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-MDS) and Resident Assessment Instrument-Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included. METHODS:Adjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models. RESULTS:Records were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31-25.40] for LTCF and 46.64 (44.24-49.12) for HC. In LTCF, the strongest risks were younger age (60-74 years vs 90+: HR, 6.00; 95% CI, 3.24-11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32-5.16; schizophrenia: 2.31; 1.47-3.62; depression: 2.29; 1.80-2.92), daily severe pain (2.01; 1.30-3.11), and daily tobacco consumption (1.78; 1.29-2.45). For those receiving HC, the strongest risk factors were younger age (60-74 years vs 90+: 2.54; 1.97-3.28), psychiatric disorders (2.20; 1.93-2.50), daily tobacco consumption (2.08; 1.81-2.39), and frequent falls (1.98; 1.46-2.68). All model interactions between setting and factors were significant. CONCLUSIONS AND IMPLICATIONS:There was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.
journal_name
J Am Med Dir Assocjournal_title
Journal of the American Medical Directors Associationauthors
Chai Y,Luo H,Yip PSF,Perlman CM,Hirdes JPdoi
10.1016/j.jamda.2020.12.022subject
Has Abstractpub_date
2021-01-15 00:00:00eissn
1525-8610issn
1538-9375pii
S1525-8610(20)31071-9pub_type
杂志文章abstract::The management of diabetes in long-term care (LTC) facilities requires facility staff to perform most self-care activities on the behalf of the residents. A practical model of care to improve diabetes management was developed and implemented at 6 LTC facilities in the Northeast United States between 2009 and 2012. The...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.06.046
更新日期:2020-08-02 00:00:00
abstract:OBJECTIVES:To determine the effect of a Social Health Maintenance Organization (S/HMO) on diverting older adults admitted into a nursing facility from converting to long-stay placement. DESIGN:Members of the SCAN S/HMO and those in Medicare Fee-For-Service were compared on successful discharge to the community after b...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2009.10.009
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Good scientific evidence indicates that calcium and vitamin D supplementation decrease the incidence of osteoporosis-related fractures among institutionalized elderly. OBJECTIVE:The objective was to study the frequency of prescribing calcium and vitamin D supplements in elderly institutionalized individuals...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1097/01.JAM.0000110649.22467.B4
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVES:To examine individual items of the SARC-F in predicting adverse outcomes. DESIGN:Prospective cohort study. SETTING:Community-dwelling older people in Hong Kong SAR China. PARTICIPANTS:A total of 4000 men and women aged 65 years and over, stratified in 3 age groups (65-69, 70-74, 75+ years of age). MEASUR...
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:To determine if participation in a 12-month longitudinal long-term care (LTC) rotation resulted in improved knowledge and attitudes about geriatrics. DESIGN:Longitudinal study with paired measurements. SETTING:A community LTC facility and a university-affiliated, community-based internal medicine residency ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2006.05.009
更新日期:2007-02-01 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:OBJECTIVE:To assess the proposed prevalence of unresponsiveness of older men and women to augment lean body mass, muscle fiber size, muscle strength, and/or physical function following prolonged resistance-type exercise training. DESIGN/SETTING/PARTICIPANTS:A retrospective analysis of the adaptive response to 12 (n = ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2015.01.071
更新日期:2015-05-01 00:00:00
abstract::Older adults living in nursing homes are the most vulnerable group of the COVID-19 pandemic. There are many difficulties in isolating residents and limiting the spread in this setting. We have developed a simple algorithm with a traffic light format for resident classification and sectorization within nursing homes, b...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.10.023
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:In cognitively normal adults, nutritional parameters are related to cognitive decline and incidence of dementia. Studies on the role of nutrition in predementia stages subjective cognitive decline and mild cognitive impairment, and mild stages of Alzheimer's disease (AD) dementia in a clinical setting are lac...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.10.020
更新日期:2020-11-15 00:00:00
abstract:OBJECTIVES:The primary objective of this study was to identify proton pump inhibitor (PPI) prescribing patterns in a population of older adults admitted to 22 Midwestern skilled long term care facilities (LTCF) with medical coverage provided by the US Medicare Part A program. The relationship between PPI prescribing pa...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.01.021
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVES:This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home Based Primary Care (HBPC). DESIGN:Retrospective claims-based study. SETTING AND ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.12.033
更新日期:2021-01-29 00:00:00
abstract:OBJECTIVE:Clinical implications of asymptomatic cases of the novel coronavirus disease 2019 (COVID-19) in nursing homes remain poorly understood. We assessed the association of symptom status and medical comorbidities on mortality and hospitalization risk associated with COVID-19 in residents across 15 nursing homes in...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.10.011
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVES:Distressing behavioral symptoms often associated with dementia are not uncommon in the long term care setting. Culture change with its "person-centered approach to care" provides a potential nonpharmacological intervention to reduce these symptoms. The purpose of this study was to examine the relationship be...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2012.02.006
更新日期:2012-07-01 00:00:00
abstract::Community care provision for older Australians is growing in places and options, based on older people's preference to stay in their own homes, coupled with its cost efficiency compared to long-term residential care. Australia's aging population, cultural diversity, and dispersed population in rural and remote areas p...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2007.11.010
更新日期:2008-02-01 00:00:00
abstract::More than 6 million adults in the United States are homebound or semi-homebound and would benefit from home-based medical care (HBMC). There is currently no nationally recognized quality of care framework for home-based medical care. We sought to capture diverse stakeholder perspectives on the essential aspects of qua...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2018.05.020
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVES:To define the prevalence of dysphagia and its associated factors and to investigate the influence of dysphagia and nutritional therapies performed in dysphagic subjects on clinical outcomes, including nutritional status, pressure ulcers, hospitalization, and mortality. DESIGN:A prospective observational stu...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2018.07.023
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:Incident reports guide fall prevention efforts in long-term care (LTC) facilities, often based on descriptions of how falls occurred. The validity of these reports is poorly understood. We examined agreement on fall characteristics between fall incident reports and analysis of video footage of real-life falls...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2014.12.003
更新日期:2015-05-01 00:00:00
abstract::Suboptimal vitamin D status is common in sick, elderly patients and is associated with secondary hyperparathyroidism, increased bone turnover, and accelerated bone loss. Nutritional supplementation of elderly patients with vitamin D and calcium has been associated with a reduction in fractures and falls. Recently, the...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2005.12.010
更新日期:2006-03-01 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:BACKGROUND:Falling is a common and serious problem in the elderly. Previous studies suggest that the use of psychotropic drugs increases the risk of falling. However, the contribution of these drugs on fall risk has not been quantified on a daily basis among the general population of nursing homes until now. OBJECTIVE...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2016.07.004
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To determine the short- (4 weeks) and long-term (6 month) effectiveness of Tibetan medicated bathing therapy in patients with post-stroke limb spasticity. DESIGN:Prospective, blinded, randomized controlled trial. SUBJECTS:Post-stroke patients with limb spasticity were recruited between December 2013 and Feb...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.10.018
更新日期:2020-03-01 00:00:00
abstract:OBJECTIVES:The recent emphasis on knowledge translation (KT) in health care is based on the premise that quality of care improves when research findings are translated into practice. This study aimed to identify the extent, nature, and settings of KT research pertaining to the care of older adults. DESIGN AND METHODS:...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2010.12.004
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:To report on the process and effect of a quality improvement project on end-of-life (EOL) care in a state veterans' home. DESIGN:The design uses survey data from representatives of the deceased, continuous quality improvement (QI) techniques, and interdisciplinary team activities. Representatives of the dece...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2005.12.020
更新日期:2006-03-01 00:00:00
abstract:BACKGROUND:Cognitive impairment is common in people living with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF); however, accurate estimates of prevalence are lacking. To date, there are no meta-analyses that have specifically investigated prevalence of mild cognitive impairment (MCI) in th...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jamda.2017.01.014
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to examine the association between psychoactive medications and sleep quality in a sample of nursing home patients. DESIGN:We studied a baseline data collection for a clinical trial of a nonpharmacologic sleep intervention program. SETTING:This study was conducted at six comm...
journal_title:Journal of the American Medical Directors Association
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/01.JAM.0000131499.71697.9E
更新日期:2004-07-01 00:00:00
abstract::Long term care facilities are important sites of care for elderly adults. Despite a growing need and interest in medical direction in nursing homes, there have been limited educational opportunities in this area for geriatric medicine fellows. This article describes a novel medical director's curriculum for first-year...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2012.10.008
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVES:To examine the association of rurality with skilled nursing facility (SNF) all-cause 30-day risk-adjusted rehospitalization rates. DESIGN:Cross-sectional study combining Center for Medicare and Medicaid Services Nursing Home Compare (CMS-NHC) website for 30-day risk-adjusted rehospitalization rates for 2014...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2018.03.001
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVES:EHealth interventions are increasingly being applied in perioperative care but have not been adequately studied for older surgical patients who could potentially benefit from them. Therefore, we evaluated the feasibility of perioperative eHealth interventions for this population. DESIGN:A systematic review ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2020.05.035
更新日期:2020-12-01 00:00:00
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: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