Journal of the American Medical Directors Association最新文献

{"title":"The Relationship Between Frailty and Psychological Functioning in Community-Dwelling Older Adults: A Systematic Review","authors":"Huan Zhao BSc (Hons) ,&nbsp;Yaping Zhong PhD","doi":"10.1016/j.jamda.2025.105707","DOIUrl":"10.1016/j.jamda.2025.105707","url":null,"abstract":"<div><h3>Objectives</h3><div>Frailty and poor psychological functioning remain major aging-related public and clinical health challenges. The multidimensional nature of these constructs, along with diverse assessment methods, complicate the study of their relationship. This study aims to examine the cross-sectional and longitudinal relationships between frailty and psychological functioning and explore how their interplay affects health-related outcomes in community-dwelling older adults.</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Setting and Participants</h3><div>Community-dwelling older adults.</div></div><div><h3>Methods</h3><div>We conducted a systematic search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Web of Science, and Scopus for English-language articles published between January 2001 and November 2024. Two authors independently screened studies, extracted data, and performed quality assessment. Data were analyzed descriptively.</div></div><div><h3>Results</h3><div>A total of 129 studies were included, covering 113 distinct cohorts of community-dwelling older adults from 37 countries. Cross-sectional analyses consistently found positive associations between frailty and depression, psychological distress, and apathy, and negative associations with mental well-being, optimism, and sense of coherence, with mixed findings for anxiety. Longitudinal studies showed that baseline depression, apathy, and poor mental vitality predicted frailty progression, while frailty at baseline predicted incident depression and worsened mental health. The interaction between frailty and depression was associated with poorer health outcomes, including increased mortality, functional disability, and hospitalization risks.</div></div><div><h3>Conclusions and Implications</h3><div>Community-based frailty management strategies should consider a broader range of psychological factors, such as mental vitality, apathy, and mental well-being. Further research is needed to explore additional psychological dimensions beyond depression and anxiety, and their relationship with frailty and aging-related health outcomes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105707"},"PeriodicalIF":4.2,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248423","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":"Prospective Association Between Sarcopenia and Long-Term Risk of Hospitalization for Infection: A Cohort Study","authors":"Wan Yu MM ,&nbsp;Wenxu Wang MBBS ,&nbsp;Xingyue Ye MBBS ,&nbsp;Rui Ren MBBS ,&nbsp;Ru Zhang MBBS ,&nbsp;Linze Xi MBBS ,&nbsp;Yang Peng PhD ,&nbsp;Difei Wang PhD","doi":"10.1016/j.jamda.2025.105702","DOIUrl":"10.1016/j.jamda.2025.105702","url":null,"abstract":"<div><h3>Objectives</h3><div>The relationship between sarcopenia and the long-term risk of hospitalization for infectious diseases is unclear. This study aimed to evaluate this relationship using a large prospective Caucasian cohort from the UK Biobank.</div></div><div><h3>Design</h3><div>This is a large prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Using the UK Biobank data, participants were assessed for handgrip strength and appendicular lean mass at baseline and categorized into the non-sarcopenia, probable sarcopenia, and sarcopenia groups. A total of 243,097 participants (mean age, 55.64 years; 52.7% female) were enrolled in this study; 12,982 (5.3%) had probable sarcopenia and 312 (0.1%) had sarcopenia.</div></div><div><h3>Methods</h3><div>Cox regression analysis was used to evaluate associations between sarcopenia and subsequent hospitalizations for infections. The long-term risk of hospitalization for infections in different sarcopenia statuses was also examined.</div></div><div><h3>Results</h3><div>During the follow-up period (median, 13.54 years), 26,769 participants were hospitalized for infections, of whom 2357 (8.8%) had probable sarcopenia and 60 (0.2%) had sarcopenia. In the fully adjusted model, sarcopenia [hazard ratio (HR), 1.62; 95% confidence interval (CI), 1.25–2.08] and probable sarcopenia (HR, 1.40; 95% CI, 1.34–1.47) at baseline were prospectively associated with the risk of hospitalization for any infection. Sarcopenia was strongly associated with gastrointestinal infections (HR, 2.69; 95% CI, 1.27–5.68), whereas probable sarcopenia was associated with liver infections (HR, 1.76; 95% CI, 1.22–2.54). The average numbers of hospitalizations for infection were significantly higher in the probable sarcopenia and sarcopenia groups than in the non-sarcopenia group (<em>P</em> &lt; .001 and <em>P</em> &lt; .020, respectively). No significant difference was observed between the probable and confirmed sarcopenia groups (<em>P</em> = .684).</div></div><div><h3>Conclusions and Implications</h3><div>Sarcopenia may help identify people at risk of hospitalization for infections, supporting the strategies for enhancing infection prevention among individuals with sarcopenia.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105702"},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208856","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":"From Nursing Homes to Home Care: Examining the Impact of the COVID-19 Pandemic on Direct Care Worker Transitions.","authors":"Katherine E M Miller, Yang Yang, Jeromie Ballreich, Karen Shen","doi":"10.1016/j.jamda.2025.105717","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105717","url":null,"abstract":"<p><strong>Objectives: </strong>Due to poor working conditions and low wages, workforce turnover in the long-term care industry has been a longstanding issue. Increased risks to workers caused by the COVID-19 pandemic exacerbated these issues. Thus, many states offered wage supports (eg, hazard pay) to try to stabilize the workforce. Our objective was to examine how exits of direct care workers employed in the long-term care industry changed during the COVID-19 pandemic, and whether hazard pay policies mediated the impact of the pandemic on worker exits.</p><p><strong>Design: </strong>We used the Annual Social and Economic Supplement to identify direct care workers and PHI reports to identify states offering hazard pay during the pandemic.</p><p><strong>Setting and participants: </strong>The analytical sample consisted of 8164 direct care workers employed in long-term care between 2016-2018 and 2020-2022 in 2 settings: (1) home settings and (2) residential care settings (nursing homes and assisted living).</p><p><strong>Methods: </strong>We decomposed direct care worker exits using the Annual Social and Economic Supplement survey responses to (1) unemployment or exiting the labor force, (2) a different health care job or industry, and (3) non-healthcare job (eg, retail). We compared the rates of these components for direct care workers prepandemic (2016-2019) and during the pandemic (2020-2023), and the association of these rates with state wage-support policies.</p><p><strong>Results: </strong>Direct care worker exits were highest in 2020, with most workers becoming unemployed or leaving the labor force. In 2021-2022, worker exits decreased relative to prepandemic periods, driven by fewer people switching jobs. Among those who switched jobs, we found that workers during the pandemic were more likely to stay in a health care industry relative to prepandemic. We found no evidence that wage support policies influenced direct care worker exits during or after the pandemic.</p><p><strong>Conclusions and implications: </strong>Our findings suggest that broader economic trends of a shrinking workforce may be the primary driver of direct care worker exits during the pandemic.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105717"},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of an Artificial Intelligence-Infused SinDance Exergame for Enhancing Physical Functions and Well-Being in Older Adults: A Pilot Randomized Controlled Trial","authors":"Ying Jiang PhD,&nbsp;Kei Oide BSc (Hons),&nbsp;Yue En Chow BSc (Hons),&nbsp;Changwu Chen MSc,&nbsp;Mandy Zhang MMed(FM), MB BCh BAO,&nbsp;Matthew Chin Heng Chua PhD,&nbsp;Si Qi Yoong BSc (Hons)","doi":"10.1016/j.jamda.2025.105701","DOIUrl":"10.1016/j.jamda.2025.105701","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105701"},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208855","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":"An Embedded Pragmatic Clinical Trial of the Individualized Positive Psychosocial Interaction (IPPI) Program","authors":"Katherine M. Abbott PhD ,&nbsp;Allison R. Heid PhD ,&nbsp;Molly Noble MGS ,&nbsp;Amy Kotterman RDN, LD ,&nbsp;Kathleen Unroe MDMHA, MS ,&nbsp;Kimberly Van Haitsma PhD","doi":"10.1016/j.jamda.2025.105700","DOIUrl":"10.1016/j.jamda.2025.105700","url":null,"abstract":"<div><h3>Objectives</h3><div>We implemented a pilot embedded pragmatic clinical trial of the evidence-based Individualized Positive Psychosocial Interaction (IPPI) program for people living with dementia (PLWD) in nursing homes. We sought to answer the following questions: Can staff consistently deliver IPPIs to enrolled residents over 6 months? How does IPPI completion impact the immediate outcome of resident mood? Can we track the impact of IPPI completion on a distal (3-month and 6-month) pragmatic clinical outcome (ie, symptoms of distress) recorded in the Minimum Dataset (MDS) 3.0?</div></div><div><h3>Design</h3><div>Nursing home staff completed an online training on emotion-focused communication and were trained to deliver IPPIs, which are short (ie, 10-minute) protocol-guided, one-on-one preference-aligned, interactions with PLWD. Staff were instructed to complete 2 IPPIs per week per resident for 6 months.</div></div><div><h3>Setting and Participants</h3><div>130 residents from 7 nursing homes.</div></div><div><h3>Methods</h3><div>Pre- and post-IPPI observed emotion evaluations were completed and MDS 3.0 data were collected for all eligible residents in the nursing home community during the study period. Descriptive statistics and frequencies were computed for rates of IPPI completions, sample descriptives, endorsement of mood change, and symptoms of distress at baseline, 3 months, and 6 months.</div></div><div><h3>Results</h3><div>IPPI participants who did not die or discharge from the nursing home completed on average 45 IPPIs over 6 months. In 59% (n = 2813) of IPPIs, mood immediately improved from negative to neutral/positive or from neutral to positive, whereas in 42% (n = 1994) of cases, mood stayed stable. MDS 3.0 data were able to show change over time in symptoms of distress from baseline to 3 months and 6 months, with most improving during the intervention period.</div></div><div><h3>Conclusions and Implications</h3><div>The IPPI program is an effective person-centered intervention for PLWD in nursing homes. It can be integrated into care and improve resident mood, and symptoms of distress can be tracked in existing clinical data.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105700"},"PeriodicalIF":4.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216173","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 Residents’ Perceived Importance of Family Involvement in Overall Care Planning and Rehabilitative Therapy Administration in Nursing Homes","authors":"Syed Naqvi BS,&nbsp;Anthony P. Nunes PhD,&nbsp;Kate L. Lapane PhD","doi":"10.1016/j.jamda.2025.105704","DOIUrl":"10.1016/j.jamda.2025.105704","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examines the association between nursing home residents' perceived importance of family involvement in overall care planning and the administration of physical and occupational therapy.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>The study focused on all newly admitted nursing home residents aged 50 years and older who transferred from acute-care facilities in 2019.</div></div><div><h3>Methods</h3><div>We analyzed data from the Minimum Data Set 3.0 for 2,112,330 residents aged 50+ years in US nursing homes. We assessed family involvement in care planning based on the resident's perceived importance of family involvement in care planning, ranging from “Not important at all” to “very important.” Exclusions were residents in hospice, comatose, or life expectancy of less than 6 months. The outcome was defined as a sum of physical and occupational therapy minutes. Adjusted linear regression models were used.</div></div><div><h3>Results</h3><div>Residents who reported “very important” family involvement were older (mean age 78 years) and received more therapy minutes compared with other groups. Those with a lesser preference for family involvement were younger and had higher body mass index, better continence, and less functional impairment. Fewer therapy minutes were received by residents with less family involvement. Residents who considered family involvement \"Not Important at All\" received 15 fewer minutes of therapy (95% CI, −18 to −13) compared with those who deemed it \"very important\" after adjusting for confounders.</div></div><div><h3>Conclusions and Implications</h3><div>The study highlights a link between family involvement in care planning and increased therapy administration in nursing homes. Residents reporting higher preference for family engagement received more therapy minutes, with this pattern consistent across various demographic and health conditions. This finding underscores the importance of family involvement in receipt of therapy and highlights the need for incorporating family engagement strategies in nursing home care planning to ensure equitable and effective care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105704"},"PeriodicalIF":4.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208853","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 of Shorter Secondary One-Leg Standing Time with Loss of Independence or Death in Community-Dwelling Older Adults in the Aizu Cohort Study (LOHAS)","authors":"Yoji Hirayama MD ,&nbsp;Hajime Yamazaki MD, PhD ,&nbsp;Yusuke Ogawa MD, MPH, PhD ,&nbsp;Yoshie Yamada MD, PhD ,&nbsp;Yosuke Yamamoto MD, PhD","doi":"10.1016/j.jamda.2025.105688","DOIUrl":"10.1016/j.jamda.2025.105688","url":null,"abstract":"<div><h3>Objectives</h3><div>Although a previous report indicated that the primary one-leg standing time (OLST), defined as the longer OLST of both legs, is associated with death, the association between secondary OLSTs (the shorter OLSTs) and death remains unclear. This study investigated the association between secondary OLSTs and the loss of independence (LOI) or death.</div></div><div><h3>Design</h3><div>Population-based cohort study.</div></div><div><h3>Setting and Participants</h3><div>This study was conducted in 2 Japanese municipalities. Between 2008 and 2010, bilateral OLSTs were measured in independent adults aged ≥65 years. In total, 3278 participants were included in the primary analysis.</div></div><div><h3>Methods</h3><div>The outcome was a composite of LOI and death. LOI was defined as the need for complete support in basic activities of daily living, corresponding to care levels 3 to 5 of the Japanese long-term care insurance certification. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) and 95% CIs for the association between secondary OLSTs and LOI or death. We also conducted additional analyses limited to those with normal primary OLSTs (≥30 seconds) and evaluated the independent role of secondary OLST.</div></div><div><h3>Results</h3><div>During follow-up (median: 7.22 years), LOI or death occurred in 452 (13.7%) participants. Shorter secondary OLSTs were associated with LOI or death; the multivariable HR (95% CI) was 2.17 (1.67-2.84) in those with secondary OLSTs of &lt;10 seconds, 1.54 (1.13-2.10) for OLSTs of 10-20 seconds, and 0.88 (0.56-1.37) for OLSTs of 20-30 seconds, compared to those with normal secondary OLSTs (≥30 seconds). These associations remained consistent in additional analyses limited to those with normal primary OLSTs.</div></div><div><h3>Conclusions and Implications</h3><div>Shorter secondary OLSTs are risk factors for LOI or death in older adults, even when the primary OLSTs are within the normal range. Assessing OLSTs on both sides is important for predicting prognostic outcomes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105688"},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132608","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":"Simplifying Sarcopenia Screening: A Community-Based Evaluation of Screening and Assessment Combinations","authors":"Tzu-Hao Tseng MD, PhD ,&nbsp;Ting-En Tseng MD ,&nbsp;Yi-Chien Lu PhD ,&nbsp;Ning-Huei Sie PhD ,&nbsp;Chih-Chien Hung MD ,&nbsp;Chung-Yi Li PhD ,&nbsp;Der-Sheng Han MD, PhD ,&nbsp;Chih-Hsing Wu MD, PhD ,&nbsp;Chen-Yu Wang PhD ,&nbsp;Shau-Huai Fu MD, PhD","doi":"10.1016/j.jamda.2025.105703","DOIUrl":"10.1016/j.jamda.2025.105703","url":null,"abstract":"<div><h3>Objectives</h3><div>Sarcopenia is a serious condition in older individuals, characterized by muscle loss and physical decline. Early detection is crucial but challenging due to subtle symptoms. The Asian Working Group for Sarcopenia (AWGS) 2019 consensus recommends detection for possible sarcopenia, but the effectiveness of the suggested tools varies, and the ideal screening combination remains unclear. This study aims to identify the most suitable screening pathway for early sarcopenia detection in community settings.</div></div><div><h3>Design</h3><div>Prospective cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Participants were recruited from locations offering congregated meal services between October 2018 and November 2019. Eligible participants were community-dwelling residents aged 50 years or older who were capable of completing the full sarcopenia survey.</div></div><div><h3>Methods</h3><div>All assessments recommended in the AWGS 2019 algorithm were conducted. We organized these tests into 12 distinct pathways, each combining a case-finding method with an assessment, either a muscle strength test or a physical performance test. Skeletal muscle mass was measured using bioelectrical impedance analysis. The validity of different combinations was then compared.</div></div><div><h3>Results</h3><div>A total of 567 participants were enrolled in this study. Among the 3 case-finding tools, calf circumference had the highest sensitivity and the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) had the lowest (80% vs 8%). Across the 12 different screening combinations tested, pathways involving calf circumference outperformed those involving the SARC-F or the SARC-F combined with calf circumference (SARC-CalF). Notably, the combination of calf circumference and handgrip strength emerged as the optimal pathway, offering the best sensitivity and satisfactory specificity, along with superior discrimination ability (indicated by receiver operating characteristic analysis) and prediction accuracy (indicated by Brier score).</div></div><div><h3>Conclusions and Implications</h3><div>The combination of calf circumference and handgrip strength is the most effective screening pathway for detecting sarcopenia in community settings. Its performance is even close to conducting all the tests outlined in the AWGS 2019 consensus. This simplified pathway may serve as a practical screening option in community settings.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105703"},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208857","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":"Did Site-Neutral Payment for Long-Term Care Hospitals Reduce Financial Incentives to Time Discharge?","authors":"Rashmita Basu PhD ,&nbsp;Anil N. Makam MD, MAS","doi":"10.1016/j.jamda.2025.105689","DOIUrl":"10.1016/j.jamda.2025.105689","url":null,"abstract":"<div><h3>Objectives</h3><div>Historically, fee-for-service Medicare reimbursed long-term care hospital (LTCH) stays as a lump-sum payment, which was substantially reduced for discharges before the diagnosis-specific short-stay outlier (SSO) threshold day, leading to large spikes in discharges on the threshold day. The objective of this study was to examine if LTCHs similarly time discharge at the SSO threshold for blended site-neutral payment cases compared with standard payment cases.</div></div><div><h3>Design</h3><div>Cross sectional.</div></div><div><h3>Setting and Participants</h3><div>Cohort of Medicare beneficiaries.</div></div><div><h3>Methods</h3><div>We used the national 100% LTCH Medicare Provider Analysis and Review Limited Data Set for fiscal year 2017 and exploited differences in prior ICU days using a multinomial model adjusting for patient demographics and case-mix. We only included stays where payment status was solely determined by prior ICU days. Our primary outcome was the discharge on the SSO threshold day. The exposure was an indicator variable for ≥3 intensive care unit days in the preceding acute care hospital, where yes equated to standard payment and no was a blended site-neutral case.</div></div><div><h3>Results</h3><div>Among 10,910 LTCH discharges (48% of cases were aged 65-74 years, 52% were female, 25% were non-white, 24% were blended site-neutral cases), we found that despite an approximately 50% reduction in payment increase, the spike in the adjusted probability of discharge on the SSO threshold day vs the day before was similar for blended site-neutral (20% vs 2%) and standard payment cases (16% vs 1%), with an adjusted difference of −3% (95% CI, −5% to 2%).</div></div><div><h3>Conclusions and Implications</h3><div>Unwarranted spikes in discharge on the SSO threshold persisted despite a 50% reduction in the payment increase, a crucial insight for policymakers and payers who seek to avoid incentives to strategically time discharges. LTCH stays should be reimbursed without meaningful payment increases based on length of stay thresholds.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105689"},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191914","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":"Latent Cognitive Profiles and Demographic Determinants in Older Adults without Dementia: A National Cross-Sectional Study","authors":"Jiaying Li PhD,&nbsp;Junxin Li PhD","doi":"10.1016/j.jamda.2025.105697","DOIUrl":"10.1016/j.jamda.2025.105697","url":null,"abstract":"<div><h3>Objectives</h3><div>Traditional cognitive well-being classification in older adults often overlooks domain-specific deficits. We aimed to validate previously identified distinct cognitive profiles among those without dementia and examine demographic predictors to guide tailored interventions for equitable healthy aging.</div></div><div><h3>Designs</h3><div>Cross-sectional study.</div></div><div><h3>Settings/Participants</h3><div>Community-dwelling adults aged ≥65 years without dementia from the National Health and Aging Trends Study (NHATS).</div></div><div><h3>Methods</h3><div>We performed a split-sample validation analysis on the identified latent profile analysis of episodic memory, executive function, orientation, psychomotor function, visual attention, and working memory. Multinomial logistic regression examined demographic predictors of each profile with Holm-Bonferroni correction.</div></div><div><h3>Results</h3><div>After the split-sample validation analysis, we confirmed that 5 latent profiles emerged (n = 2219): profile 1, overall intact (50.5% of all samples); profile 2, isolated moderate orientation impairment (15.6%); profile 3, mild global impairment with preserved orientation (22.0%); profile 4, mild global impairment with significant orientation impairment (5.5%); and profile 5, moderate global impairment (6.2%). Compared with profile 1, profile 2 was exclusively related to aged ≥90 years, with normal income negatively associated. Similarly, profile 3 was linked to ages 85-89 and ≥90 years, as well as Black or Hispanic ethnicity. Profile 4 was positively associated with aged ≥90 years and Black or Hispanic ethnicity, and negatively associated with normal income. Profile 5 was associated with aged ≥90 years and Black or Hispanic ethnicity, whereas normal income and self-rated good or excellent health were negatively associated with profile 5 (all adjusted <em>P</em> &lt; .05).</div></div><div><h3>Conclusions and Implications</h3><div>About half of older adults exhibit domain-specific deficits, suggesting tailored interventions are essential. Profile 5 needs comprehensive strategies, whereas orientation-focused training could benefit profiles 2, 3, and 4. Demographic factors—particularly age, ethnicity, and income—should guide customization to enhance intervention participation and adherence.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105697"},"PeriodicalIF":4.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199491","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}