Journal of the American Medical Directors Association最新文献

{"title":"Impact of Vitamin D Supplementation on Cognition in Adults With Mild to Moderate Vitamin D Deficiency: Outcomes From the VitaMIND Randomized Controlled Trial","authors":"Anne Corbett PhD ,&nbsp;Rod Taylor PhD ,&nbsp;David Llewellyn PhD ,&nbsp;Janice M. Ranson PhD ,&nbsp;Adam Hampshire PhD ,&nbsp;Ellie Pickering MSc ,&nbsp;Abbie Palmer BSc ,&nbsp;Dag Aarsland MD ,&nbsp;Dorina Cader PhD ,&nbsp;Diana Frost ,&nbsp;Clive Ballard MD","doi":"10.1016/j.jamda.2025.105711","DOIUrl":"10.1016/j.jamda.2025.105711","url":null,"abstract":"<div><h3>Objectives</h3><div>Preserved cognitive health with ageing is a public health imperative. Vitamin D deficiency is associated with poor cognition, but it is unclear whether supplementation would provide benefit, particularly in individuals with mild/moderate deficiencies which do not have other clinical risks. The objective of this study was to establish the impact of daily vitamin D supplementation on cognition in older adults with mild to moderate vitamin D deficiency.</div></div><div><h3>Design</h3><div>Two-arm, parallel, 24-month randomized controlled trial, with vitamin D supplementation compared with a placebo.</div></div><div><h3>Setting and Participants</h3><div>This was a remote trial, completed from home involving 620 adults, aged ≥ 50 years, with mild to moderate vitamin D deficiency and early cognitive impairment.</div></div><div><h3>Methods</h3><div>The primary outcome was executive function measured through Trail Making Test Part B and other secondary measures of cognition, function, and well-being.</div></div><div><h3>Results</h3><div>Vitamin D supplementation conferred no significant benefit to executive function compared with placebo at follow-up on the primary outcome (between-group difference, 5770; 95% CI, −2189 to 13,730) or cognition, function, or well-being. Secondary analyses in defined subgroups and a per-protocol analysis also showed no significant impact on any outcome measures.</div></div><div><h3>Conclusions and Implications</h3><div>Vitamin D supplementation produced no measurable improvement in cognitive outcomes in older adults with mild to moderate vitamin D deficiency. The remote trial methodology provides an innovative approach to large-scale trials.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105711"},"PeriodicalIF":4.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248421","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":"Turnover Contemplation in Long-Term Care: Examining Personal and Structural Variables in Canada","authors":"Guytano Virdo PhD,&nbsp;Tamara Daly PhD","doi":"10.1016/j.jamda.2025.105710","DOIUrl":"10.1016/j.jamda.2025.105710","url":null,"abstract":"<div><h3>Objectives</h3><div>There are high rates of turnover documented among frontline care work staff in long-term residential care (LTC). Turnover has been associated with negative organizational outcomes. This study examined turnover contemplation among LTC workers in several Canadian provinces.</div></div><div><h3>Design</h3><div>A questionnaire including closed- and open-ended questions was sent out to Canadian LTC workers. Workers received a hard copy of the survey through mail and were able to send the hard copy back or complete the survey online.</div></div><div><h3>Setting and Participants</h3><div>Canadian LTC workers (N = 347) were surveyed about their work using open- and closed-ended questions. This included demographic information and variables related to working conditions, interactions with supervisors and colleagues, and resident care.</div></div><div><h3>Methods</h3><div>Data were analyzed in IBM SPSS Statistics. Descriptive statistics and a binary logistic regression were performed using turnover contemplation as the outcome variable.</div></div><div><h3>Results</h3><div>Among Canadian LTC workers, contemplating leaving their current position is significantly and positively associated with lower support from immediate supervisors, working in a non–government-owned facility, and having less autonomy to perform more social care tasks.</div></div><div><h3>Conclusions and Implications</h3><div>LTC facilities, and systems more broadly, could improve worker retention rates by improving supervisory support and allowing workers to spend more time meaningfully interacting with patients.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105710"},"PeriodicalIF":4.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Plant-Based Dietary Patterns and the Long-Term Trajectory of Depressive Symptoms: A 10-Year Longitudinal Study","authors":"Wenhao Zhou ME ,&nbsp;Huanting Zhang ME ,&nbsp;Jianan He ME ,&nbsp;Jie Shen PhD","doi":"10.1016/j.jamda.2025.105712","DOIUrl":"10.1016/j.jamda.2025.105712","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies have analyzed associations between plant-based dietary patterns and depressive symptoms. However, little is known about the association of plant-based dietary patterns with the long-term trajectory of depressive symptoms in older Chinese adults.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 1666 individuals aged &gt;65 years during the period from 2008 to 2018 were included, who had complete dietary data and complete evaluations of depressive symptoms in 4 waves.</div></div><div><h3>Methods</h3><div>Data from the Chinese Longitudinal Health and Longevity Survey (CLHLS) were used in this study. We used the simplified Food Frequency Questionnaire at baseline to assess the overall Plant-based Diet index and unhealthy Plant-based Diet Index. Depressive symptoms were assessed by participants' responses to 5 questions. We used a group-based trajectory model to determine the trajectory of depressive symptoms and used multiple logistic regression to analyze the association of plant-based dietary patterns with the long-term trajectory of depressive symptoms in older Chinese adults.</div></div><div><h3>Results</h3><div>The study included 1666 older adults. We identified 3 trajectories of depressive symptoms. The results showed that participants with the highest quintile of Plant-based Diet index were less likely to be on a moderate depression trajectory [odds ratio (OR), 0.597; 95% CI, 0.358-0.994] or a highly progressive depression trajectory (OR, 0.344; 95% CI, 0.171-0.692) than those with the lowest quintile. In contrast, the odds of the highest unhealthy Plant-based Diet Index quintile being on a moderate depression trajectory (OR, 2.750; 95% CI, 1.555-4.863) or a highly progressive depression trajectory (OR, 6.168; 95% CI, 3.014-12.623) were increased.</div></div><div><h3>Conclusions and Implications</h3><div>Adherence to plant-based dietary patterns was associated with a lower likelihood of being on an unfavorable depressive trajectory, whereas an unhealthy plant-based diet was associated with an increased likelihood of being on an unfavorable depressive trajectory.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105712"},"PeriodicalIF":4.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248418","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 Impact of Nursing Staff Wages on Nursing Home Quality: An Instrumental Variable Approach","authors":"Rohit Pradhan PhD ,&nbsp;Akbar Ghiasi PhD ,&nbsp;Robert Weech-Maldonado PhD","doi":"10.1016/j.jamda.2025.105705","DOIUrl":"10.1016/j.jamda.2025.105705","url":null,"abstract":"<div><h3>Objective</h3><div>Nursing staff are central to ensuing high-quality care in nursing homes (NHs), yet their wages often lag behind those in other health care settings. This study aimed to examine whether higher wages for nursing staff—registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs)—were associated with better NH quality.</div></div><div><h3>Design</h3><div>This was an observational study using panel data from 2020 to 2022.</div></div><div><h3>Setting and Participants</h3><div>The study included all Centers for Medicare and Medicaid Services–certified US NHs. The analytic data file comprised 37,577 facilities.</div></div><div><h3>Methods</h3><div>This study used multiple secondary datasets, including the Payroll-Based Journal, Medicare Cost Reports, Care Compare: Five-Star Quality Rating System (Five-Star QRS), and LTCFocus.org. The primary outcome was NH quality, operationalized through the quality domain of the Five-Star QRS. The primary independent variables were the facility-level average hourly wages for RNs, LPNs, and CNAs, adjusted for inflation. To address potential endogeneity, average nursing staff wages at the county level, excluding the index facility, were used as an instrument for wages.</div></div><div><h3>Results</h3><div>A 1-dollar increase in wages for RNs, LPNs, and CNAs was associated with 12% (95% CI, 1.07–1.17), 10% (95% CI, 1.05–1.15), and 8% (95% CI, 1.07–1.45) higher odds, respectively, of obtaining a higher star rating (<em>P</em> &lt; .001). Marginal effects analysis showed that a 1-dollar increase in wages was associated with a 2.4%, 2.0%, and 1.8% higher likelihood of achieving a 5-star rating for RNs, LPNs, and CNAs, respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Higher nursing staff wages were associated with increased odds of achieving a higher quality rating. NHs need to offer competitive wages as part of broader efforts to improve quality. Targeted reimbursement strategies may be necessary to support wage increases, especially for facilities serving a high proportion of vulnerable residents.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105705"},"PeriodicalIF":4.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248422","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":"A Better Way to Care for Long-Term Care Residents in Times of Medical Urgency: An Implementation Intervention Using a Stepped-Wedge Design to Reduce Unnecessary Acute Care Transfers","authors":"Abraham Munene PhD ,&nbsp;Leanna Wyer MSc ,&nbsp;Patrick McLane PhD ,&nbsp;Vivian Ewa MD ,&nbsp;Eddy Lang MD ,&nbsp;Peter Faris PhD ,&nbsp;Shawna Reid RN ,&nbsp;Tatiana Penconek RN ,&nbsp;Greta Cummings RN, PhD ,&nbsp;Guanmin Chen MPH, PhD ,&nbsp;Jillian Walsh MD ,&nbsp;Eldon Spackman PhD ,&nbsp;Marian George ,&nbsp;Jayna Holroyd-Leduc MD","doi":"10.1016/j.jamda.2025.105716","DOIUrl":"10.1016/j.jamda.2025.105716","url":null,"abstract":"<div><h3>Objective</h3><div>Approximately 25% of long-term care (LTC) residents are transferred to an emergency department (ED) when experiencing an acute change in health status. This can place strain on health care resources and negatively impact residents. Many residents’ conditions could be managed within LTC if appropriate supports were provided. This implementation study objective was to optimize and evaluate processes followed when considering acute care management and transfer decisions for residents in LTC.</div></div><div><h3>Design</h3><div>A randomized stepped-wedge design was used to implement a standardized LTC-to-ED care and referral pathway, supported by 2 INTERACT tools. The pathway was implemented within 9 cohorts of (4-5) LTC facilities every 3 months, supported by an implementation coach. Implementation strategies considered local LTC context and barriers, as well as pandemic-related challenges.</div></div><div><h3>Setting and Participants</h3><div>40 LTC facilities and 4 EDs within Calgary, Canada.</div></div><div><h3>Methods</h3><div>The primary outcome was change in transfers from LTC to ED; secondary outcomes included hospital admissions, use of facilitated telephone consultation between LTC and ED physicians, and community paramedic visits. Analysis used negative binomial regression to estimate the incident rate (per 1000 residents), while adjusting for the different cohorts. An economic evaluation was conducted using a unit cost analysis.</div></div><div><h3>Results</h3><div>A reduction in the incident rate of LTC-to-ED transfers was observed with the intervention (1.70 postintervention vs 1.91 preintervention; <em>P</em> &lt; .001), along with reduction in hospital admission (0.94 vs 1.08; <em>P</em> &lt; .001). There was an increase in use of facilitated telephone consultations between MDs but no increase in community paramedic visits. The intervention saved the health care system CAD$7.9 million over the postimplementation evaluation period.</div></div><div><h3>Conclusion and Implications</h3><div>Implementation of a standardized LTC-to-ED care and referral pathway appears to reduce ED transfers and hospitalizations among LTC residents, while realizing cost savings to the health care system. Reducing unnecessary transfers from LTC to ED, and instead focusing on earlier identification and management of acute medical issues within LTC, looks to be a feasible, patient-centered, and resource-optimized approach to care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105716"},"PeriodicalIF":4.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258336","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":"Diagnostic Prediction Models for Sarcopenia: A Systematic Review and Meta-Analysis","authors":"Xiangyu Zhang BS ,&nbsp;Rongna Lian MD ,&nbsp;Huiyu Tang MD ,&nbsp;Shuyue Luo MD ,&nbsp;Xiaoyan Chen MD ,&nbsp;Jing Lu PhD ,&nbsp;Ming Yang MD","doi":"10.1016/j.jamda.2025.105698","DOIUrl":"10.1016/j.jamda.2025.105698","url":null,"abstract":"<div><h3>Objectives</h3><div>Early detection and diagnosis of sarcopenia remain challenging. Despite significant progress in predictive modeling, there is no comprehensive evaluation of their diagnostic performance and methodologic quality across different modeling approaches and populations. This study aims to systematically evaluate the diagnostic accuracy of prediction models for sarcopenia across different modeling approaches and reference standards.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis of diagnostic test accuracy studies.</div></div><div><h3>Setting and Participants</h3><div>Both men and women at any age and ethnicity with sarcopenia, regardless of comorbidities.</div></div><div><h3>Methods</h3><div>We systematically searched Ovid MEDLINE, Embase, and Cochrane Central databases until June 2024. Studies developing or validating prediction models for sarcopenia diagnosis were included. We performed a bivariate random-effects meta-analysis and used hierarchical summary receiver operating characteristic models to synthesize diagnostic accuracy data.</div></div><div><h3>Results</h3><div>Thirteen studies comprising 122,252 participants were included. The prediction models demonstrated robust overall performance in development sets [sensitivity, 82%; 95% CI, 75%-87%; specificity, 84%; 95% CI, 74%-90%; area under curve (AUC), 0.89; 95% CI, 0.86-0.91) and internal validation sets (AUC, 0.86; 95% CI, 0.83-0.89]. In validation sets, traditional statistical models maintained consistent performance (sensitivity, 86%; 95% CI, 80%-91%; specificity, 72%; 95% CI, 67%-77%), whereas machine learning approaches achieved higher specificity (84%; 95% CI, 71%-91%) despite moderate sensitivity (70%; 95% CI, 56%-81%). Only one study conducted external validation, reporting moderate sensitivity (71%; 95% CI, 62%-78%) and excellent specificity (98%; 95% CI, 96%-99%) with an AUC of 0.97.</div></div><div><h3>Conclusions and Implications</h3><div>Current prediction models show promising diagnostic accuracy for sarcopenia, with different modeling approaches having complementary strengths. However, further research is needed to address the limitations of existing models, including methodologic heterogeneity and limited external validation, before clinical implementation can be recommended.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105698"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199489","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":"Decoding the Enigmatic Link Between Sensory Impairment and Organic Mental Disorders: Insights From Biological Aging and Social Support in a Population Cohort Study","authors":"Ce Liu MS ,&nbsp;Li He MS ,&nbsp;Ya Xiao MS ,&nbsp;Hao Zhao MS ,&nbsp;Zhaoru Yang MS ,&nbsp;Huanhuan Wei MS ,&nbsp;Huan Chen MS ,&nbsp;Tong Liu PhD ,&nbsp;Kai Zhang PhD ,&nbsp;Bin Luo PhD","doi":"10.1016/j.jamda.2025.105709","DOIUrl":"10.1016/j.jamda.2025.105709","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study was to investigate the association between sensory impairments and organic mental disorders. We also examined biological age acceleration as a potential mediator and social support as a potential moderator of this association.</div></div><div><h3>Design</h3><div>This was a longitudinal cohort study using Cox proportional hazards models with mediation and moderation analyses.</div></div><div><h3>Setting and Participants</h3><div>A total of 330,983 UK Biobank participants (mean age ± SD, 56.41 ± 8.09 years) were categorized into 4 groups: no sensory impairment (n = 60,636), hearing impairment (n = 22,297), visual impairment (n = 12,271), and dual-sensory impairment (n = 5757).</div></div><div><h3>Methods</h3><div>Sensory status was self-reported, biological age acceleration was assessed through 3 biomarkers (homeostasis disorder, Klemera-Doubal method biological age, and phenotypic age), and organic mental disorders were identified via <em>International Classification of Diseases, 10th Edition</em> codes (F00-F09) from national health registries. Survival analyses were adjusted for sociodemographic factors, lifestyle, and health status.</div></div><div><h3>Results</h3><div>Over a 13.85-year median follow-up, 9645 participants developed organic mental disorders. Dual-sensory impairment showed the strongest association [hazard ratio (HR), 1.54; 95% CI, 1.45-1.64], followed by visual (HR, 1.20; 95% CI, 1.12-1.28) and hearing impairment (HR, 1.12; 95% CI, 1.05-1.20). Biological age acceleration mediated 24.5% to 38.9% of these associations (strongest through Klemera-Doubal method biological age). Social support demonstrated significant moderating effects, particularly in dual-sensory impairment, where high social support reduced risk (HR, 1.34; 95% CI, 1.12-1.60) compared with low social support (HR, 4.76; 95% CI, 2.35-9.65).</div></div><div><h3>Conclusions and Implications</h3><div>Sensory impairments are associated with an increased risk of organic mental disorders, potentially partly mediated by accelerated biological aging, with social support demonstrating a significant moderating effect. The gradient of risk across impairment types and the substantial potential mediating effect of biological age acceleration are consistent with multiple pathways linking sensory and cognitive health. These findings indicate that comprehensive interventions targeting sensory health, biological aging, and social support may represent potential targets for interventions aimed at preventing cognitive disorders in aging populations.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105709"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208854","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":"Feasibility of a Multimodal Prehabilitation Program Before Elective Knee and Hip Arthroplasty in Older Adults: A Qualitative Analysis of the PRE4OS Study","authors":"Bastien Genet MD,&nbsp;Abdoulaye Barry MSc,&nbsp;Prisca Lucas PhD,&nbsp;Judith Cohen-Bittan MD,&nbsp;Michaël Nicolas PT,&nbsp;Dominique Bonnet-Zamponi MD, PhD,&nbsp;Charlotte Naline MD,&nbsp;Dehbia Ouafi-Hendel MD,&nbsp;Véronique François MD,&nbsp;Claire Davy MSc,&nbsp;Jacques Boddaert MD, PhD,&nbsp;Lorène Zerah MD, PhD","doi":"10.1016/j.jamda.2025.105706","DOIUrl":"10.1016/j.jamda.2025.105706","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105706"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216175","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":"Central Nervous System Polypharmacy Among People Living With Dementia","authors":"Elizabeth A. Bayliss MD, MSPH ,&nbsp;J. David Powers MS ,&nbsp;Linda A. Weffald PharmD ,&nbsp;Jon R. Rasmussen PharmD ,&nbsp;Lisa E. Pieper MSHA, MBA ,&nbsp;Mahesh Maiyani MBA ,&nbsp;Jonathan Norton BS ,&nbsp;Ariel R. Green MD, PhD ,&nbsp;Orla C. Sheehan MD, PhD ,&nbsp;Cynthia M. Boyd MD, MPH","doi":"10.1016/j.jamda.2025.105708","DOIUrl":"10.1016/j.jamda.2025.105708","url":null,"abstract":"<div><h3>Objectives</h3><div>The Centers for Medicare and Medicaid Services Polypharmacy-CNS (Poly-CNS) quality metric identifies individuals taking multiple medications with central nervous system side effects. The Poly-CNS measure may reduce risky prescribing for persons living with dementia (PLWD).</div></div><div><h3>Design</h3><div>Secondary analysis of the Optimize cluster randomized pragmatic trial of deprescribing education in primary care conducted between April 1, 2019, and March 31, 2020.</div></div><div><h3>Setting and Participants</h3><div>Two overlapping cohorts of PLWD taking 5+ chronic medications. The “full intervention” cohort was randomized at the clinic level to receive patient and clinician deprescribing education materials. The “clinician education cohort” included additional individuals whose clinicians received educational materials but who did not receive patient materials.</div></div><div><h3>Methods</h3><div>Description of individuals meeting Poly-CNS criteria based on pharmacy dispensing records and their highest frequency combinations of medications. Generalized linear mixed models compared the odds of meeting Poly-CNS criteria by intervention or control group and modeled associations between patient characteristics and CNS polypharmacy at any time. Longitudinal analysis using generalized linear mixed models assessed trends of meeting Poly-CNS criteria over time.</div></div><div><h3>Results</h3><div>The proportion meeting Poly-CNS criteria at any time during the observation period in the full intervention cohort (N = 2908) was 12.3% and 10.8% in the clinician education cohort (N = 5226). Adjusted <em>P</em> value for trend over time in the combined full intervention cohort was .0587, and &lt;.0001 in the clinician education cohort. There was no effect of the intervention on odds of meeting Poly-CNS criteria in either cohort. Characteristics in both cohorts independently associated with meeting Poly-CNS criteria were younger age, greater morbidity burden, and female sex plus hospice use at baseline in the full intervention cohort. The most commonly combined medications were opioids plus antidepressants plus gabapentin.</div></div><div><h3>Conclusions and Implications</h3><div>Individuals with cognitive limitations and multimorbidity pharmacologically treated for mood and/or pain symptoms may be at risk for CNS polypharmacy.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105708"},"PeriodicalIF":4.2,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216174","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":"Late-Life Dementia Care: Identifying Distinct Care Patterns in the Last Years of Life","authors":"Gaia G. Bagnasco MSc,&nbsp;Judith A.M. Bom PhD,&nbsp;Bram Wouterse PhD","doi":"10.1016/j.jamda.2025.105699","DOIUrl":"10.1016/j.jamda.2025.105699","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify common long-term care patterns in the 6 years before death among individuals aged ≥65 years with dementia in the Netherlands and to examine how sociodemographic and health factors are associated with these patterns.</div></div><div><h3>Design</h3><div>A longitudinal retrospective study was conducted using routinely recorded data for the entire Dutch population on health care use, cause of death, and sociodemographics.</div></div><div><h3>Setting and Participants</h3><div>We identified 43,578 individuals who passed away in 2021 with dementia based on their use of dementia-related services and recorded cause of death.</div></div><div><h3>Methods</h3><div>Using ordered logit latent class analysis, we estimated the likelihood of individuals using long-term care (1: no formal LTC; 2: community-based home care services; 3: nursing home care) in each of the 6 years prior to death. Predictors included age, gender, migration background, partner status, polypharmacy, chronic illness groups, homeownership status, and household income quartiles.</div></div><div><h3>Results</h3><div>Three groups with distinct care patterns were identified: the Late Formal Care Group initially did not receive formal LTC but transitioned to community-based home care services and nursing homes 4 years before death, primarily relying on nursing home care. The Mixed Care Group used community-based home care services 6 years before death and shifted to nursing home care in their final years. A large share of the Early Nursing Home Group already used nursing home care 6 years before death, with nearly all individuals residing in nursing homes during their last 3 years. The Late Formal Care Group typically had higher income, greater homeownership rates, more often had a partner, and exhibited better health than the other groups, which accessed formal care earlier.</div></div><div><h3>Conclusions and Implications</h3><div>Variations in care patterns highlight that greater socioeconomic resources, stronger support, and better health relate to later formal care use. Understanding these patterns is vital for informed policy planning and resource allocation.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105699"},"PeriodicalIF":4.2,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199490","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}