Journal of the American Medical Directors Association最新文献

{"title":"Postural Sway Characteristics Distinguish Types of Dementia","authors":"Kosuke Fujita PhD ,&nbsp;Taiki Sugimoto PhD ,&nbsp;Hisashi Noma PhD ,&nbsp;Yujiro Kuroda PhD ,&nbsp;Nanae Matsumoto PhD ,&nbsp;Kazuaki Uchida PhD ,&nbsp;Yoko Yokoyama MS ,&nbsp;Yoshinobu Kishino MD ,&nbsp;Takashi Sakurai MD, PhD","doi":"10.1016/j.jamda.2025.105497","DOIUrl":"10.1016/j.jamda.2025.105497","url":null,"abstract":"<div><h3>Objectives</h3><div>The increasing number of patients with dementia necessitates the development of rapid and convenient tools to assist with dementia diagnosis. We previously demonstrated the difference in the postural control characteristics during static standing among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and vascular dementia (VaD). In this study, we evaluated the classification accuracy of the postural sway test to assess its capacity to distinguish between types of dementia.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting and Participants</h3><div>Memory clinic outpatients aged 65-85 years who were clinically diagnosed with AD, DLB, VaD, and cognitively normal (CN) outpatients.</div></div><div><h3>Methods</h3><div>Static upright standing measurements were conducted under open- and closed-eye conditions to calculate 40 parameters. After variable selection based on statistical significance, 3 dementia classification models (AD vs DLB, AD vs VaD, and DLB vs VaD) based on postural control parameters were created. Bias-corrected accuracy measures using bootstraps were used for assessing the classification performances.</div></div><div><h3>Results</h3><div>The data of 1734 participants (1158 with AD, 105 with DLB, 46 with VaD, and 425 with CN) were analyzed. The area under the curves of receiver operating characteristic curves for AD vs DLB, AD vs VaD, and DLB vs VaD were 0.647 (0.646-0.649), 0.763 (0.761-0.765), and 0.659 (0.656-0.662), respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Postural control characteristics differentiated between dementia types with reasonable to good accuracy, especially in the comparison between AD and VaD. Postural control testing may become a valuable assistive tool for dementia diagnosis in the future.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105497"},"PeriodicalIF":4.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433371","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":"Effectiveness of Telehealth Interventions on Cognitive Function and Quality of Life in Adults With Neurological Disorders: A Systematic Review and Meta-Analysis","authors":"Yule Hu MSc ,&nbsp;Yan Li PhD ,&nbsp;Jiaying Li MSc ,&nbsp;Justina Yat Wa Liu PhD ,&nbsp;Sylvia M. Gustin PhD ,&nbsp;Mengqi Li PhD ,&nbsp;Angela Yee Man Leung PhD","doi":"10.1016/j.jamda.2025.105491","DOIUrl":"10.1016/j.jamda.2025.105491","url":null,"abstract":"<div><h3>Objective</h3><div>Telehealth is an encouraging solution for the remote delivery of cognitive interventions. This review aimed to identify the characteristics and effectiveness of telehealth interventions on cognitive functions and related quality of life in adults with neurological disorders.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Settings and Participants</h3><div>Community and residential, adults with neurological disorders.</div></div><div><h3>Methods</h3><div>Six English and 2 Chinese databases were searched from inception to August 2024. Randomized controlled trials that evaluated telehealth interventions for cognitive function in adults with neurological disorders were eligible. The meta-analysis was conducted using R (Version 4.1.3). The Revised Cochrane risk of bias tool for randomized trials (RoB 2) tool was used for risk of bias assessment.</div></div><div><h3>Results</h3><div>Sixteen studies with 952 participants were included, 14 of which were eligible for the meta-analysis. Asynchronous telehealth via apps/websites with regular online supervision was the most commonly used format. The pooled results suggested that telehealth interventions could significantly improve global cognitive function [standardized mean difference (SMD) = 0.95; 95% confidence interval (CI): 0.06∼1.83; <em>P</em> = .035], memory (SMD, 0.79; 95% CI: 0.36∼1.23; <em>P</em> = .0004), and quality of life (SMD, 0.57; 95% CI, 0.14∼1.00; <em>P</em> = .01) compared with controls. However, there was no statistically significant effect on attention (SMD, 0.12; 95% CI, −0.11∼0.35, <em>P</em> = .31), executive function (SMD, 0.06; 95% CI, −0.30∼0.42, <em>P</em> = .73), or language (SMD, 0.44; 95% CI, −0.01∼0.89, <em>P</em> = .054).</div></div><div><h3>Conclusions and Implications</h3><div>Telehealth interventions are safe, feasible and acceptable for adults with neurological disorders, and could potentially reduce health care cost. They have beneficial effects on global cognitive function, memory, and quality of life. More exercise-based telehealth interventions with adequate statistical power and rigorous designs are needed to evaluate the long-term benefits and financial impact.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105491"},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425610","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":"Sex-Specific Body Composition Profile Determined by Pelvic Computed Tomography Associated with Mortality in Older Patients with Hip Fracture","authors":"Wenwei Zhu MD ,&nbsp;Qianyun Liu MD ,&nbsp;Zhimin Yan MD ,&nbsp;Wenming Zhou MD ,&nbsp;Pengfei Rong MD, PhD ,&nbsp;Zhichao Feng MD, PhD","doi":"10.1016/j.jamda.2025.105502","DOIUrl":"10.1016/j.jamda.2025.105502","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous research has demonstrated notable differences in body composition and mortality risk following hip fracture between sexes. This study aimed to investigate the sex-specific associations between body composition profile and mortality in older patients undergoing hip fracture surgery.</div></div><div><h3>Design</h3><div>Dual-center cohort study.</div></div><div><h3>Setting and Participants</h3><div>We included 488 older patients (aged ≥60 years) with hip fracture treated with surgery.</div></div><div><h3>Methods</h3><div>The cross-sectional area and attenuation of skeletal muscle, subcutaneous adipose tissue, and intermuscular adipose tissue at the the upper thigh level on preoperative pelvic computed tomography (CT) were measured. The relationship between body composition and mortality was determined using Cox proportional hazards analysis stratified by sex.</div></div><div><h3>Results</h3><div>The mean age of the cohort was 76.2 ± 8.7 years, and 312 (63.9%) were women. Within 1 year after surgery, 89 (18.2%) patients died. Female patients had greater subcutaneous adipose tissue area [SATA; median (interquartile range), 196.5 (160.1∼228.5) vs 147.1 (111.3∼181.1) cm²; <em>P</em> &lt; .001] and lower skeletal muscle area [SMA; 187.2 (167.3∼212.4) vs 255.5 (223.2∼286.1) cm²; <em>P</em> &lt; .001] compared with male patients. In the sex-stratified multivariable analyses, SATA in females [hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.86∼0.97; <em>P</em> = .003] and SMA in men (HR, 0.93; 95% CI, 0.86∼1.00; <em>P</em> = .05) were significant predictors of 1-year mortality. Incorporation of SATA or SMA within the existing Nottingham Hip Fracture Score (NHFS) showed slightly improved performance in predicting 1-year mortality among women [area under the curve (AUC), 0.70 vs 0.64, <em>P</em> = .11] or men (AUC, 0.76 vs 0.71, <em>P</em> = .06), respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Reduced subcutaneous adiposity is associated with mortality in older women undergoing hip fracture surgery, while reduced muscle mass predicts mortality in men. These findings highlight the importance of considering sexual dimorphism in the development of novel biomarkers and effective treatment strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105502"},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441287","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":"Engagement of Relatives in End-of-life Care of Residents in Long-Term Care Facilities: A Cross-Sectional Study in 5 EU Countries","authors":"Natalia Drapała MPH ,&nbsp;Ilona Barańska MSc, MPH, PhD ,&nbsp;Lieve Van den Block MSc, PhD ,&nbsp;Tinne Smets MSc, PhD ,&nbsp;Nele Van Den Noortgate MD, PhD ,&nbsp;Harriet Finne-Soveri MD, PhD ,&nbsp;Giovanni Gambassi MD, PhD ,&nbsp;Bregje D. Onwuteaka-Philipsen PhD ,&nbsp;Katarzyna Szczerbińska MD, PhD","doi":"10.1016/j.jamda.2025.105492","DOIUrl":"10.1016/j.jamda.2025.105492","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the extent and factors associated with relatives' engagement in end-of-life care for residents of long-term care facilities (LTCFs) during the last week before the resident's death.</div></div><div><h3>Design</h3><div>A cross-sectional retrospective survey.</div></div><div><h3>Setting and Participants</h3><div>A total of 814 relatives of deceased LTCF residents in a representative sample of 229 LTCFs in Belgium, Finland, Italy, the Netherlands, and Poland.</div></div><div><h3>Methods</h3><div>LTCFs reported all residents’ deaths in the past 3 months. In each case, standardized questionnaires were sent to the LTCF manager, nurse, physician, and relative most involved in care. A multivariable logistic regression model was applied to assess which factors and characteristics of the relative and deceased resident were associated with more time spent with the resident in the last week of life.</div></div><div><h3>Results</h3><div>Compared with Poland, relatives from the Netherlands [odds ratio (OR), 14.22; 95% CI, 6.56–30.82], Belgium (OR, 10.24; 95% CI 4.87–24.52), and Finland (OR, 2.57; 95% CI, 1.18–5.58) had higher odds of spending more than 14 hours with residents in the last week of life. Female relatives, who were their partners or spouses, and who provided more than 11 hours of care weekly before the resident's admission to the LTCF (OR, 2.96; 95% CI 1.55–5.65) were more likely to visit the dying resident during the last week of life. Residents placed in the LTCF due to their behavioral problems or dependency in activities of daily living (ADL) were less frequently visited by their relatives in the last week of life (OR, 0.34; 95% CI, 0.16–0.71 and OR, 0.54; 95% CI, 0.36–0.82, respectively).</div></div><div><h3>Conclusions and Implications</h3><div>Resident's behavioral problems and dependency in ADLs at the time of admission to the LTCF were associated with their relative's lower engagement in end-of-life care. We also found substantial differences in relatives' engagement among countries. Further research is required to identify the causes of these discrepancies and to develop culture-specific support for relatives.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105492"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425612","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 Frailty and Quality of Life in Middle-Aged and Older Adults","authors":"Seo Yeong Bak,&nbsp;Young Choi PhD","doi":"10.1016/j.jamda.2025.105493","DOIUrl":"10.1016/j.jamda.2025.105493","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigated the relationship between frailty and quality of life in middle-aged and older adults, and determined how age influences the relationship between frailty and quality of life.</div></div><div><h3>Design</h3><div>A cross-sectional study from Korean Longitudinal Study of Ageing (2006–2020).</div></div><div><h3>Setting and Participants</h3><div>There were a total of 9301 participants aged ≥45 years at baseline (2006).</div></div><div><h3>Methods</h3><div>Frailty was assessed using the Korean Frailty Instrument, which categorized participants as non-frail, pre-frail, or frail. Quality of life (QoL) was measured using a visual analog, ranging from 0 (worst) to 100 (best) in 10-point intervals. We used multiple linear mixed models to examine the association between frailty and QoL among middle-aged and older adults and to test the interaction effect of frailty status and age on QoL.</div></div><div><h3>Results</h3><div>Of 9301 participants, 53.7% were non-frail, 30.3% were pre-frail, and 16.0% were frail. Average QoL scores were 68.7 in the non-frail group, 59.9 in the pre-frail group, and 48.2 in the frail group (<em>P</em> &lt; .001). The linear mixed model analysis showed that pre-frail (β = −2.235, SE = 0.152, <em>P</em> &lt; .001) and frail (β = −5.072, SE = 0.269, <em>P</em> &lt; .001) individuals had lower QoL scores compared with non-frail individuals. Although QoL scores remained stable across age groups in non-frail individuals, those with frail status showed an increase in QoL with age.</div></div><div><h3>Conclusions and Implications</h3><div>Frailty is significantly associated with lower QoL in both middle-aged and older adults. In addition, the interaction of age and frailty showed that QoL improves with age in frail people. This suggests that the impact of frailty on QoL is greater in middle age.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105493"},"PeriodicalIF":4.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425672","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":"Statins Reduce Delirium Risk in Older Adults With Type 2 Diabetes","authors":"Mingyang Sun MD ,&nbsp;Xiaoling Wang PhD ,&nbsp;Zhongyuan Lu PhD ,&nbsp;Yitian Yang MD, PhD ,&nbsp;Shuang Lv MD ,&nbsp;Mengrong Miao MD ,&nbsp;Wan-Ming Chen PhD ,&nbsp;Szu-Yuan Wu MD, MPH, PhD ,&nbsp;Jiaqiang Zhang MD, PhD","doi":"10.1016/j.jamda.2025.105490","DOIUrl":"10.1016/j.jamda.2025.105490","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the impact of statins on delirium incidence in older adults with type 2 diabetes mellitus (T2DM), focusing on hydrophilic versus lipophilic statins and dose-response effects.</div></div><div><h3>Design</h3><div>Retrospective cohort study using propensity score matching and Cox regression analysis, with competing risk analysis to account for mortality.</div></div><div><h3>Setting and Participants</h3><div>A total of 110,090 older adults (aged ≥65 years) with type 2 diabetes mellitus identified from Taiwan's National Health Insurance Research Database (2008–2021), including 55,045 statin users and 55,045 matched non-users.</div></div><div><h3>Methods</h3><div>Delirium incidence was compared between statin users and non-users, adjusting for potential confounders. Analyses evaluated the differential effects of hydrophilic and lipophilic statins and assessed the dose-response relationship using cumulative daily doses.</div></div><div><h3>Results</h3><div>Statin use significantly reduced delirium risk [adjusted hazard ratio (aHR), 0.73; 95% confidence interval (CI), 0.67–0.79; <em>P</em> &lt; .0001]. Hydrophilic statins showed greater protection (aHR, 0.67; 95% CI, 0.59–0.76) compared with lipophilic statins (aHR, 0.76; 95% CI, 0.69–0.82). Higher cumulative doses were associated with greater risk reductions, with the highest dose quartile (Q4) demonstrating an aHR of 0.36 (95% CI, 0.30–0.43). The incidence rate ratio (IRR) was 0.70 (95% CI, 0.65–0.76; <em>P</em> &lt; .0001).</div></div><div><h3>Conclusions and Implications</h3><div>Statins, particularly hydrophilic types and higher doses, significantly reduce delirium risk in older adults with type 2 diabetes mellitus. These findings support statins’ role in mitigating cognitive decline and improving outcomes in this population, with implications for clinical practice and future research.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105490"},"PeriodicalIF":4.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425614","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":"Disparities in Infection Risk Among Home Health Care Patients: A Study Using Area Deprivation Index","authors":"Jingjing Shang PhD, RN ,&nbsp;Uduwanage Gayani E. Perera PhD ,&nbsp;Jianfang Liu PhD ,&nbsp;Ashley M. Chastain DrPH ,&nbsp;David Russell PhD ,&nbsp;Jinjiao Wang PhD, RN ,&nbsp;Thomas V. Caprio MD ,&nbsp;Yolanda Barrón MS ,&nbsp;Sarah Szanton PhD ,&nbsp;Suning Zhao MPH ,&nbsp;Margaret V. McDonald MSW","doi":"10.1016/j.jamda.2024.105455","DOIUrl":"10.1016/j.jamda.2024.105455","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between neighborhood deprivation and infection-related hospitalizations among home health care (HHC) patients across different rurality levels.</div></div><div><h3>Design</h3><div>Retrospective observation analysis of 2019 national data sets, including Medicare data linked to 2019 Area Deprivation Index (ADI) data and Rural-Urban Continuum Codes (RUCCs).</div></div><div><h3>Setting and Participants</h3><div>The sample includes 3,656,810 HHC patients from 8135 HHC agencies nationwide. Patients were predominantly White (77.6%), with an average age of 80 years, and mostly female (61.7%). The sample included 24% dual-eligible patients and those living in large metropolitan (53.8%), small metro (30.2%), rural adjacent (11.4%), and remote rural areas (4.6%).</div></div><div><h3>Methods</h3><div>Hospital admissions due to infection were identified through <em>International Classification of Diseases, Tenth Revision</em> (<em>ICD-10</em>), codes. Neighborhood deprivation was measured by the 2019 ADI. Patients were stratified by RUCC (large metro, small metro, rural adjacent, or remote rural). Within each rurality stratum, ADI quartiles were constructed, with higher quartiles indicating greater neighborhood deprivation. Multivariable logistic regression was conducted, adjusting for multiple-level variables.</div></div><div><h3>Results</h3><div>As neighborhood deprivation increased, there was a rise in the proportion of dual-eligible, female, Black, and Hispanic patients, whereas the proportion of White patients decreased, especially in rural areas. Rural areas with higher ADI rankings showed lower quality metrics and reduced health care resources. Higher ADI quartiles were significantly associated with increased infection risks after adjusting for covariates, but this was only observed in remote rural areas, not in urban areas.</div></div><div><h3>Conclusions and Implications</h3><div>The findings highlight significant policy and clinical implications for remote rural areas. Policymakers should increase investments in rural health infrastructure, enhance telehealth, improve transportation services, and offer incentives for health care providers to practice in these areas. The nonsignificant association between neighborhood deprivation and infection outcomes in metropolitan areas may stem from the ADI's limited sensitivity to urban contexts, highlighting the need for more nuanced indices that better capture urban socioeconomic challenges.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105455"},"PeriodicalIF":4.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374309","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":"Prolonged Use of Antidepressants Among Older People Residing in Long-Term Care Facilities","authors":"Georgina A. Hughes BPharm(Hons) ,&nbsp;Maria C. Inacio PhD ,&nbsp;Debra Rowett BPharm ,&nbsp;Gillian E. Caughey PhD ,&nbsp;Tracy Air MBiostat ,&nbsp;Catherine Lang BPhys(Hons) ,&nbsp;Megan Corlis BA(AppSci) ,&nbsp;Janet K. Sluggett PhD","doi":"10.1016/j.jamda.2024.105482","DOIUrl":"10.1016/j.jamda.2024.105482","url":null,"abstract":"<div><h3>Objectives</h3><div>Antidepressants are commonly used by older people and use increases during transition to long-term care facilities (LTCFs); however, little is known regarding duration of use following LTCF entry. This study aimed to examine duration of antidepressant use among new and existing antidepressant users after LTCF entry.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Non-Indigenous individuals aged 65 to 105 years who entered LTCFs in 2 Australian states between 2015 and 2018 and received an antidepressant between LTCF entry and ≤60 days after, were included.</div></div><div><h3>Methods</h3><div>Cumulative incidence function and Fine-Gray regression models adjusted for age, sex, and LTCF entry year, accounted for the competing risk of death, and estimated the subdistribution hazard ratio (sHR) and 95% confidence interval (95% CI) for antidepressant discontinuation for all, new, and existing users.</div></div><div><h3>Results</h3><div>Overall, 28,426 individuals entering 1035 LTCFs were included, of whom 22,365 (78.7%) were existing antidepressant users and 6061 (21.3%) were new users. Selective serotonin reuptake inhibitors and mirtazapine were commonly utilized. Overall, 36.1% (95% CI 35.1–37.1) of residents discontinued antidepressants (median follow-up 614 days, interquartile range 338–1002) following entry and 50.3% (95% CI 49.4–51.2) were dispensed enough to last until death. New antidepressant users had a 36% (adjusted sHR, 1.36; 95% CI, 1.29–1.44) higher risk of discontinuation compared with existing users.</div></div><div><h3>Conclusions and Implications</h3><div>Prolonged antidepressant use is common in LTCFs, and therapy is often continued until the end-of-life. Initiating nonpharmacological alternatives, regular review of antidepressant appropriateness, and seeking discontinuation opportunities where appropriate can minimize potentially inappropriate antidepressant use and risk of harm.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105482"},"PeriodicalIF":4.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074921","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":"Injurious Falls before, during, and after Stroke Diagnosis: A Population-based Study","authors":"Lulu Zhang PhD ,&nbsp;Jiao Wang PhD ,&nbsp;Xiaokang Dong PhD ,&nbsp;Abigail Dove MSC ,&nbsp;Sakura Sakakibara MSC ,&nbsp;Xinkui Liu PhD ,&nbsp;Chengzeng Wang PhD ,&nbsp;Zhida Wang PhD ,&nbsp;Anna-Karin Welmer PhD ,&nbsp;Weili Xu PhD","doi":"10.1016/j.jamda.2024.105465","DOIUrl":"10.1016/j.jamda.2024.105465","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to examine changes in the incidence of injurious falls before, during, and after stroke, and to identify risk factors of injurious falls before and after stroke diagnosis.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Within the Swedish Twin Registry, 4431 participants (aged 66.5 ± 10.3 years) with incident stroke and 4431 stroke-free controls (aged 66.5 ± 10.3 years) were identified and matched with cases according to birth year and sex. Cases and controls were retrospectively and prospectively followed for a total of 21 years.</div></div><div><h3>Methods</h3><div>Information on the onset of stroke and injurious falls was ascertained from medical records in the National Patient Registry. Data were analyzed using conditional Poisson regression and generalized estimating equation models.</div></div><div><h3>Results</h3><div>During the 4 to 10 year pre-stroke period, the standardized incidence rates of injurious falls were 4.29–7.53 per 1000 person-years in stroke and 3.97–7.47 per 1000 person-years in control groups. The incidence of injurious falls among participants with stroke was significantly higher compared with non-stroke controls beginning 3 years before stroke [incidence rate ratio (IRR), 1.27; 95% confidence interval (CI), 1.02–1.59], peaked during the year of stroke diagnosis (IRR, 2.55; 95% CI, 2.17–3.01), and declined 4 years after stroke (IRR, 1.42; 95% CI, 1.14–1.77) until reaching a similar level as the controls (IRRs around 1.11–1.56). Former/current smoking, heavy drinking, and overweight were associated with increased falls during the pre-stroke period, and being single and heart disease with falls during the post-stroke period.</div></div><div><h3>Conclusions and Implications</h3><div>Among people with stroke, incidence of injurious falls is significantly elevated already 3 years before stroke diagnosis and lasting until 4 years post-stroke. Risk factors for falls differ pre-stroke and post-stroke. Taking preventive measures may be beneficial in managing both stroke and fall-related risks.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 3","pages":"Article 105465"},"PeriodicalIF":4.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007509","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":"Changing Oral Health Trajectories: A 10-Year Cross-Sectional Comparison of 2 Domiciliary Dental Care Patient Groups in Nursing Homes","authors":"Lynn E.R. Janssens DDS ,&nbsp;Mirko Petrovic PhD ,&nbsp;Finbarr P. Allen PhD ,&nbsp;Roos Colman MSc ,&nbsp;Barbara E. Janssens PhD","doi":"10.1016/j.jamda.2024.105471","DOIUrl":"10.1016/j.jamda.2024.105471","url":null,"abstract":"<div><h3>Objectives</h3><div>Since 2010, Gerodent has been a comprehensive oral health care program including biannual domiciliary dental care in nursing homes in Flanders, Belgium. Previous research revealed poor oral health among nursing home residents attending the mobile clinic. The objective of this study was to evaluate potential changes in the oral health needs of patients receiving domiciliary dental care, thus providing insights for future cohorts.</div></div><div><h3>Design</h3><div>This study compares the oral health status and treatment needs of 2 cross-sectional samples.</div></div><div><h3>Setting and Participants</h3><div>First-time patients attending the mobile dental clinic in nursing homes, collected a decade apart.</div></div><div><h3>Methods</h3><div>Generalized estimating equations were used to compare both samples [sample 1 (S1): 2010–2012: n = 1226; sample 2 (S2): 2021–2023: n = 775]. Results were adjusted for age, sex, increased reimbursement for health care costs, number of medications and care dependency. Differences in oral health outcomes were decomposed in a component attributed to the explanatory variables and an unexplained component using the Blinder–Oaxaca decomposition analysis.</div></div><div><h3>Results</h3><div>There were statistically significant lower edentulism rates in S2 (28%) than S1 [42%; odds ratio (OR), 1.82; 95% CI, 1.34–2.47]. Among dentate patients, S2 had a significantly lower caries prevalence (S1: 70% vs S2: 53%; OR, 0.55; 95% CI, 0.44–0.69) and a significantly higher mean of filled teeth (S1: 1.5 vs S2: 2.8; rate ratio, 1.82; 95% CI, 1.58–2.09). In the dentate sample, 77% of S1 and 54% of S2 residents required extractions and/or restorations (OR, 0.72; 95% CI, 0.53–0.98). The decomposition analysis showed that the change in explanatory variables attributed little to the shift in dental status. The explained component accounted for only 13.5% of the total risk difference in edentulism (bias-corrected and accelerated 95% CI, −0.6% to 30.6%).</div></div><div><h3>Conclusion and Implications</h3><div>From 2021 to 2023, more dentate care home residents consulted Gerodent with more natural teeth per person, showing lower levels of untreated disease, maintaining dental team treatment demands comparable with 2010–2012. These findings underscore the continued urgency for structured and accessible dental service provision for nursing home residents.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105471"},"PeriodicalIF":4.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074905","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}