Journal of the American Medical Directors Association最新文献

{"title":"Outcomes of Discontinuing Long-Term Opioid Therapy among Older Cancer Survivors in Long-Term Care Settings","authors":"Yu-Jung Jenny Wei PhD ,&nbsp;Almut G. Winterstein PhD ,&nbsp;Siegfried Schmidt MD, PhD ,&nbsp;Roger B. Fillingim PhD ,&nbsp;Stephan Schmidt PhD ,&nbsp;Michael J. Daniels ScD ,&nbsp;Steven T. DeKosky MD ,&nbsp;Henry Young MD ,&nbsp;Ting-Yuan David Cheng PhD","doi":"10.1016/j.jamda.2025.105522","DOIUrl":"10.1016/j.jamda.2025.105522","url":null,"abstract":"<div><h3>Objectives</h3><div>Clinical decisions to continue or discontinue long-term opioid therapy (LTOT; ≥3 months) for older cancer survivors remain challenging due to limited evidence on the risks and benefits of this treatment practice. This study aims to examine the associations of discontinuing LTOT with clinical and opioid-related adverse event (ORAE) outcomes among older cancer survivors residing in long-term care (LTC) settings.</div></div><div><h3>Designs</h3><div>This retrospective cohort study analyzed data from the 100% Medicare nursing home sample from 2010 to 2021.</div></div><div><h3>Setting and Participants</h3><div>LTC residents aged ≥65 years who were survivors of cancer for at least 1 year and received LTOT for chronic pain.</div></div><div><h3>Methods</h3><div>Discontinuation of LTOT was defined as no prescription opioid refills for at least 90 days. Clinical outcomes included worsening pain, physical function, and depression; ORAE outcomes included counts of pain-related hospitalizations, pain-related emergency department visits, opioid use disorder, and opioid overdose. We used modified Poisson models for clinical outcomes and Poisson models for ORAE outcomes, adjusting baseline covariates via inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Of 21,861 episodes of cancer survivors with LTOT, 18,984 survivors (86.8%) continued LTOT, whereas 2877 survivors (13.2%) discontinued LTOT. The discontinuers vs continuers had lower adjusted risk of worsening pain (relative risk 0.65, 95% CI 0.59–0.74, <em>P</em> &lt; .001) and lower adjusted rates of opioid use disorder (rate ratio 0.76, 95% CI 0.64–0.90, <em>P</em> &lt; .001) and opioid overdose (rate ratio 0.33, 95% CI 0.21–0.52, <em>P</em> &lt; .001) at the 1-year follow-up, with no difference in physical function and depressive symptoms or rates of pain-related hospitalizations and emergency department visits.</div></div><div><h3>Conclusions and Implications</h3><div>Discontinuing vs continuing LTOT was associated with lower risk of worsening pain, opioid use disorder, and opioid overdose, with nondifferential risks of the other studied outcomes. Discontinuing vs continuing LTOT may confer benefits that outweigh risks among older LTC cancer survivors.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105522"},"PeriodicalIF":4.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523766","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":"Trends in the Use of Medicare Home Health Care among Congregate Living Residents","authors":"Jun Li PhD ,&nbsp;Bo Zheng MPA ,&nbsp;Brian McGarry PhD","doi":"10.1016/j.jamda.2025.105498","DOIUrl":"10.1016/j.jamda.2025.105498","url":null,"abstract":"<div><h3>Objective</h3><div>To examine trends in home health care (HHC) use in congregate living and compare characteristics of HHC use between Medicare patients in congregate living and those in other home settings.</div></div><div><h3>Design</h3><div>Retrospective cohort study describing HHC use, in and outside of congregate living, using national Medicare claims, assessment, and administrative data (2014-2019). We compared HHC use by setting, on HHC quality, planned visit quantity, referral source (post-acute or community-initiated), and recertifications. We additionally examined whether HHC patterns across settings differed by patient dual eligibility and race-ethnicity.</div></div><div><h3>Setting and Participants</h3><div>Traditional Medicare (TM) and Medicare Advantage (MA) HHC patients aged 67 and older in congregate living or elsewhere.</div></div><div><h3>Methods</h3><div>Multivariable regressions.</div></div><div><h3>Results</h3><div>15.9% of HHC episodes in 2018-2019 were in congregate living, which increased 20.5% between 2014 and 2019. TM patients in congregate living were 4.4% (2.3 ppt, 95% CI: 1.7, 2.9) more likely to use high-quality agencies, had 8.7% (0.7 visits, 95% CI: 0.7, 0.8) more planned visits, were 27.6% (14.9 ppt, 95% CI: 14.7, 15.1) more likely to have community-initiated referrals, and 9.9% (3.2 ppt, 95% CI: 2.9, 3.5) more likely to be recertified compared with TM patients in other settings; differences were similar between settings among MA enrollees. Compared with their counterparts, dually eligible and racial-ethnic minoritized populations in congregate living were 2.6% (−1.5 ppt, 95% CI: −2.2, −0.8%) and 1.6% less likely (−0.9 ppt, 95% CI: −1.6, −0.3%) to use high-quality agencies, respectively, and dually eligible patients in congregate living had 6% fewer planned visits (−0.64 visits, 95% CI: −0.72, −55); these differences persisted across settings.</div></div><div><h3>Conclusion and Implications</h3><div>Congregate living may have facilitated access to higher quality and quantity of HHC, but inequitably. Further research is needed to determine the value of high-frequency community-initiated HHC referrals in congregate living.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105498"},"PeriodicalIF":4.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433383","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":"Association between Fear of Falling and Visuospatial and Executive Functions in Older Adults with Subjective Cognitive Decline: A Cross-Sectional Study","authors":"Seok-Yoon Son MD ,&nbsp;Chae Yoon Kim HBSc ,&nbsp;Baek-Yong Choi MD ,&nbsp;Seung-Woo Ryoo MD ,&nbsp;Kun-Hee Oh MD ,&nbsp;Jin-Young Min PhD ,&nbsp;Kyoung-Bok Min MD, PhD","doi":"10.1016/j.jamda.2025.105500","DOIUrl":"10.1016/j.jamda.2025.105500","url":null,"abstract":"<div><h3>Objectives</h3><div>Fear of falling (FOF) is a common health concern among older adults. Although cognitive impairment (CI) is a risk factor for FOF, the specific cognitive domains associated with FOF remain unclear. This study examined the association between FOF and domain-specific cognitive functions in older adults. We also analyzed whether this association varied based on CI, recent fall experience, or engagement in physical activity.</div></div><div><h3>Design</h3><div>This was a cross-sectional study analyzing the relationship between FOF and cognitive performance across various domains, with stratifications by CI status, fall history, and physical activity levels.</div></div><div><h3>Setting and Participants</h3><div>The study included 591 older adults with mild CI who visited the Veterans Health Service Medical Center in Korea.</div></div><div><h3>Methods</h3><div>Cognitive performance in attention, language, visuospatial, memory, and frontal or executive domains was assessed using the Seoul Neuropsychological Screening Battery-Core. FOF was measured using the Activities-specific Balance Confidence Scale. Covariates, including demographics, physical health, and activity levels, were adjusted in the analyses.</div></div><div><h3>Results</h3><div>Higher FOF was significantly associated with lower performance in the visuospatial domain [Rey Complex Figure Test (β = 0.04, <em>P</em> = .002)] and the frontal or executive domain [Digit Symbol Coding (β = 0.05, <em>P</em> &lt; .001), Controlled Oral Word Association Test (β = 0.02, <em>P</em> = .041), Trail Making Test (β = 0.06, <em>P</em> &lt; .001), and Color Word Stroop Test (β = 0.04, <em>P</em> &lt; .001)] after adjusting for covariates. The observed association was particularly evident in older adults with CI or those not engaging in moderate physical activity. The association was consistent regardless of fall history in the past year.</div></div><div><h3>Conclusions and Implications</h3><div>High FOF was associated with poor visuospatial and frontal or executive functions. These findings underscore the link between FOF and cognitive function, suggesting that specific cognition in visuospatial and frontal or executive domains may contribute to FOF development.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105500"},"PeriodicalIF":4.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433344","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":"Do Medicare Accountable Care Organizations Impact Health Care Utilization among Long-Stay Nursing Home Residents?","authors":"Xiao (Joyce) Wang PhD ,&nbsp;Emmanuelle Belanger PhD ,&nbsp;Derek Lake PhD ,&nbsp;Christopher Santostefano MPH, RN ,&nbsp;Joan Teno MD, MS ,&nbsp;Susan L. Mitchell MD, MPH ,&nbsp;Pedro Gozalo PhD","doi":"10.1016/j.jamda.2025.105518","DOIUrl":"10.1016/j.jamda.2025.105518","url":null,"abstract":"<div><h3>Objectives</h3><div>Nursing home (NH) residents are high-cost, high-need Medicare beneficiaries. Accountable Care Organizations (ACOs) have the potential to improve quality of care and reduce potentially unnecessary health care utilization. This study aimed to assess the impact of Medicare Shared Savings Program (MSSP) ACOs on health care utilization among long-stay NH residents.</div></div><div><h3>Design</h3><div>“Intention-to-treat” and quasi-experimental design.</div></div><div><h3>Setting and Participants</h3><div>A national cohort of 158,259 fee-for-service Medicare beneficiaries who were long-stay NH residents in 2011 or 2018. In each year, residents were included in the sample the first time their Minimum Data Set (MDS) assessments (ie, index MDS) met the following inclusion criteria: (1) aged 66+; (2) dependence in 2 or more activities of daily living; (3) neither enrolled in hospice nor in coma; and (4) NH length of stay ≥90 days.</div></div><div><h3>Methods</h3><div>We followed residents’ health care utilization and Medicare expenditures for 1 year after their index MDS date. Outcomes included any health care utilization in different care settings (ie, inpatient, outpatient emergency room visit/observational stay, skilled nursing facility, hospice) and corresponding Medicare expenditures. We used difference-in-differences models to estimate the association between ACO attribution and health care utilization in 2018, using 2011 as the pre-ACO baseline. To determine ACO attribution among the 2011 cohort, we developed an algorithm to replicate the ACO attribution in 2018 and used it to identify residents who would have been attributed to 2018 ACOs back in 2011. To address the endogeneity issue between ACO attribution and utilization outcomes, we used an “intention-to-treat” design to determine ACO attribution.</div></div><div><h3>Results</h3><div>Adjusted difference-in-differences results showed a lack of significant associations between ACO attribution and health care utilization or Medicare expenditures among long-stay NH residents.</div></div><div><h3>Conclusions and Implications</h3><div>ACOs did not affect health care utilization of long-stay NH residents. Future payment reforms need to ensure that their benefits could reach these vulnerable older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105518"},"PeriodicalIF":4.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502127","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":"Successful Care Conferences: Nursing Home Staff, Persons with Dementia, and Caregiver Perspectives","authors":"Gail L. Towsley PhD,&nbsp;Linda S. Edelman PhD, RN,&nbsp;Roxanne Geurin MPH","doi":"10.1016/j.jamda.2025.105504","DOIUrl":"10.1016/j.jamda.2025.105504","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study was to identify best practices for nursing home (NH) virtual care conferences using Me &amp; My Wishes—videos that document care preferences of residents, including those living with Alzheimer's disease and related dementias. Videos are shared during care conferences with care partners and staff to ensure that the care provided aligns with the resident's wishes, especially as they approach the end of life.</div></div><div><h3>Design</h3><div>A qualitative descriptive design involving focus groups providing the perspective of 3 groups (people living with dementia, NH staff, and care partners) was used to determine what makes a successful care conference when the care conference is conducted virtually.</div></div><div><h3>Setting and Participants</h3><div>Convenience sampling was used to recruit focus group participants (ie, community advisors) from various geographic locations. Recruitment was facilitated through established relationships with community partner groups. Advisors included NH leaders, community-dwelling older adults, and care partners.</div></div><div><h3>Methods</h3><div>Six virtual focus group sessions were conducted from February to June 2023. A semistructured guide was used to identify key factors of successful virtual care conferences when using the Me &amp; My Wishes intervention. Sessions were recorded, transcribed, and analyzed using content analysis.</div></div><div><h3>Results</h3><div>Three domains for successful virtual care conferences were identified. They are resident-driven, engaging, and structured. They include interdisciplinary care team members most familiar with the resident, prioritize the needs and preferences of residents to ensure they are central to the discussion, and encourage active participation of residents and care partners. Finally, care conferences are led by trained facilitators, with the entire interdisciplinary care team receiving training on conducting and participating in care conferences, including providing technology support to maximize resident and care partner engagement.</div></div><div><h3>Conclusions and Implications</h3><div>Successful care conferences, whether in-person or virtual, require structured approaches that prioritize resident involvement and include people who know the resident best.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105504"},"PeriodicalIF":4.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441290","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":"Corrigendum to ‘Remote Vital Sign Monitoring in Admission Avoidance Hospital at Home: A Systematic Review’ [Journal of the American Medical Directors Association 25 (2024) 105080]","authors":"Rajan Patel MSc ,&nbsp;Tabitha D. Thornton-Swan BA ,&nbsp;Laura C. Armitage MBBCh ,&nbsp;Sarah Vollam PhD ,&nbsp;Lionel Tarassenko DPhil ,&nbsp;Daniel S. Lasserson MD ,&nbsp;Andrew J. Farmer MD","doi":"10.1016/j.jamda.2024.105453","DOIUrl":"10.1016/j.jamda.2024.105453","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105453"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837147","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":"PALTmed Events and Products","authors":"","doi":"10.1016/S1525-8610(25)00079-9","DOIUrl":"10.1016/S1525-8610(25)00079-9","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105562"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561362","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)00076-3","DOIUrl":"10.1016/S1525-8610(25)00076-3","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105559"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561366","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":"Directions & Connections","authors":"","doi":"10.1016/S1525-8610(25)00078-7","DOIUrl":"10.1016/S1525-8610(25)00078-7","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105561"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561655","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":"Pharmacists Improving Osteoporosis Management in Long-Term Care Using Fracture Risk Assessments: A Feasibility Study","authors":"Catherine D. Laird BPharm,&nbsp;Kylie A. Williams BPharm, PhD,&nbsp;Helen Benson BPharm, PhD","doi":"10.1016/j.jamda.2025.105494","DOIUrl":"10.1016/j.jamda.2025.105494","url":null,"abstract":"<div><h3>Objectives</h3><div>The primary outcome of this study is to test the feasibility of pharmacists completing Fracture Risk Scale (FRS) assessments using resident data routinely held by long-term care (LTC) facilities. Secondary outcomes are to ascertain the proportion of residents assessed as high fracture risk who currently receive osteoporosis medicines and explore whether under- or overuse of osteoporosis medicines is occurring based on residents' fracture risk.</div></div><div><h3>Design</h3><div>Feasibility study.</div></div><div><h3>Setting and Participants</h3><div>Four LTC facilities from southeast Queensland, Australia, with a total of 281 residents participated in the study during April and May 2024.</div></div><div><h3>Methods</h3><div>A pharmacist reviewed individual resident files for all residents of participating facilities. Necessary data were extracted from resident files to determine their fracture risk using the FRS manual calculation tool. Residents' use of osteoporosis medicines and nutritional supplements (vitamin D and calcium) was analyzed based on their calculated fracture risk.</div></div><div><h3>Results</h3><div>FRS assessments were completed for 275 residents (97.9%). There were 149 residents (54.2%) assessed as having a high fracture risk, of which 43 (28.9%) were prescribed an osteoporosis medicine. Conversely, 28 residents (22.2%) with a low fracture risk received an osteoporosis medicine. Underuse of vitamin D and calcium supplements was found for all residents, irrespective of fracture risk.</div></div><div><h3>Conclusions and Implications</h3><div>The feasibility of pharmacists completing FRS assessments was demonstrated. Incorporating the FRS into routine clinical practice provides a promising means to support pharmacists advising on osteoporosis prescribing decisions for LTC residents. Widespread underuse of vitamin D and calcium for all LTC residents and the underuse of osteoporosis medicines by residents with a high fracture risk were found. Future research is necessary to establish if incorporating the FRS into clinical practice can address this undertreatment and reduce fracture rates in LTC.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105494"},"PeriodicalIF":4.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433370","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}