 58 died during the 1-year follow-up period. Both CFS and NEWS2 were independently associated with 1-year mortality in an age-adjusted Cox proportional hazards model. The adjusted hazard ratios were 1.33 (95% CI, 1.07-1.66) per unit increase in CFS and 1.26 (95% CI, 1.14-1.39) per unit increase in NEWS2. A supplementary analysis of the vital signs contributing to NEWS2 revealed that elevated respiratory rate and hypotension were independently associated with increased 1-year mortality, with adjusted hazards ratios being 2.71 (95% CI, 1.35-5.46) and 3.05 (95% CI, 1.54-6.01), respectively. When combining CFS and NEWS2, moderately to severely frail patients (CFS ≥6) with low NEWS2 (0-4) showed a tendency toward increased mortality, whereas among those with high NEWS2 (≥5), frailty did not appear to further influence mortality risk.</div></div><div><h3>Conclusions and Implications</h3><div>CFS, NEWS2, and the vital signs elevated respiratory rate and hypotension are associated with 1-year mortality in patients admitted to a MipAC unit.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105718"},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310072","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":"Frailty, Latent Health Profiles, and Antiretroviral Therapy: Predicting Success of Skilled Nursing Facility Care in an HIV Population","authors":"Brianne L. Olivieri-Mui PhD ,&nbsp;Ellen P. McCarthy PhD ,&nbsp;Sandra M. Shi MD, MPH ,&nbsp;Ira B. Wilson MD ,&nbsp;Jieun Jang PhD ,&nbsp;Gahee Oh MD ,&nbsp;Aneeka Ratnayake PhD ,&nbsp;Chan Mi Park MD ,&nbsp;Dae Hyun Kim MD, ScD","doi":"10.1016/j.jamda.2025.105714","DOIUrl":"10.1016/j.jamda.2025.105714","url":null,"abstract":"<div><h3>Objectives</h3><div>People with HIV (PWH) likely need short-term skilled nursing facility (SNF) care more than people with greater financial and social support to remain home. Therefore, we sought to understand how frailty among health profiles with distinct driving conditions, antiretroviral therapy (ART), and sociodemographic factors relate to success of short-term SNF for PWH.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Short-term SNF stays for PWH.</div></div><div><h3>Methods</h3><div>Stays (n = 1640) were identified in a 2014–2019 Medicare 5% random sample. Zero-Inflated Poisson regression estimated rate ratios for home time lost in 1-year post-discharge by age (&lt;65 vs 65+), health profiles established by latent profile analysis, frailty, and days covered by ART.</div></div><div><h3>Results</h3><div>Overall, 716 (44%) SNF stays were aged 65+, 1154 (70%) were male, 764 (47%) were Black, 321 (20%) were frail, and 784 (48%) had ART ≥80% of days before admission. There were 3 health profiles: substance use (SU; n = 467), cardiovascular and pulmonary (CV/PULM; n = 665), or multisystem including SU, CV, PULM, and mental health (MULTI; n = 508). Among stays aged &lt;65, SU [rate ratio (95% confidence interval), 1.12 (1.09–1.15)] had more and MULTI [0.87 (0.85–0.89)] had fewer days lost than the CV/PULM group, but any ART carried higher rates of days lost compared with none. Among those aged 65+, SU [0.89 (0.85–0.92)] had fewer days lost, but MULTI [0.97 (0.94–1.00)] was similar in home time loss compared with the CV/PULM group. Having ART &lt;80% of days [1.10 (1.06–1.13)], frailty [1.07 (1.03–1.11)], or pre-frailty [1.07 (1.04–1.10)] had higher rates of days lost.</div></div><div><h3>Conclusions and Implications</h3><div>Although health profiles may help identify conditions most likely impacting health of PWH, frailty may be key to identifying those having the highest needs and at risk for greater home time loss following SNF stays, with this impact varying by age.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105714"},"PeriodicalIF":4.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248420","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}