Abstract:
OBJECTIVE:Describe the care preference changes among nursing home residents receiving proactive Advance Care Planning (ACP) conversations from health care practitioners during the COVID-19 pandemic. DESIGN:Retrospective chart review. SETTING AND PARTICIPANTS:Nursing home residents (n = 963) or their surrogate decision makers had at least 1 ACP conversation with a primary health care practitioner between April 1, 2020, and May 30, 2020, and made decisions of any changes in code status and hospitalization preferences. METHODS:Health care practitioners conducted ACP conversations proactively with residents or their surrogate decision makers at 15 nursing homes in a metropolitan area of the southwestern United States between April 1, 2020, and May 30, 2020. ACP conversations reviewed code status and goals of care including Do Not Hospitalize (DNH) care preference. Resident age, gender, code status, and DNH choice before and after the ACP conversations were documented. Descriptive data analyses identified significant changes in resident care preferences before and after ACP conversations. RESULTS:Before the most recent ACP discussion, 361 residents were full code status and the rest were Out of Hospital Do Not Resuscitate (DNR). Of the individuals with Out of Hospital DNR, 188 residents also chose DNH. After the ACP conversation, 88 residents opted to change from full code status to Out of Hospital DNR, thereby increasing the percentage of residents with Out of Hospital DNR from 63% to 72%. Almost half of the residents decided to keep or change to the DNH care option after the ACP conversation. CONCLUSION AND IMPLICATIONS:Proactive ACP conversations during COVID-19 increased DNH from less than a quarter to almost half among the nursing home residents. Out of Hospital DNR increased by 9%. It is important for all health care practitioners to proactively review ACP with nursing home residents and their surrogate decision makers during a pandemic, thereby ensuring care consistent with personal goals of care and avoiding unnecessary hospitalizations.
journal_name
J Am Med Dir Assocjournal_title
Journal of the American Medical Directors Associationauthors
Ye P,Fry L,Champion JDdoi
10.1016/j.jamda.2020.11.011subject
Has Abstractpub_date
2021-01-01 00:00:00pages
209-214issue
1eissn
1525-8610issn
1538-9375pii
S1525-8610(20)30975-0journal_volume
22pub_type
杂志文章abstract::Memantine is approved for treatment of moderate to severe Alzheimer disease (AD) but is also investigated as a treatment option for a number of different conditions, and even though there are reports of a number of adverse effects, including new-onset seizures and psychosis, it is considered to be generally well toler...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.01.010
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in long-term care (LTC), but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use. OBJECTIVES:The objective of the study was to evalu...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.07.025
更新日期:2020-03-01 00:00:00
abstract::Osteoporosis is expected to increase as our population pyramid shifts toward old age. It is associated with increased risk of fractures, leading to complications of limitation of ambulation, loss of independence, and chronic pain. Depression is also a common occurrence in the elderly population. Currently, up to 35% o...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2011.09.003
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVES:The objective of this study was to evaluate the benefits of influenza vaccination against hospitalization and mortality on frail elderly people. DESIGN:The design was a population-based retrospective cohort study. SETTING:Taiwan's National Health Insurance claims data. PARTICIPANTS:Participants were 5063 ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.12.003
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVES:To assess the 30-day mortality predictive markers in the oldest patients with Clostridioides difficile infection (CDI) and to analyze the accuracy of the European severity risk markers in this population. DESIGN:Observational prospective multicenter cohort study conducted by the French Infectious Diseases S...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.07.002
更新日期:2020-01-01 00:00:00
abstract::The prevalence of malnutrition ranges up to 50% among patients in hospitals worldwide, and disease-related malnutrition is all too common in long-term and other health care settings as well. Regrettably, the numbers have not improved over the past decade. The consequences of malnutrition are serious, including increas...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2014.05.011
更新日期:2014-08-01 00:00:00
abstract:RATIONALE:Malnutrition screening among nursing home residents is often performed with tools developed for use among older subjects, and sometimes with tools designed for an adult population. Only a few tools have been designed specifically for the nursing home setting. This systematic review assesses the criterion and ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2013.10.006
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVES:To determine the prevalence, rate of underdiagnosis and undertreatment, and association with activities of daily living dependency of spasticity in a nursing home setting. DESIGN:Cross-sectional study. SETTING AND PARTICIPANTS:This study is an analysis of a deidentified data set generated by a prior qualit...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.01.005
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:There is a lack of studies disentangling whether changes in frailty are associated with subsequent changes in depressive symptoms or vice versa among the oldest old. Consequently, we aimed to disentangle this link. DESIGN:Three waves [follow-up (FU) wave 7 to FU wave 9; n = 423 individuals in the analytical ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.10.008
更新日期:2020-11-19 00:00:00
abstract:BACKGROUND:Although many older adults require skilled nursing facility (SNF) care after acute hospitalization, it is unclear whether internal medicine residents have sufficient knowledge of the care that can be provided at this site. METHODS:We developed a 10-item multiple choice pre-test that assessed knowledge of th...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2014.08.004
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVES:The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults. DESIGN:A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703)...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.06.024
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Exercise has been proposed as a possible treatment for postprandial hypotension (PPH), yet, its use has not been extensively investigated. This study aimed to determine the effects of intermittent walking on blood pressure (BP) and heart rate (HR) following ingestion of a glucose drink in older people with P...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamda.2014.08.013
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVES:This study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC). DESIGN:Retrospective cohort study. SETTING AND PARTICIPANTS:The LTC data were collected using Resident Assessment Instrument-Minimum Data Set (RAI-MD...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.12.022
更新日期:2021-01-15 00:00:00
abstract:PURPOSE:The culture change (CC) movement aims to transform the traditional nursing home (NH) that is institutional in design with hierarchical management structure into a homelike environment that empowers residents and frontline staff. This study examines differences in adoption of CC practices according to a NH's sel...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2009.11.002
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVES:To describe current practices of incontinence care in nursing homes (NHs) provided by certified nurse assistants (CNAs), and to evaluate the feasibility and acceptability of an integrated incontinence care product, the One Step Incontinence System (OSIS) in the NH setting. While the ultimate purpose of OSIS ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jamda.2006.10.001
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVES:To investigate the association between polypharmacy and medication regimen complexity with time to first hospitalization, number of hospitalizations, and number of hospital days over a 12-month period. DESIGN:A 12-month prospective cohort study. PARTICIPANTS AND SETTING:A total of 383 residents of 6 Austra...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2016.08.019
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to create a screening tool to predict first-time injurious falls in community-living older men and women. DESIGN:Longitudinal cohort study between 2001 and 2009. SETTING:The Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden. PARTICIPANTS:Community-living ol...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.02.023
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:Prognostic information is important for guiding palliative care planning for patients with dementia. We aim to validate a risk score that uses Minimum Data Set (MDS) to estimate 6-month mortality for nursing home residents with advanced dementia. DESIGN:Two cohort studies. SETTING:Six nursing homes in The N...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamda.2007.05.004
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVES:Prevention and public reporting of falls have suffered due to inadequate attention given to the association of falls and cognitive impairment (CI) among nursing home (NH) residents. This study examines the relationship between CI, residence on dementia special care units (SCUs) and other resident characteris...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2012.07.018
更新日期:2012-11-01 00:00:00
abstract::The aging population in China is growing rapidly and by the middle of this century will peak. In addition, in 2000, elderly people aged 80 and older accounted for 18% of the world's population of oldest old. We identify here ways to begin addressing China's unique aging population needs. Through improving geriatric an...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2009.06.007
更新日期:2009-09-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2017.09.006
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVE:Medical students often lack training in complex geriatric medical decision making. We therefore developed the serious game, GeriatriX, for training medical decision making with weighing patient preferences, and appropriateness and costs of medical care. We hypothesized that education with GeriatriX would impr...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamda.2014.04.011
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVE:To evaluate whether botulinum toxin can decrease the burden for caregivers of long term care patients with severe upper limb spasticity. METHOD:This was a double-blind placebo-controlled trial with a 24-week follow-up period. SETTING:A 250-bed long term care hospital, the infirmary units of 3 regional hospi...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamda.2012.03.005
更新日期:2012-06-01 00:00:00
abstract:INTRODUCTION:Antibiotic stewardship programs (ASPs) are coordinated interventions promoting the appropriate use of antibiotics to improve patient outcomes and reduce microbial resistance. These programs are now mandated in nursing homes (NHs) but it is unclear if these programs improve resident outcomes. This systemati...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2017.06.019
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVES:To assess the effectiveness of a wireless network (WiFi-based) localization system (devices mounted on resident wheelchairs) in decreasing caretaker time spent searching for residents and providing alerts of residents going outdoors in a skilled nursing facility. DESIGN:A controlled study over two 2-month p...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2012.04.010
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVE:Venous thromboembolism (VTE) is common in the elderly, but its epidemiology in nursing home residents remains unclear. This study estimated rates of VTE recorded on nursing home admission and incidence during residence. DESIGN:Retrospective analysis of AnalytiCare long term care (LTC) database for the period...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.02.003
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVES:Nursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic he...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2018.11.002
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:To analyze the burden of institutionalizations after femoral fracture and compare it with other "catastrophic" disease entities like stroke, myocardial infarction, or pneumonia. DESIGN/SETTING/PARTICIPANTS:Routine data of 414,000 hospitalized German patients aged 66 years and older were used to calculate ins...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2015.05.013
更新日期:2015-08-01 00:00:00
abstract:IMPORTANCE:Currently there is no risk factor scale that identifies older persons at risk of frailty. OBJECTIVES:In this study, we identified significant multisystem risk factors of frailty, developed a simple frailty risk index, and evaluated it for use in primary care on an external validation cohort of community-liv...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2014.03.008
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVES:Approximately 14% of Medicare beneficiaries are readmitted to a hospital within 30 days of home health care admission. Individuals with dementia account for 30% of all home health care admissions and are at high risk for readmission. Our primary objective was to determine the association between dementia sev...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.09.012
更新日期:2020-04-01 00:00:00