Journal of the American Medical Directors Association
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Meta Analysis
Frailty as a Predictor of All-Cause Mortality Among Older Nursing Home Residents: A Systematic Review and Meta-analysis.
We performed a meta-analysis based on prospective cohort studies to synthesize the pooled risk effect and to determine whether frailty is a predictor of all-cause mortality. ⋯ Frailty is a significant predictor of all-cause mortality in older nursing home residents. Therefore, there is an urgent need to screen for frailty in nursing home residents and carry out appropriate multidisciplinary intervention strategies to prevent poor outcomes and reduce the rate of mortality among older nursing home residents.
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Identifying strong predictors for falls and mobility limitations in older adults with a falls-related emergency department visit is crucial. This study aimed to compare, in this clinical population, the incremental predictive value of the Short Physical Performance Battery (SPPB) component tests for incident falls, injurious falls, and mobility limitations. ⋯ In high-fall-risk older adults, the SPPB balance and sit-to-stand tests predicted falls whereas the SPPB gait speed test was adept at predicting mobility limitations. No one test is best across all situations, so the choice of test will depend on the goal of the assessment.
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To derive and validate a model to predict a patient's probability of skilled nursing facility (SNF) discharge using data available from day 1 of hospitalization. ⋯ It is possible to predict the day of admission with good accuracy and clinical usability a patient's risk of SNF discharge. The ability to identify early in the hospitalization patients likely to use post-acute services has implications for clinicians, administrators, and policy makers working to improve discharge planning and care transitions.
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To determine whether or not and to what extent the association between sedentary time and frailty was moderated by moderate-to-vigorous physical activity in older adults. ⋯ Moderate-to-vigorous physical activity is a moderator in the relationship between sedentary time and frailty in older adults, offsetting the harmful effects of sedentary behavior with 27 minutes/d of moderate-to-vigorous activity. Engaging in moderate-to-vigorous physical activities should be encouraged. Reducing sedentary behavior may also be beneficial, particularly among inactive older adults.
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Trends over time in the United States show success in rebalancing long-term services and supports (LTSS) toward increased home- and community-based services (HCBS) relative to institutionalized care. However, the diffusion and utilization of HCBS may be inequitable across rural and urban residents. We sought to identify potential disparities in rural HCBS access and utilization, and to elucidate factors associated with these disparities. ⋯ LTSS rebalancing efforts that limit the institutional LTSS safety net may have unintended consequences in rural contexts if they do not account for supply-side barriers to HCBS. We identified supply-side factors that (1) inhibit beneficiaries' access to HCBS, (2) affect the adequacy and continuity of HCBS, and (3) potentially impact long-term business viability for HCBS providers. Spatial isolation of beneficiaries may contribute to a perceived lack of demand and reduce chances of funding for new services. Addressing these problems requires stakeholder collaboration and comprehensive policy approaches with attention to rural infrastructure.