Journal of the American Medical Directors Association
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To explore factors associated with frailty across the continuum of healthy aging to cognitive impairment (mild cognitive impairment [MCI], mild and moderate Alzheimer disease [AD]). ⋯ Our findings lend initial support to the case for stage-specific interventions for physical frailty with the focus on SO in healthy community-dwelling older persons and cognitive-based measures in older adults with cognitive impairment. The accurate clinical phenotyping would then set the stage for future potential investigative therapies along these specific lines, rather than an undifferentiated approach.
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The aim of this study was to describe the process of advance care planning (ACP) and to explore factors related to the timing and content of ACP in nursing home patients with dementia, as perceived by family, physicians, and nurses. ⋯ ACP is a multifactorial process, which may lean on professional caregivers' guidance. The most acute decisions are covered in advance, but a responsive as well as a proactive style is seen with other treatment decisions. Further research is needed to increase understanding of whether and how the physicians' strategies affect care processes and outcomes.
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Comparative Study
A Frailty Index Based on Common Laboratory Tests in Comparison With a Clinical Frailty Index for Older Adults in Long-Term Care Facilities.
Easily employed measures of frailty are needed in the evaluation of elderly people. Recently, a frailty index (FI) based on deficits in commonly used laboratory tests (the FI-LAB) has been proposed. To address the usefulness of the FI-LAB in long-term care (LTC) settings, we studied institutionalized participants in the Canadian Study of Health and Aging first clinical examination database. Our objectives were to compare the FI-LAB with a clinical FI LTC (FI-Clinical-LTC) focused on common health deficits seen in LTC and to assay its relationship with mortality. ⋯ An FI based on routinely collected laboratory data can identify LTC residents at increased risk of death. This approach may be a useful screening tool in this setting.
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Comparative Study
Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter?
To establish if proprietary status (ie, for-profit or not-for-profit) is associated with mortality and hospitalizations among publicly funded long-term care (nursing) homes. ⋯ Publicly funded for-profit facilities have significantly higher rates of both mortality and hospital admissions.
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Medical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. ⋯ The MedTEC program appears to be a successful innovation in medical student education on levels of care. It could serve as a model for building competency of health professionals on managing care transitions and determining appropriate levels of care for older adults.