Journal of the American Medical Directors Association最新文献

{"title":"Adherence to Guideline Recommendations on Psychotropic Drug Use for Challenging Behavior in Dementia","authors":"Joury van der Griend MD ,&nbsp;Fenne Wouters PhD ,&nbsp;Gary Y.C. Yeung MD ,&nbsp;Ineke J. Gerridzen MD, PhD ,&nbsp;Karlijn J. Joling PhD ,&nbsp;Sytse U. Zuidema MD, PhD ,&nbsp;Martin Smalbrugge MD, PhD ,&nbsp;Eefje M. Sizoo MD, PhD","doi":"10.1016/j.jamda.2024.105474","DOIUrl":"10.1016/j.jamda.2024.105474","url":null,"abstract":"<div><h3>Objective</h3><div>Psychotropic drugs are frequently prescribed for challenging behavior in residents with dementia in nursing homes. Recommendations on psychotropic drug use for challenging behavior are described in the Dutch multidisciplinary guideline “Problem behavior in dementia.” This study aimed to gain insight into the adherence to guideline recommendations on drug type and timing of evaluations of different types of psychotropic drugs for challenging behavior in a national sentinel network of Dutch nursing homes.</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting and Participants</h3><div>Data on psychotropic drug use of residents in a sentinel network of 22 nursing homes across the Netherlands were collected during a 3-month measurement period in 2021.</div></div><div><h3>Methods</h3><div>Physicians completed registration forms integrated into the electronic health record after reporting on psychotropic drug use in progress notes. Prescribed drug type(s), type of drug intervention (start/stop/change in dosage/evaluation), and drug indications were recorded. Adherence to guideline recommendations on drug type was achieved if prescribed psychotropic drugs were recommended for the specified indication. Adherence to guideline recommendations on timing of evaluations was achieved if evaluations were reported within 7 days after starting.</div></div><div><h3>Results</h3><div>A total of 1279 forms on psychotropic drug use for specified challenging behaviors in 599 residents were collected. Recommended psychotropic drugs were used in 57% of all forms. The highest rate of recommended psychotropic drugs was for psychotic behavior (80%), followed by agitation (48%). Adherence was lowest for nighttime restlessness (22%). Of all newly started prescriptions, 17% were evaluated within the recommended 7 days after starting.</div></div><div><h3>Conclusions and Implications</h3><div>Adherence to guideline recommendations on drug type was present in just over half of the cases. Frequently, evaluations were not reported or were performed after the recommended time frame. Further research is needed to determine the reasons for non-recommended psychotropic drug use, low evaluation reporting rates, and factors that influence adherence. The use of a sentinel network may increase awareness and adherence.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105474"},"PeriodicalIF":4.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059454","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":"A Comparison of Measures for Identifying Possible Dementia in Veterans Affairs Nursing Home Residents","authors":"Joshua D. Niznik PharmD, PhD ,&nbsp;Florentia E. Sileanu MS ,&nbsp;Xinhua Zhao PhD ,&nbsp;Kelvin Tran PharmD, MPS ,&nbsp;Laura C. Hanson MD, MPH ,&nbsp;Alan Kinlaw PhD ,&nbsp;Thomas R. Radomski MD, MS ,&nbsp;Alexa Ehlert MS ,&nbsp;Sydney Springer PharmD, MS ,&nbsp;Binxin Cao PharmD, MPH ,&nbsp;Loren J. Schleiden MS ,&nbsp;Carolyn T. Thorpe PhD, MPH","doi":"10.1016/j.jamda.2024.105481","DOIUrl":"10.1016/j.jamda.2024.105481","url":null,"abstract":"<div><h3>Objectives</h3><div>Identifying people with possible dementia in health care systems is important to study outcomes and target improvements in care. This study sought to compare the performance of diagnostic codes and Minimum Data Set (MDS)-based measures for identifying dementia and cognitive impairment in older veteran nursing home residents.</div></div><div><h3>Design</h3><div>Retrospective, cross-sectional analysis.</div></div><div><h3>Setting and Participants</h3><div>We used real-world health care data from the Veterans Affairs (VA) Residential History File, VA Corporate Data Warehouse (CDW), Medicare claims, and the MDS to assemble a cohort of VA Community Living Center (CLC) admissions over 2015 to 2021 for veterans aged ≥ 65 with dual VA and Medicare enrollment (n = 54,234).</div></div><div><h3>Methods</h3><div>We defined 3 measures of possible dementia: (1) claims/CDW diagnoses using Chronic Conditions Warehouse (CCW) algorithms for Alzheimer’s disease or non-Alzheimer’s dementia; (2) MDS active diagnosis items for Alzheimer’s disease and non-Alzheimer’s dementia; and (3) MDS Cognitive Function Scale (CFS) assessment indicating at least mild cognitive impairment. We calculated proportions identified with each definition, and sensitivity, specificity, and positive predictive value of claims/CDW diagnoses and MDS indicators for dementia for identifying CFS impairment.</div></div><div><h3>Results</h3><div>Among VA CLC residents, 61.4% met at least 1 criterion for possible dementia (38.6% claims/CDW, 23.3% MDS active diagnosis, 50.8% CFS). Diagnoses from claims/CDW had 56.5% sensitivity and 80.0% specificity for identifying veterans with CFS cognitive impairment. Active diagnoses from the MDS exhibited poorer sensitivity (38.1%), but higher specificity (92.0%) identifying veterans with cognitive impairment on the CFS.</div></div><div><h3>Conclusions and Implications</h3><div>Consistent with what has been reported in Medicare nursing home residents, we observed only partial overlap between indicators of possible dementia across diagnosis codes and other indicators vs cognitive assessments in MDS. Our findings support the utility of these measures for identifying individuals with possible dementia across different systems, but further work is needed to understand implications when using diagnosis codes or cognitive assessments.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105481"},"PeriodicalIF":4.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074902","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":"Effects of Visitation Restriction on Antipsychotic Drug Use among Nursing Home Residents with ADRD during the COVID-19 Pandemic","authors":"Tingting Zhang MD, PhD ,&nbsp;Christopher M. Santostefano MPH, RN ,&nbsp;Daniel Harris MPH, PhD ,&nbsp;Antoinette B. Coe PharmD, PhD ,&nbsp;Andrew R. Zullo PharmD, PhD ,&nbsp;Lauren B. Gerlach DO, MS ,&nbsp;Richa Joshi MS ,&nbsp;Julie P.W. Bynum MD, MPH ,&nbsp;Theresa I. Shireman PhD","doi":"10.1016/j.jamda.2024.105480","DOIUrl":"10.1016/j.jamda.2024.105480","url":null,"abstract":"<div><h3>Objectives</h3><div>To estimate the immediate and long-term effects of a visitor restriction policy on antipsychotic use in nursing home (NH) residents with Alzheimer's disease and related dementias (ADRD) during COVID-19.</div></div><div><h3>Design</h3><div>A repeated cross-sectional study time series analysis was conducted using NH electronic health records (EHRs) from January 1, 2020, to December 31, 2021.</div></div><div><h3>Setting and Participants</h3><div>A large, multistate sample of NH residents living with ADRD.</div></div><div><h3>Methods</h3><div>We calculated weekly changes in facility-level prevalence of antipsychotic use using interrupted time series (ITS) to compare level and slope changes in antipsychotic use before, during, and after NH visitation restrictions. Generalized linear models with generalized estimating equations, logit link, binomial distribution, and AR-1 correlation structure were used for all ITS analyses. Final models were stratified by long- and short-stay residents and adjusted for NH-level covariates including resident demographics, clinical diagnoses, and nurse staffing.</div></div><div><h3>Results</h3><div>We observed more than 8500 long-stay and 2700 short-stay NH residents with ADRD. Among long-stay residents, the weekly prevalence of antipsychotic use increased from 18.9% as of January 7, 2020, to 24.9% by December 31, 2021. For short-stay residents, antipsychotic use increased from 21.1% to 26.6% over this same window. The ITS analysis showed no meaningful changes in the relative rate of change in antipsychotic use during and after visitor restrictions, relative to pre-policy trends.</div></div><div><h3>Conclusions and Implications</h3><div>The Centers for Medicare and Medicaid Services visitation restriction policy had no meaningful impact on antipsychotic use among NH residents with ADRD. However, antipsychotic use increased over time for both long- and short-stay residents and remained above pre-pandemic levels by the end of 2021. Our findings emphasize the potential for increased reliance on pharmacotherapy to manage resident symptoms during public health emergencies. Future infection control efforts should prioritize safe interpersonal care delivery and consider policies that improve vigilance of medication utilization changes among high-risk populations.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105480"},"PeriodicalIF":4.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074916","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 Stroll Safe Randomized Controlled Trial: Program Effects on Falls Self-Efficacy","authors":"Tracy Chippendale PhD, OTR/L ,&nbsp;Lijing Wei BS ,&nbsp;Alex Dahlen PhD","doi":"10.1016/j.jamda.2024.105478","DOIUrl":"10.1016/j.jamda.2024.105478","url":null,"abstract":"<div><h3>Objective</h3><div>Outdoor falls can negatively impact the health and functional abilities of community-dwelling older adults. Although there are existing evidence-based programs for falls prevention, none specifically target outdoor falls. To fill this gap in research and practice, the Stroll Safe program was developed. Prior studies have examined outcomes for Stroll Safe related to knowledge of outdoor fall risks and safe strategy use. The purpose of this study was to examine outcomes related to outdoor falls self-efficacy.</div></div><div><h3>Design</h3><div>In this cluster randomized controlled trial, we examined the effects of the Stroll Safe program on outdoor falls self-efficacy as per scores on the Outdoor Falls Self-Efficacy Questionnaire (OFSQ).</div></div><div><h3>Setting and Participants</h3><div>The study was conducted in 8 naturally occurring retirement communities. Participants (N = 93) were community-dwelling older adults with a history of outdoor falls and/or who were fearful of falling outside.</div></div><div><h3>Methods</h3><div>Linear mixed-effects models were used for the analyses.</div></div><div><h3>Results</h3><div>The intervention group had a significantly higher OFSQ score post-intervention (<em>P</em> &lt; .001), which persisted at the 6-week follow-up (<em>P</em> &lt; .001). Four of the 5 items in the OFSQ showed the same behavior.</div></div><div><h3>Conclusions and Implications</h3><div>Results reveal that the Stroll Safe program is effective in increasing outdoor falls self-efficacy building on previously established program benefits.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105478"},"PeriodicalIF":4.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066531","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":"Antipsychotic Use in Older Adults with Dementia: Community and Nursing Facility Trends in Texas, 2015-2020","authors":"Youngran Kim PhD ,&nbsp;Trudy M. Krause DrPH ,&nbsp;Rafael Samper-Ternent MD, PhD ,&nbsp;Antonio L. Teixeira MD, PhD","doi":"10.1016/j.jamda.2024.105463","DOIUrl":"10.1016/j.jamda.2024.105463","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess recent trends in antipsychotic use among older adults with Alzheimer's disease and related dementias (ADRDs) according to their residential status and determine the factors associated with the use of antipsychotics.</div></div><div><h3>Design</h3><div>Population-based, cross-sectional study using Texas Medicare Fee-for-Service data.</div></div><div><h3>Setting and Participants</h3><div>Individuals aged ≥ 65 years with ADRDs who had at least 3 months of Medicare Part A and B, and Part D for prescription drug coverage, in any year between 2015 and 2020.</div></div><div><h3>Methods</h3><div>Temporal trends for antipsychotic use were reported by calendar year, and the associations between antipsychotic use and potential predictors were assessed overall and by residential status.</div></div><div><h3>Results</h3><div>Among an annual average of 161,848 older adults with ADRDs (median age, 82 years; 64.8% female), overall antipsychotic use decreased by 25.8%, from 14.5% in 2015 to 10.8% in 2020. The decline was primarily observed among those with any nursing facility (NF) residence, where use dropped from 22.1% to 12.4%, whereas community-dwelling individuals maintained a steady rate of approximately 10%. Factors associated with increased antipsychotic use included male sex, Black and Hispanic individuals, dual eligibility, Alzheimer's disease (non-Alzheimer's disease), emergency department visits, hospitalization, depression, and anxiety disorders. However, these associations varied across residential statuses. Older age was more strongly associated with decreased antipsychotic use among those with NF residence than those in the community. Compared with white individuals, Black individuals were more likely to receive antipsychotics in the community, whereas Hispanic and Asian individuals were more likely to receive antipsychotics among those with NF residence.</div></div><div><h3>Conclusions and Implications</h3><div>Although antipsychotic use substantially decreased among those with NF residence, it remained steady among community-dwelling individuals. Given that two-thirds of individuals with dementia reside in the community, more attention is needed to understand antipsychotic use in this population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105463"},"PeriodicalIF":4.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007482","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 Self-Perceived Fatigue, Muscle Fatigue, and Sleep Disorders with Cognitive Function in Older Adults: A Cross-Sectional Study","authors":"Ali Kapan PhD ,&nbsp;Milos Ristic MSc ,&nbsp;Richard Felsinger MD ,&nbsp;Thomas Waldhoer PhD, Professor","doi":"10.1016/j.jamda.2024.105477","DOIUrl":"10.1016/j.jamda.2024.105477","url":null,"abstract":"<div><h3>Objectives</h3><div>Fatigue and sleep disorders are common geriatric conditions and are associated with an increased risk of cognitive decline. This study aimed to examine the relationships among self-perceived fatigue, objective muscle fatigue, sleep apnea risk, insomnia, and cognitive function, focusing on their associations with mild cognitive impairment (MCI).</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>The study involved 217 older adults (median age: 80 years, 65.6% women) from 2 residential care facilities in Vienna, Austria.</div></div><div><h3>Methods</h3><div>Cognitive function was assessed with the Mini-Mental State Examination. Sleep quality and disturbances were evaluated using the Athens Insomnia Scale (AIS) and STOP-BANG questionnaire. Subjective fatigue was measured with the Multidimensional Fatigue Inventory, and objective muscle fatigue through 2 rounds of 10 maximal handgrip strength tests, separated by a 1-hour rest. Multivariable regression models adjusted for age, sex, comorbidities, sleep medication, and total number of medications were used to analyze associations among fatigue, sleep disturbance, and MCI.</div></div><div><h3>Results</h3><div>Participants with MCI (n = 72) had significantly lower handgrip strength (median Fmax1: 18.75 kg vs 23.44 kg), higher muscle fatigue ratios (median: 1.40 vs 1.19), and poorer recovery ratios (median: 0.85 vs 1.01) compared with those without MCI (n = 145). Sleep disorders and fatigue measures were more common in those with MCI, with 80.6% reporting insomnia (AIS ≥6) compared with 21.4% in the cognitively intact group. Logistic regression showed that muscle fatigue combined with sleep apnea risk was associated with the highest odds of cognitive impairment [odds ratio (OR), 6.12; 95% CI, 2.77−13.51; adjusted OR, 3.02; 95% CI, 1.15−7.92]. Recovery capacity showed a positive association with cognitive function (β = 0.150, <em>P</em> &lt; .05).</div></div><div><h3>Conclusions and Implications</h3><div>Sleep apnea, muscle fatigue, and reduced recovery capacity are significantly associated with cognitive decline in older adults. Assessing these factors may help in identifying individuals at risk of cognitive impairment.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105477"},"PeriodicalIF":4.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066525","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":"Machine Learning Prediction for Postdischarge Falls in Older Adults: A Multicenter Prospective Study","authors":"Yuko Takeshita RN, MSN ,&nbsp;Mai Onishi RN, MSN ,&nbsp;Hirotada Masuda MD, PhD ,&nbsp;Mizuki Katsuhisa RN, MSN ,&nbsp;Kasumi Ikuta RN, MSN ,&nbsp;Yuichiro Saizen RN, MSN ,&nbsp;Misaki Fujii RN ,&nbsp;Misaki Kasamatsu RN, MSN ,&nbsp;Nobuyuki Inaizumi RN ,&nbsp;Yuzuki Maeizumi RN ,&nbsp;Yoshinobu Kishino MD ,&nbsp;Tsuneo Nakajima MD, PhD ,&nbsp;Eriko Koujiya RN, PhD ,&nbsp;Miyae Yamakawa RN, PhD ,&nbsp;Yoichi Takami MD, PhD ,&nbsp;Koichi Yamamoto MD, PhD ,&nbsp;Yumi Umeda-Kameyama MD, PhD ,&nbsp;Shosuke Satake MD, PhD ,&nbsp;Hiroyuki Umegaki MD, PhD ,&nbsp;Yasushi Takeya MD, PhD","doi":"10.1016/j.jamda.2024.105414","DOIUrl":"10.1016/j.jamda.2024.105414","url":null,"abstract":"<div><h3>Objectives</h3><div>The study aimed to develop a machine learning (ML) model to predict early postdischarge falls in older adults using data that are easy to collect in acute care hospitals. This may reduce the burden imposed by complex measures on patients and health care staff.</div></div><div><h3>Design</h3><div>This prospective multicenter study included patients admitted to and discharged from geriatric wards at 3 university hospitals and 1 national medical center in Japan between October 2019 and July 2023.</div></div><div><h3>Setting and Participants</h3><div>The participants were individuals aged ≥65 years. Of the 1307 individuals enrolled during the study period, 684 were excluded, leaving 706 for inclusion in the analysis.</div></div><div><h3>Methods</h3><div>We extracted 19 variables from admission and discharge data, including physical, mental, psychological, and social aspects and in-hospital events, to assess the main outcome measure: falls occurring within 3 months postdischarge. We developed a prediction model using 4 major classifiers, Extra Trees, Bernoulli Naive Bayes, AdaBoost, and Random Forest, which were evaluated using a 5-fold cross-validation. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance.</div></div><div><h3>Results</h3><div>Among the 706 patients, 114 (16.1%) reported a fall within 3 months postdischarge. The Extra Trees classifier demonstrated the best predictive performance, with an AUC of 0.73 on the test data. Important features included the Lawton Instrumental Activities of Daily Living scale, Clinical Frailty Scale (≥4 points), presence of urinary incontinence, 15-item Geriatric Depression Scale (≥5 points), and preadmission residence, all assessed at admission.</div></div><div><h3>Conclusions and Implications</h3><div>To our knowledge, this is the first study to develop an ML model for predicting early postdischarge falls among older patients in acute care hospitals. The findings suggest that this model could assist in developing fall-prevention strategies to ensure seamless transition of care from hospitals to communities.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105414"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864686","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)00032-5","DOIUrl":"10.1016/S1525-8610(25)00032-5","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 2","pages":"Article 105515"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094990","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":"Interventions to Reduce Loneliness among Community-dwelling Older Adults: A Network Meta-analysis and Systematic Review","authors":"Yinghui Sun MD ,&nbsp;Haiyou Huang BM ,&nbsp;Guangyun Cai MD ,&nbsp;Jing Gu PhD ,&nbsp;Gordon K.L. Leung MD ,&nbsp;Yanxiao Gao PhD ,&nbsp;Samuel Y.S. Wong PhD ,&nbsp;Eliza L.Y. Wong PhD ,&nbsp;Winnie W.S. Mak PhD ,&nbsp;Timothy Kwok PhD ,&nbsp;Phoenix K.H. Mo PhD","doi":"10.1016/j.jamda.2024.105441","DOIUrl":"10.1016/j.jamda.2024.105441","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the effectiveness of interventions in reducing loneliness among community-dwelling older adults.</div></div><div><h3>Design</h3><div>A network meta-analysis (NMA) and systematic review.</div></div><div><h3>Setting and Participants</h3><div>Interventional studies were included if they contained original quantitative data on interventions to reduce loneliness among community-dwelling older adults. Qualitative studies were included if they contained views on loneliness coping strategies or intervention evaluation.</div></div><div><h3>Methods</h3><div>Six English databases and 3 Chinese databases were searched for studies published before August 2023. We extracted mean and standard deviation for the NMA to examine the overall effectiveness and efficacy of different interventions on loneliness. Thematic analysis was used to derive perspectives on coping strategies to mitigate loneliness.</div></div><div><h3>Results</h3><div>Forty-six quantitative studies with 6049 participants and 40 qualitative studies with 1095 participants were included in the analysis. The pooled effect size was large and significant [standardized mean difference (SMD), −0.95; 95% CI, −1.32 to −0.58; <em>P</em> &lt; .001], indicating a strong effect of interventions in reducing loneliness. Subgroup analyses revealed significant differences in effect sizes by study region and health risk. Results of the NMA suggested interventions seem to be most effective when having psychosocial interventions as the content, a combination of individual and group as the delivery mode, and a mixture of face-to-face and online methods as the contact mode. Findings of the qualitative synthesis revealed 2 main dimensions of activities for reducing loneliness, including delivery modes (individual or group or combination) and settings (indoor or outdoor or combination). Strategies for coping with loneliness at the social, cognitive, and behavioral levels were also identified.</div></div><div><h3>Conclusions and Implications</h3><div>The present study identified the most effective components of loneliness interventions in reducing loneliness among older adults. Findings offer important insights for practice and policy-making on potential strategies that can be used to reduce loneliness among community-dwelling older adults.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105441"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971543","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":"Shared Decision-Making on Tobacco Smoking by Older Adults Living in Residential Care Facilities: Care Professionals’ Perspectives","authors":"Lisette de Graaf MSc ,&nbsp;Tineke Roelofs PhD ,&nbsp;Meriam Janssen PhD ,&nbsp;Sascha Bolt PhD ,&nbsp;Katrien Luijkx PhD","doi":"10.1016/j.jamda.2024.105466","DOIUrl":"10.1016/j.jamda.2024.105466","url":null,"abstract":"<div><h3>Objectives</h3><div>Older adults with physical or cognitive disabilities may need to move to residential care facilities (RCFs). Some older adults smoke tobacco and become dependent on their care professionals to continue smoking. Care professionals need to balance an individual resident’s quality of life and well-being with the health and safety of all residents and staff. Shared decision-making (SDM) could support care professionals in these dilemmas. This study assesses multiple factors that could affect care professionals’ behavior and degree of SDM regarding residents’ tobacco use.</div></div><div><h3>Design</h3><div>We conducted quantitative cross-sectional research.</div></div><div><h3>Setting and Participants</h3><div>We included care professionals working in psychogeriatric and somatic units in Dutch RCFs.</div></div><div><h3>Methods</h3><div>Data were collected with an online or hard copy survey and analyzed with <em>t</em>-tests and regression analyses using SPSS.</div></div><div><h3>Results</h3><div>Care professionals’ positive attitudes toward residents’ tobacco use are significantly associated with a lower degree of SDM concerning this use and enabling residents to smoke more often. The degree of SDM regarding residents’ tobacco use is significantly positively associated with limiting residents’ tobacco use and the degree of person-centered care (PCC). Care professionals working in somatic units report a significantly higher degree of SDM regarding residents’ tobacco use compared with those working in psychogeriatric units.</div></div><div><h3>Conclusions and Implications</h3><div>Residents’ wish to smoke tobacco is a complex matter within RCFs. Care professionals’ attitudes cause inconsistencies in their behavior and the degree of SDM. Moreover, care professionals tend to use SDM more often when they need to limit residents’ use and cannot fulfill residents’ unhealthy habits, such as smoking tobacco. SDM could support care professionals to deal with dilemmas regarding residents’ tobacco use by including residents in decisions, regardless of the outcome. However, multiple factors affect care professionals’ behavior and the degree of SDM. Especially, their attitudes need to be addressed. SDM is further complicated by national acts and organizational policies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105466"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007530","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}