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Journal of the American Medical Directors Association
Lippincott Williams & Wilkins
Journal of the American Medical Directors Association

Lippincott Williams & Wilkins

1525-8610

Journal of the American Medical Directors Association/Journal Journal of the American Medical Directors AssociationISTPAHCISCI
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    Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review

    Shah, Manish N.GEAR 2 O-ADC NetworkGettel, Cameron J.Falvey, Jason R....
    13页
    查看更多>>摘要：Objectives: We aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation. Design: Systematic scoping review. Setting and Participants: ED patients with cognitive impairment and/or their care partners. Methods: Informed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations. Results: From 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage. Conclusions and Implications: This scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
      原文链接:
    • NSTL

    Emergency Department Communication in Persons Living With Dementia and Care Partners: A Scoping Review

    Carpenter, Christopher R.Leggett, JessecaBellolio, FernandaBetz, Marian...
    32页
    查看更多>>摘要：Objectives: To synthesize published research exploring emergency department (ED) communication strategies and decision- making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prioritize future research. Design: Systematic scoping review. Settings and Participants: PLWD and their care partners in the ED setting. Methods: Informed by 2 Patient-Intervention-Comparison-Outcome (PICO) questions, we conducted systematic electronic searches of medical research databases for relevant publications following standardized methodological guidelines. The results were presented to interdisciplinary stakeholders, including dementia researchers, clinicians, PLWD, care partners, and advocacy organizations. The PICO questions included: How does communication differ for PLWD compared with persons without dementia? Are there specific communication strategies that improve the outcomes of ED care? Future research areas were prioritized. Results: From 5451 studies identified for PICO-1, 21 were abstracted. From 2687 studies identified for PICO-2, 3 were abstracted. None of the included studies directly evaluated communication differences between PLWD and other populations, nor the effectiveness of specific communication strategies. General themes emerging from the scoping review included perceptions by PLWD/care partners of rushed ED communication, often exacerbated by inconsistent messages between providers. Care partners consistently reported limited engagement in medical decision-making. In order, the research priorities identified included: (1) Barriers/facilitators of effective communication; (2) valid outcome measures of effective communication; (3) best practices for care partner engagement; (4) defining how individual-, provider-, and system-level factors influence communication; and (5) understanding how each member of ED team can ensure high-quality communication. Conclusions and Implications: Research exploring ED communication with PLWD is sparse and does not directly evaluate specific communication strategies. Defining barriers and facilitators of effective communication was the highest-ranked research priority, followed by validating outcome measures associated with improved information exchange. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
      原文链接:
    • NSTL

    Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review

    Nowroozpoor, ArminDussetschleger, JeffPerry, WilliamSano, Mary...
    58页
    查看更多>>摘要：Objectives: To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED). Design: Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners. Setting and Participants: Scoping reviews focused on adult ED patients. Methods: Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and abstracted for relevant information and presented at the stakeholder consensus conference for discussion and ranked prioritization. Results: We identified a total of 1464 publications and included 45 to review for accurate tools and approaches for detecting cognitive impairment and dementia. Twenty-seven different assessments and instruments have been studied in the ED setting to evaluate cognitive impairment and dementia, with many focusing on sensitivity and specificity of instruments to screen for cognitive impairment. For pragmatic tools, we identified a total of 2166 publications and included 66 in the review. Most extensively studied tools included the Ottawa 3DY and Six-Item Screener (SIS). The SIS was the shortest to administer (1 minute). Instruments with the highest negative predictive value were the SIS (vs MMSE) and the 4 A's Test (vs expert diagnosis). The GEAR 2.0 Advancing Dementia Care Consensus conference ranked research priorities that included the need for more approaches to recognize more effectively and efficiently persons who may be at risk for cognitive impairment and dementia, while balancing the importance of equitable screening, purpose, and consequences of differentiating various forms of cognitive impairment. Conclusions and Implications: The scoping review and consensus process identified gaps in clinical care that should be prioritized for research efforts to detect cognitive impairment and dementia in the ED setting. These gaps will be addressed as future GEAR 2.0 research funding priorities. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
      原文链接:
    • NSTL

    Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review

    Dresden, Scott M.Taylor, ZacharySerina, PeterKennedy, Maura...
    29页
    查看更多>>摘要：Objectives: To summarize research on optimal emergency department (ED) care practices for persons living with dementia (PLWDs) and develop research priorities. Design: Systematic scoping review. Settings and Participants: PLWDs in the ED. Methods: The following Patient-Intervention-Comparison- Outcome (PICO) questions were developed: PICO 1, What components of emergency department care improve patient-centered outcomes for persons with dementia? PICO 2, How do emergency care needs for persons with dementia differ from other patients in the emergency department? A scoping review was conducted following PRISMA-ScR guidelines and presented to the Geriatric Emergency care Applied Research 2.0 Advancing Dementia Care network to inform research priorities. Results: From the 6348 publications identified, 23 were abstracted for PICO 1 and 26 were abstracted for PICO 2. Emergency care considerations for PLWDs included functional dependence, behavioral and psychological symptoms of dementia, and identification of and management of pain. Concerns regarding ED care processes, the ED environment, and meeting a PWLD's basic needs were described. A comprehensive geriatric assessment and dedicated ED unit, a home hospital program, and a low-stimulation bed shade and contact-free monitor all showed improvement in patient-centered or health care use outcomes. However, all were single-site studies evaluating different outcomes. These results informed the following research priorities: (1) training and dementia care competencies; (2) patient-centric and care partnerecentric evaluation interventions; (3) the impact of community- and identity-based factors on ED care for PLWDs; (4) economic or other implementation science measures to address viability; and (5) environmental, operational, personnel, system, or policy changes to improve ED care for PLWDs. Conclusions and Implications: A wide range of components of both ED care practices and ED care needs for PLWDs have been studied. Although many interventions show positive results, the lack of depth and reproducible results prevent specific recommendations on best practices in ED care for PLWDs. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
      原文链接:
    • NSTL

    Exercise and Nutritional Intervention for Physical Function of the Prefrail: A Systematic Review and Meta-Analysis

    Liu, ChengyuXu, HongxuanChen, LiruZhu, Mingwei...
    19页
    查看更多>>摘要：Objectives: The aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function. Design: Systematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197). Setting and Participants: Randomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions. Methods: Ovid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values). Results: We included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21.1.42, I-2 = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70.2.34, I-2 = 6%), and gait speed (n = 4, standard weighted mean difference -1.06, 95% CI -1.87 to -0.25, I-2 = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index. Conclusions and Implications: Our systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults. (C) 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
      原文链接:
    • NSTL

    Identifying Unexpected Deaths in Long-Term Care Homes

    Rangrej, JagadishKaufman, SamWang, SpingKerem, Aidin...
    8页
    查看更多>>摘要：Objectives: Predicting unexpected deaths among long-term care (LTC) residents can provide valuable information to clinicians and policy makers. We study multiple methods to predict unexpected death, adjusting for individual and home-level factors, and to use as a step to compare mortality differences at the facility level in the future work. Design: We conducted a retrospective cohort study using Resident Assessment Instrument Minimum Data Set assessment data for all LTC residents in Ontario, Canada, from April 2017 to March 2018. Setting and Participants: All residents in Ontario long-term homes. We used data routinely collected as part of administrative reporting by health care providers to the funder: Ontario Ministry of Health and Long-Term Care. This project is a component of routine policy development to ensure safety of the LTC system residents. Methods: Logistic regression (LR), mixed-effect LR (mixLR), and a machine learning algorithm (XGBoost) were used to predict individual mortality over 5 to 95 days after the last available RAI assessment. Results: We identified 22,419 deaths in the cohort of 106,366 cases (mean age: 83.1 years; female: 67.7%; dementia: 68.8%; functional decline: 16.6%). XGBoost had superior calibration and discrimination (Cstatistic 0.837) over both mixLR (0.819) and LR (0.813). The models had high correlation in predicting death (LR-mixLR: 0.979, LR-XGBoost: 0.885, mixLR-XGBoost: 0.882). The inter-rater reliability between the models LR-mixLR and LR-XGBoost was 0.56 and 0.84, respectively. Using results in which all 3 models predicted probability of actual death of a resident at <5% yielded 210 unexpected deaths or 0.9% of the observed deaths. Conclusions and Implications: XGBoost outperformed other models, but the combination of 3 models provides a method to detect facilities with potentially higher rates of unexpected deaths while minimizing the possibility of false positives and could be useful for ongoing surveillance and quality assurance at the facility, regional, and national levels. Crown Copyright (C) 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
      原文链接:
    • NSTL

    Food Insecurity and Functional Disability Among Older Adults in Ghana: The Role of Sex and Physical Activity

    Amoah, DinahTavener, MeredithAframa, Adjeiwa AkosuaDintrans, Pablo Villalobos...
    7页
    查看更多>>摘要：Objectives: We examined the associations between food insecurity and functional disability among older adults in Ghana and, the roles of sex and physical activity on the relationship. Design: A cross-sectional study design was employed. Setting and participants: A total of 4446 older adults (50+ years of age) from the Study on Global Aging and Adult Health Ghana Wave 2, a countrywide study, was completed in 2015. Methods: Logistic regression models were used to examine the associations between measures of food insecurity and functional disability using data from Study on Global Aging and Adult Health Ghana Wave 2. Functional disability was assessed using World Health Organization Disability Assessment Schedule 2.0 composed of 12 items in 6 domains of cognition, mobility, self-care, getting along, life activities, and participation in society. Food insecurity was assessed from 12-month food sufficiency and experience of hunger over the last 12 months. Results: Approximately 11% were identified as having functional disability. The prevalence of food insecurity was 23.8% for insufficient food intake and 18.3% for hunger. Adjusting for all variables, older adults who reported consuming insufficient food (OR 2.27; 95% CI 1.57, 3.28), and those who experienced hunger (OR 2.35; 95% CI 1.59, 3.46) had higher odds of functional disability, compared with those not reporting these issues. Sex differences modified the association between hunger and functional disability. Physical activity served as a protective factor (OR 0.60; 95% CI 0.38, 0.95) on the association implying that older adults who engaged in physical activity were 40% less likely to experience food insecurity-induced functional disability. Conclusions and Implications: Food insecurity is associated with functional disability among older adults. Results highlight the usefulness of tackling the social determinants of health and promoting financial/social security in older age in a changing Ghanaian society. (C) 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
      原文链接:
    • NSTL