Journal of the American Medical Directors Association最新文献

{"title":"Impact of Quality Improvement Interventions on Hospital Admissions from Nursing Homes: A Systematic Review and Meta-Analysis","authors":"Ines Basso PhD ,&nbsp;Silvia Gonella RN, PhD ,&nbsp;Erika Bassi PhD ,&nbsp;Silvia Caristia PhD ,&nbsp;Sara Campagna PhD ,&nbsp;Alberto Dal Molin PhD","doi":"10.1016/j.jamda.2024.105261","DOIUrl":"10.1016/j.jamda.2024.105261","url":null,"abstract":"<div><h3>Objective</h3><div>To synthesize evidence assessing the effectiveness of quality improvement (QI) interventions in reducing hospital service use from nursing homes (NHs).</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis of randomized controlled trials (RCTs), controlled before-after (CBA), uncontrolled before-after (UBA), and interrupted time series studies. Searches were conducted in MEDLINE, CINAHL, The Cochrane Library, Embase, and Web of Science from 2000 to August 2023 (PROSPERO: CRD42022364195).</div></div><div><h3>Setting and Participants</h3><div>Long-stay NH residents (&gt;30 days).</div></div><div><h3>Methods</h3><div>Included QI interventions using a continuous and data-driven approach to assess solutions aimed at reducing hospital service use. Risk of bias was assessed using JBI tools. Delivery arrangements and implementation strategies were categorized through EPOC taxonomy.</div></div><div><h3>Results</h3><div>Screening of 14,076 records led to the inclusion of 22 studies describing 29 QI interventions from 6 countries across 964 NHs. Ten studies, comprising 4 of 5 RCTs, 3 of 4 CBAs, and 1 of 12 UBAs were deemed to have a low risk of bias. All but 3 QI interventions used multiple component delivery arrangements (median 6; IQR 3-8), focusing on the “coordination of care and management of care processes” alone or combined with “changes in how, when, where, and by whom health care is delivered.” The most frequently used implementation strategies were educational meetings (n = 25) and materials (n = 20). The meta-analysis of 11 studies showed a significant reduction in “all-cause hospital admissions” for QI interventions compared with standard care (rate ratio, 0.60; 95% CI, 0.41-0.87; <em>I</em>² = 99.3%), with heterogeneity due to study design, QI intervention duration, type of delivery arrangements, and number of implementation strategies. No significant effects were found for emergency department (ED) visits or potentially avoidable hospitalizations.</div></div><div><h3>Conclusions and Implications</h3><div>The study provides preliminary evidence supporting the implementation of QI interventions seeking to reduce hospital admissions from NHs. However, these findings require confirmation through future experimental research.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105261"},"PeriodicalIF":4.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349039","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":"Detecting Agitated Behaviors in Nursing Home Residents With Dementia Using Electronic Medical Records","authors":"Hyunkyung Yun MS, MSW ,&nbsp;Vincent Mor PhD ,&nbsp;Christopher Santostefano MPH, RN ,&nbsp;Ellen McCreedy PhD, MPH","doi":"10.1016/j.jamda.2024.105289","DOIUrl":"10.1016/j.jamda.2024.105289","url":null,"abstract":"<div><h3>Objectives</h3><div>Agitated behaviors (behaviors) are common in nursing home (NH) residents with Alzheimer's disease and related dementias (ADRD). Pragmatic trials of behavior management interventions rely on routinely collected Minimum Data Set (MDS) data to evaluate study outcomes, despite known underreporting. We describe a method to augment MDS-based behavioral measures with structured and unstructured data from NH electronic medical records (EMR).</div></div><div><h3>Design</h3><div>Repeated cross-sectional analyses of EMR data from a single multistate NH corporation.</div></div><div><h3>Setting and Participants</h3><div>Long-stay residents (at least 90 days in NH) with ADRD from January 2020 through August 2022.</div></div><div><h3>Methods</h3><div>Quarterly and annual assessments of NH residents with ADRD during the study period were identified. For MDS, any behavior was defined as a score of 1 or higher on the Agitated and Reactive Behavior Scale. For structured EMR data, any behavior was defined as increased resident agitation, verbal aggression, or physical aggression on the Interventions to Reduce Acute Care Transfers, Change in Condition form (INTERACT). For unstructured EMR data, any behavior was defined using keyword searches of free-text orders.</div></div><div><h3>Results</h3><div>A total of 77,936 MDS assessments for 19,705 long-stay residents with ADRD in 322 NHs were identified; 14.8% (SD 35.6) of residents had behaviors per month using MDS alone, 16.2% (SD 36.9) using MDS and INTERACT, and 18.6% (SD 38.9) using MDS, INTERACT, and orders. Supplementing MDS with EMR data increased behavior identification by 3.8 percentage points (a 25.7% relative increase). Less than 0.5% had behaviors noted in all 3 sources consistently across study months.</div></div><div><h3>Conclusions and Implications</h3><div>Using EMR data increased detectable behaviors vs the MDS alone. The 3 sources captured different types of behaviors and using them together may be a more comprehensive identification strategy. These results are important for better targeting of interventions and allocation of resources to improve the quality of life for NH residents with ADRD-related behaviors.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 12","pages":"Article 105289"},"PeriodicalIF":4.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349035","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":"Intra-Individual Variability of Direct Oral Anticoagulant Levels in Frail Older Patients upon, during, and after Acute Hospitalization: the DOAC-FRAIL Study","authors":"Melanie J. de Jong MSc,&nbsp;Hamza Saadan MSc,&nbsp;Bram H.M. van der Hooft MSc,&nbsp;Dave L.S. Hellenbrand MSc,&nbsp;Renee A.G. Brüggemann MD, PhD,&nbsp;Hugo Ten Cate MD, PhD,&nbsp;Sander M.J. van Kuijk MSc, PhD,&nbsp;Robin M.J.M. van Geel MD, PhD,&nbsp;Yvonne M.C. Henskens MSc, PhD,&nbsp;Kristien Winckers MD, PhD,&nbsp;Fabienne J.H. Magdelijns MD, PhD","doi":"10.1016/j.jamda.2024.105280","DOIUrl":"10.1016/j.jamda.2024.105280","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 12","pages":"Article 105280"},"PeriodicalIF":4.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349053","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":"Development of a Predictive Hospitalization Model for Skilled Nursing Facility Patients","authors":"Ben Kandel PhD ,&nbsp;Cheryl Field MSN, RN ,&nbsp;Jasmeet Kaur MS ,&nbsp;Dean Slawson BS ,&nbsp;Joseph G. Ouslander MD","doi":"10.1016/j.jamda.2024.105288","DOIUrl":"10.1016/j.jamda.2024.105288","url":null,"abstract":"<div><h3>Objectives</h3><div>Identifying skilled nursing facility (SNF) patients at risk for hospitalization or death is of interest to SNFs, patients, and patients' families because of quality measures, financial penalties, and limited clinical staffing. We aimed to develop a predictive model that identifies SNF patients likely to be hospitalized or die within the next 7 days and validate the model's performance against clinician judgment.</div></div><div><h3>Design</h3><div>Retrospective multivariate prognostic model development study.</div></div><div><h3>Setting and Participants</h3><div>Patients in US SNFs that use the PointClickCare electronic health record (EHR) system. We used data from the first 100 days of skilled stays for 5,642,474 patients in 8440 SNFs, from January 1, 2019, through March 31, 2023.</div></div><div><h3>Methods</h3><div>We used data collected in the course of clinical care to develop a machine learning model to predict the likelihood of patient hospitalization or death within the next 7 days. The data included vital signs, diagnoses, laboratory results, food intake, and clinical notes. We also asked SNF nurses and hospital case managers to make their own predictions as a comparison. The EHR was used as the source of information on whether the patient died or was hospitalized.</div></div><div><h3>Results</h3><div>The model had sensitivity of 35%, specificity of 92%, positive predictive value (PPV) of 18%, and area under the receiver operator curve (AUC) of 0.75. A variation of the model in which we did not include progress notes and food intake achieved an AUC of 0.70. Nurse raters achieved a sensitivity of 61%, specificity of 73%, and PPV of 10%.</div></div><div><h3>Conclusions and Implications</h3><div>Machine learning models can accurately predict the likelihood of hospitalization or death within the next 7 days among SNF patients. These models do not require additional SNF staff time and may be useful in readmission reduction programs by targeting more frequent monitoring proactively to those at highest risk.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 1","pages":"Article 105288"},"PeriodicalIF":4.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349036","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":"Reduction of Rehospitalization with Addition of Geriatrics/Transitions of Care Consult Service","authors":"Anthony E. Jackson MD ,&nbsp;Autumn N. Brubaker DO ,&nbsp;Candice R. Coffey MD ,&nbsp;Jessica L. Kalender-Rich MD, CMD","doi":"10.1016/j.jamda.2024.105287","DOIUrl":"10.1016/j.jamda.2024.105287","url":null,"abstract":"<div><div>Older adults are at high risk of rehospitalization after an acute event and at even higher risk of permanently losing an activity of daily living with each hospitalization. This is especially true in those with encephalopathy, delirium, dementia, falls, and failure to thrive. Although it is widely known that rehospitalization rates are higher in patients who discharge to skilled nursing and long-term care facilities, geriatrics consultations have not been shown to consistently decrease this risk. In this study, we added a novel component specific to transitions of care alongside a traditional geriatrics consultation for patients discharging to a skilled nursing or long-term care facility. Results show evidence of significant rehospitalization reduction for patients with markers of cognitive impairment and frailty.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 12","pages":"Article 105287"},"PeriodicalIF":4.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349054","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":"Skilled Nursing Facility Rehabilitation Intensity and Successful Discharge in Persons with Dementia","authors":"Thomas A. Bayer MD, ScM ,&nbsp;Lan Jiang MSc ,&nbsp;Mriganka Singh MD ,&nbsp;Zachary J. Kunicki PhD, MPH, MS ,&nbsp;Julia W. Browne PhD ,&nbsp;Thomas Nubong MD ,&nbsp;Catherine M. Kelso MD ,&nbsp;John E. McGeary PhD ,&nbsp;Wen-Chih Wu MD, MPH ,&nbsp;James L. Rudolph MD, SM","doi":"10.1016/j.jamda.2024.105286","DOIUrl":"10.1016/j.jamda.2024.105286","url":null,"abstract":"<div><h3>Objectives</h3><div>Skilled therapies (STs), including audiology, speech-language therapy, occupational therapy, and physical therapy, can address functional deficits in dementia. This study aims to quantify the association between ST and successful discharge after heart failure (HF) hospitalization in persons living with dementia.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>We included veterans with dementia (VwD) hospitalized for HF in Veterans Affairs (VA) medical centers and then admitted to non-VA skilled nursing facilities (SNFs) from January 2011 to June 2019.</div></div><div><h3>Methods</h3><div>Follow-up continued 120 days after SNF admission. We measured ST hours per week using MDS admission assessments. We defined successful discharge as SNF discharge occurring within 90 days of SNF admission with MDS discharge status not hospital or institutional setting, and 30 days’ survival after discharge without Medicare or VA-paid rehospitalization or reinstitutionalization. We estimated relative risk using multiple variable regression to adjust for measured sources of confounding.</div></div><div><h3>Results</h3><div>Our final sample included 8255 VwD. The mean (SD) age was 80 (10) years, and 8074 (98%) were male. Successful discharge occurred in 2776 (34%) of the sample. The median (IQR) weekly hours of ST was 10.4 (7.1–12.1). Sextile 1 received less than 5.2 hours per week of ST. The adjusted relative risk (95% CI) for sextiles 2–6 compared with sextile 1 were, respectively, 2.20 (1.85–2.62), 2.48 (2.09–2.94), 2.52 (2.12–2.99), 2.62 (2.21–3.11), and 2.69 (2.27–3.19).</div></div><div><h3>Discussion</h3><div>During SNF care after HF hospitalization, 5.3 or more hours of STs per week was associated with a higher rate of successful discharge, in a roughly dose-dependent fashion, up to a 170% increase in the highest sextile of ST hours.</div></div><div><h3>Conclusions and Implications</h3><div>Higher ST hours are associated with successful discharge from SNF after HF hospitalization.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 12","pages":"Article 105286"},"PeriodicalIF":4.2,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349056","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":"Incidence, Prevalence, and Risk for Urinary Incontinence for People with Dementia in the Community in Aotearoa New Zealand: An interRAI Study","authors":"Vanessa Burholt PhD ,&nbsp;Gary Cheung PhD ,&nbsp;Sharon A. Awatere PhD ,&nbsp;Julie F. Daltrey MNurs(Hons)","doi":"10.1016/j.jamda.2024.105285","DOIUrl":"10.1016/j.jamda.2024.105285","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify 1-year period prevalence, 5-year incidence rate, and risks for urinary incontinence (UI) for people living with dementia.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Participants completed an International Residential Assessment Instrument Home Care (interRAI-HC) assessment in a 5-year period between August 1, 2016 and July 31, 2021 in Aotearoa New Zealand (N = 109,964).</div></div><div><h3>Methods</h3><div>For prevalence analysis, a dementia cohort was selected for a 1-year period from August 1, 2020 to July 31, 2021 (n = 7775). For incidence analysis, participants in the dementia cohort were followed from the first dementia diagnosis during the 5-year period. Dementia was identified by combining diagnoses of “Alzheimer's disease” and “Dementia other than Alzheimer's disease.” Participants were coded with UI if they were infrequently, occasionally, or frequently incontinent or if continence was managed with catheter/ostomy. Univariate and multivariate logistic regression analyses identified risk factors predicting UI onset. Cox regression analysis compared survival curves (months without UI) of the dementia and non-dementia cohorts, adjusting for variables significantly associated with incident UI in either cohort.</div></div><div><h3>Results</h3><div>The 1-year period (August 1, 2020 to July 31, 2021) prevalence of UI was 50.1% among people with dementia. The 5-year incident UI rate was 30.2 per 100 person-years for the dementia cohort and 24.5 per 100 person-years for the non-dementia cohort. Parkinson's disease posed the greatest risk of UI in both cohorts [dementia cohort odds ratio (OR), 3.0; 95% CI, 2.1–4.2; non-dementia cohort OR, 1.7; 95% CI, 1.4–2.0]. Controlling for risk factors, the hazard ratio for UI was 1.4 for people with dementia.</div></div><div><h3>Conclusions and Implications</h3><div>UI affects a significant proportion of people with dementia in Aotearoa New Zealand. Health professionals should directly ask about UI and consider living arrangements and comorbidities for people with dementia. Data-driven insights from interRAI-HC can guide resource allocation and service planning.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105285"},"PeriodicalIF":4.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349052","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":"The Diagnostic Accuracy and Cutoff Value of Phase Angle for Screening Sarcopenia: A Systematic Review and Meta-Analysis","authors":"Jian Zhang MM ,&nbsp;Ning Wang MD ,&nbsp;Jiatian Li PhD, MD ,&nbsp;Yilun Wang PhD, MD ,&nbsp;Yongbing Xiao PhD, MD ,&nbsp;Tingting Sha PhD","doi":"10.1016/j.jamda.2024.105283","DOIUrl":"10.1016/j.jamda.2024.105283","url":null,"abstract":"<div><h3>Objectives</h3><div>Phase angle (PhA) declines with age and is a reliable marker for muscle function, making it a potential screening indicator for sarcopenia. However, studies examined the reliability and validity of PhA for detecting sarcopenia, yielding inconsistent results. This meta-analysis aimed to evaluate the accuracy and cutoff value of PhA for screening sarcopenia and examine the potential confounding factors.</div></div><div><h3>Design</h3><div>This is a meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>PubMed, Embase, and Cochrane Library were searched up to September 18, 2023. Eighteen studies (6184 participants) were included reporting the diagnostic accuracy of PhA for screening sarcopenia.</div></div><div><h3>Methods</h3><div>Pooled accuracy [ie, the computed area under the curve value (AUC)] and cutoff value interval for screening sarcopenia were estimated using a random-effects model. Meta-regression analyses were conducted to identify sources of heterogeneity.</div></div><div><h3>Results</h3><div>The AUC value was 0.81. Pooled sensitivity and specificity were 80% and 70%. The calculated 95% CI of the cutoff value of PhA for screening sarcopenia falls between 4.54° and 5.25°. The results of meta-regression analyses showed that ethnicity, body mass index (BMI), health status, and diagnostic criteria were the main factors affecting the diagnostic accuracy for screening sarcopenia (with all <em>P</em> values &lt; 0.01).</div></div><div><h3>Conclusion and Implications</h3><div>PhA may serve as a robust screening tool for sarcopenia, and the recommended cutoff interval falls between 4.54° and 5.25°. Ethnicity, BMI, health status, and diagnostic criteria can affect PhA's efficacy in sarcopenia screening.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105283"},"PeriodicalIF":4.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349057","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":"Digital Technology Use in US Community-Dwelling Seniors With and Without Homebound Status","authors":"Wenting Peng MMedsc ,&nbsp;Gangjiao Zhu MSc ,&nbsp;Zengyu Chen MSN ,&nbsp;Tianxue Hou MSN ,&nbsp;Yuqian Luo MMedSc ,&nbsp;Lihua Huang MSN ,&nbsp;Jianfeng Qiao MSN ,&nbsp;Yamin Li PhD","doi":"10.1016/j.jamda.2024.105284","DOIUrl":"10.1016/j.jamda.2024.105284","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine (1) the prevalence of digital technology use, including information and communication technology devices, everyday technology use, and digital health technology use among community-dwelling older adults with or without homebound status and (2) the associations of digital technology use with homebound status.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>We used the 2022 National Health and Aging Trends Study (NHATS) data that included 5510 community-dwelling older adults.</div></div><div><h3>Methods</h3><div>Digital technology use was assessed using self-reported outcomes of the technological environment component of the NHATS, including information and communication technology devices, everyday technology use, and digital health technology use. Homebound status was measured with 4 mobility-related questions regarding the frequency, independence, and difficulties of leaving home. Survey-weighted, binomial logistic regression was used to examine the associations of 17 technological-related outcomes and homebound status.</div></div><div><h3>Results</h3><div>Overall, the prevalence of homebound older adults was 5.2% (95% CI, 4.4%–6.1%), representing an estimated 2,516,403 people. The prevalence of digital technology use outcomes varied according to homebound status. The prevalence of any technology used in homebound, semi-homebound, and non-homebound populations was 88.5%, 93.3%, and 98.5%, respectively. Compared with non-homebound older adults, semi-homebound older adults had lower odds of emailing (OR, 0.71; 95% CI, 0.53–0.94), using the internet for any other reason (OR, 0.70; 95% CI, 0.49–0.99), visiting medical providers (OR, 0.68; 95% CI, 0.48–0.95), and handling insurance (OR, 0.75; 95% CI, 0.56–0.99); homebound older adults had lower odds of using a phone (OR, 0.41; 95% CI, 0.28–0.59), using any everyday technology (OR, 0.58; 95% CI, 0.38–0.89), visiting medical providers (OR, 0.52; 95% CI, 0.35–0.76), and handling insurance (OR, 0.57; 95% CI, 0.38–0.86).</div></div><div><h3>Conclusions and Implications</h3><div>Non-homebound older adults are more likely to use digital technology than those who are semi-homebound or homebound. Public health care providers should prioritize efforts to enhance digital inclusion to ensure that all older adults can benefit from the advantages of digital technology.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105284"},"PeriodicalIF":4.2,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349037","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":"Short-Term Immunogenicity of Licensed Subunit RSV Vaccines in Residents of Long-Term Care Facilities (LTCF) Compared to Community-Dwelling Older Adults","authors":"Ann R. Falsey MD ,&nbsp;Angela R. Branche MD ,&nbsp;Michael Peasley BS ,&nbsp;Mary Cole RN ,&nbsp;Kim K. Petrone MD ,&nbsp;Spencer Obrecht RN ,&nbsp;Kari Steinmetz BS ,&nbsp;Tanya Smith BS ,&nbsp;Alexis Owen BS ,&nbsp;Christopher S. Anderson PhD ,&nbsp;Clyde Overby PhD ,&nbsp;Derick R. Peterson PhD ,&nbsp;Edward E. Walsh MD","doi":"10.1016/j.jamda.2024.105281","DOIUrl":"10.1016/j.jamda.2024.105281","url":null,"abstract":"<div><h3>Objectives</h3><div>Phase 3 licensing trials for the recently approved respiratory syncytial virus (RSV) vaccines did not include many residents of long-term care facilities (LTCF). Our primary objective was to assess humoral immune responses in LTCF residents, aged 60 and older, to the RSV vaccines, and demonstrate noninferiority to antibody responses in community-dwelling (CD) adults who were representative of the phase 3 trial participants in whom the vaccines were highly efficacious.</div></div><div><h3>Design</h3><div>Prospective non-randomized intervention trial of RSV vaccines in LTCF residents.</div></div><div><h3>Setting and Participants</h3><div>Research clinic and 2 LTCFs. Adults aged ≥60 years old, free of immunosuppression and planning to receive an RSV vaccine were eligible.</div></div><div><h3>Methods</h3><div>LTCF and CD participants received either the GSK or Pfizer RSV vaccine in equal numbers. Blood was collected before and 30 days after vaccination. Total immunoglobulin (Ig)G to the prefusion F protein of RSV group A (F_A) and B (F_B), and neutralizing activity were measured, and geometric mean titer (GMT) and geometric mean fold rise (GMFR) calculated. Intercurrent respiratory illnesses were tracked.</div></div><div><h3>Results</h3><div>A total of 76 LTCF residents and 76 CD adults were enrolled. Day 30 blood was unavailable from 3 residents and 3 had RSV infection and vaccination was deferred, leaving data for 76 CD and 70 LTCF adults for analysis. Serum IgG GMFR prefusion F_A (9.9 vs 12.5, <em>P</em> = .14), prefusion F_B (8.7 vs 11.0, <em>P</em> = .17) were not statistically different in CD and LTCF cohorts, respectively, and also equivalent for GMFR in viral neutralization titers (12.8 vs. 15.5, <em>P</em> = .32). As measured by GMT or GMFR, RSV vaccine responses of LTCF residents met noninferiority criteria compared with the CD cohort.</div></div><div><h3>Conclusions and Implications</h3><div>This small immunobridging study demonstrates robust antibody responses to RSV vaccines in LTCF residents providing support for their use in this high-risk population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105281"},"PeriodicalIF":4.2,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349055","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}