搜索结果：Journal of the American Medical Directors Association

Ethnic and linguistic minorities in nursing homes often face poorer health outcomes, particularly in language-discordant settings. This study examined the impact of the pandemic on end-of-life outcomes for Chinese-speaking residents in language-concordant and language-discordant facilities. Population-based retrospective cohort study. Chinese-speaking nursing home residents over 65 years old in Ontario, Canada, who died within the first 10 months of the pandemic (n = 636), compared with those who died before the pandemic (n = 423). Primary language spoken was identified using the Resident Assessment Instrument-Minimum Data Set, version 2.0. Nursing homes were classified as language concordant if they were culturally designated facilities or if Chinese-speaking residents represented at least 20% of their resident population. Outcomes included location of death and acute care use (ie, hospitalization or emergency department [ED] visits) in the last 30 days of life. Multilevel models were used to assess the immediate impact of the pandemic on these outcomes by language concordance status. Chinese-speaking residents in language-concordant homes had significantly lower risks of hospitalization (risk ratio [RR], 0.52; 95% CI, 0.30-0.91), ED visits (RR, 0.48; 95% CI, 0.34-0.69), and hospital deaths (RR, 0.55; 95% CI, 0.37-0.83) during the pandemic relative to the prepandemic period. In language-discordant homes, risk of hospitalization declined (RR, 0.51; 95% CI, 0.32-0.80), but changes in ED visits and hospital deaths were not statistically significant between the 2 periods. Lower ED visits and hospital deaths were observed primarily among Chinese-speaking residents in language-concordant nursing homes, despite their prepandemic rates being equivalent to or higher than those in language-discordant settings. This suggests that enhanced language support may have facilitated better conversations about care that could be provided in place during the public health crisis, thereby avoiding transfers to acute care at the end of life.

The diagnosis of depression may be challenging in older adults with dementia because of atypical symptoms and overlap with other comorbidities. While the Cornell Scale for Depression in Dementia (CSDD) is the gold standard for screening, the Saint Louis University-Appetite, Mood, Sleep, Activity, and Thoughts of Death (SLU-AMSAD), another brief screening tool designed to assess late-life depression, seems to be more practical than the CSDD, with a shorter test duration. Cross-sectional validation study. In this study, conducted at a geriatric outpatient clinic, a total of 111 patients with dementia were enrolled, and both depression and dementia were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The SLU-AMSAD was administered to both patients and caregivers, along with the CSDD. Spearman's rank correlation coefficient was used to assess the correlation between the SLU-AMSAD and CSDD. The diagnostic accuracy of the SLU-AMSAD was evaluated using receiver operating characteristic analysis, with the area under the curve (AUC). Caregiver-reported SLU-AMSAD scores demonstrated a strong correlation with CSDD (r = 0.875; P < .001), whereas patient-reported SLU-AMSAD scores exhibited a moderate positive correlation (r = 0.384; P < .001). With an optimal cutoff of &#x2265;3, diagnostic performance was substantially stronger for the caregiver-reported SLU-AMSAD-achieving 95.3% sensitivity and 93.6% specificity (AUC, 0.984; 95% CI, 0.965-1.000; P < .001)-whereas the patient-reported SLU-AMSAD yielded a sensitivity of 59.4% and a specificity of 83% (AUC, 0.731; 95% CI, 0.638-0.823; P < .001). The SLU-AMSAD is a valid and practical screening tool for depression in older adults with dementia. Given the shorter duration and strong caregiver-reported performance, it should be integrated into clinical dementia assessment, facilitating early detection and intervention for depression in such a vulnerable patient group.

The Life-Space Assessment (LSA) is a measure that assesses community mobility; however, its predictive validity has not been assessed in Canadians. This study assessed the predictive validity of the LSA among community-dwelling Canadians for adverse outcomes after 3 years. A longitudinal analysis of the Canadian Longitudinal Study on Aging (CLSA) comprehensive data set. Data from the CLSA were used (n = 22,695). The average age of the sample at baseline was 62.9 years (SD, 10.1), with a median LSA score of 90 (interquartile range, 74-100). Receiver operating characteristic curves were conducted to determine whether the LSA scores at baseline could distinguish between those who experienced adverse outcomes at 3-year follow-up. Analyses were stratified by age and sex. We expected an area under the curve (AUC) of &#x2265;0.7. AUC values ranged from 0.50 to 0.58 for predicting emergency department visits, nursing/convalescent home visits, hospitalizations, serious injuries, and injuries because of a fall. When stratified by age and sex, AUC values remained low. The LSA did not show evidence of predictive validity for adverse outcomes among middle-aged and older Canadian adults after a 3-year follow-up. This may be because of the CLSA sample being relatively highly functioning at baseline, the 3-year-long gap in assessment, and the low prevalence of adverse outcomes in this sample. Further research is needed to determine the usefulness of the LSA for predicting these adverse outcomes at the population level.

To evaluate the proportion, demographic characteristics, and care needs of people with Parkinson's disease (PD) in Australian residential aged care facilities (RACFs). Retrospective observational study (2012-2022) and cross-sectional study (2022). Permanent residents with PD living in Australian RACF during 2012 to 2022. Annual data, including demographic and clinical characteristics between 2012 and 2022, were obtained from the Australian Institute of Health and Welfare National Aged Care Databases. The Aged Care Funding Instrument assessed care needs as high, medium, or low across 3 domains. Trends in the proportion and profile of residents with PD over time were reported descriptively, together with cross-sectional data from residents in 2022. Joinpoint regression analysis was used to explore changes in the proportion of PD over time. The associations between demographic and clinical factors and high care needs and the associations between sex and dementia, depression, and anxiety were examined in the 2022 cohort using logistic regression. From 2012 to 2022, the number of residents with PD increased from 8962 to 10,024, representing a within-RACF proportion of 5.5% in 2022. The percentage of residents with high care needs increased over this period in all Aged Care Funding Instrument domains (activities of daily living: 63%-85%; behavior: 55%-68%; and complex health care: 39%-68%). In 2022, 51% of residents with PD were male, and 66% were aged &#x2265;80 years. The proportion of PD was higher among males (8.4% vs 4.1% females), and they were more likely to have dementia compared with females (odds ratio, 1.6; 95% CI, 1.5-1.7). Age was not associated with high activities of daily living or complex health care needs. The population of residents with PD in RACFs is growing, with increasing levels of disability and comorbid health conditions. These findings highlight the need for evolving care models, workforce development, and planning to meet the growing demand for services.

To examine how organizations assess their innovation readiness (IR) maturity using the Maastricht Innovation Readiness Approach (MIRA) Questionnaire. Cross-sectional study in 21 Dutch long-term care organizations. Health care professionals with insight into their organization's IR completed the questionnaire, including those in care, management, human resource management, communication, and client representation. Data were collected using the MIRA Questionnaire, based on the IR framework, containing 4 domains: strategic direction, organization of innovation, leadership for innovation, and learning climate. The response options include 5 IR positions: "not," "informal," "occasionally," "consistently," and "optimally," reflecting a progression in IR maturity and a "no insight" position. The MIRA Questionnaire was completed by 409 participants in 21 long-term care organizations. Across nearly all (n = 20) organizations, "consistently" was most frequently selected (mean [after which is M] = #21, 38%), particularly within the "strategic direction" domain (M = #21, 43%). In the "learning environment" domain, however, the "not" and "informal" positions were most frequently chosen (M = #21, 34%), suggesting that these factors were either not implemented or put in practice or only implemented without formalization. Questions about the active involvement of managers and intended end users (clients and family members) received more frequent responses in the "not and informal" positions (M = #21, 47%, 21%) and fewer responses in the "occasionally, consistently, and optimally" positions (M = #21, 25%, 59%). The main findings indicate that most health care organizations' attention goes to strategy and organizing for innovation but less to leadership and the learning climate. This might indicate a temporal order in organizing the IR factors. Improving IR requires balanced attention to all factors of the IR framework. MIRA can support organizations by identifying specific steps to improve IR. Additional research is necessary to longitudinally track whether and how organizations translate MIRA use into actions that improve their IR. Policymakers can utilize these findings to develop sector-wide programs that promote learning for sustainable IR.

Functional decline during acute-care hospitalization is a critical challenge. While rehabilitation volume influences recovery, the role of organizational factors is less defined. We examined whether therapist-led ward-based management modifies the association between conventional rehabilitation volume and activities of daily living (ADL) gain. Multicenter retrospective observational cohort study. Data from 4166 consecutive patients across 18 acute-care wards in 9 Japanese hospitals. The primary outcome was ADL gain (Barthel Index change from admission to discharge). Ordinary least squares regression models with mean-centered continuous variables were employed to evaluate interaction patterns while adjusting for age, admission Barthel Index, and ward-level average length of stay per clinical specialty. We investigated the independent main effects, 2-way interactions, and the 3-way interaction among therapist-led ward management, weekday rehabilitation volume, and weekend rehabilitation volume. While the main effect of ward management was not significant (P = .390), a significant positive 2-way interaction emerged between management and weekend rehabilitation volume (&#x3b2; = 0.968; P = .021). Furthermore, a significant 3-way interaction was observed among management, weekday, and weekend rehabilitation volume (&#x3b2; = 0.186; P = .005), with all variance inflation factors for interaction terms &#x2264;5.05. Therapist-led ward management was not independently associated with ADL gain; however, significant interaction patterns were observed with weekday and weekend rehabilitation volume. In particular, the interaction with weekend rehabilitation volume suggests that ward-based management may support more consistent rehabilitation delivery across the week. These findings suggest that organizational ward-based management may influence how rehabilitation exposure is associated with functional recovery during acute-care hospitalization. Organizational strategies emphasizing structured interdisciplinary integration, rather than solely increasing therapy volume, may help support functional outcomes in hospitalized older adults.

To analyze the global, regional, and national burden of heart failure (HF) attributable to hypertensive heart disease (HHD) from 1990 to 2021, with a focus on age and sex disparities, thereby providing multidimensional evidence to optimize hypertension control strategies and strengthen targeted HF prevention systems. Cross-sectional trend analysis using the Global Burden of Disease 2021 database, with decomposition and inequality analyses. Not applicable. Using standardized methodologies from the Global Burden of Disease 2021 study, we assessed the burden of HHD-related HF across global, regional, and national levels, with stratification by age and sex. Joinpoint regression was employed to identify inflection points in temporal trends. Spearman correlation analysis evaluated the association between age-standardized rates and the sociodemographic index (SDI). Cross-national inequality analysis and decomposition methods were further applied. Over the 32-year period, both the prevalence and years lived with disability rates of HHD-related HF increased globally. Low-SDI regions bore the highest absolute burden, whereas high-SDI countries exhibited the most pronounced relative growth in burden. Absolute and relative inequalities in HHD-related HF declined significantly. Population aging, population growth, and epidemiologic transitions collectively drove the rising burden. The global burden of HHD-related HF continues to rise, primarily fueled by population aging, though regional trends, and underlying drivers vary substantially. To address this challenge effectively, tailored prevention strategies should be implemented alongside global collaboration and equitable health care resource allocation, ensuring region-specific precision in HHD-related HF control.

To assess 30-day mortality, readmissions, and cost-effectiveness following implementation of a new postsurgical care pathway compared with usual care after hip fracture. Prospective multicenter cohort study (January 2022-June 2025). The intervention was implemented from November 2023. The study was conducted across 3 hospitals and 18 municipalities in the Region of Southern Denmark. A total of 2609 patients aged &#x2265;65 years undergoing hip fracture surgery were included (mean age, 82 years; 67% female). Of these, 524 received the intervention and 2085 received usual care. The intervention consisted of a 14-day postdischarge period with structured safety monitoring (vital signs, mobilization, and pain), mandatory municipal nurse follow-up visits, and the option for nurse-hospital consultation to support at-home management. The primary outcome was 30-day mortality. Secondary outcomes included 30-day readmission, mean 3-month costs, number needed to treat, and incremental cost per saved life. Analysis was preplanned, and average treatment effects were estimated using targeted maximum likelihood estimation for mortality G-computations for readmission. Thirty-day mortality decreased from 11.9% to 8.0% in the intervention group (odds ratio, 0.60; 95% CI, 0.37-0.85), corresponding to a number needed to treat of 19. Readmissions increased (18.6% vs 13.6%; risk ratio, 1.28; 95% CI, 1.05-1.56). Mean 3-month costs were &#x20ac;1079 higher in the intervention group (95% CI, &#x20ac;395-&#x20ac;1767). The incremental cost per life saved was &#x20ac;21,590. Implementation of a structured postsurgical care pathway reduced early mortality after hip fracture and was cost-effective according to international thresholds, despite increased readmissions. These findings support the adoption of coordinated postdischarge care pathways in clinical practice and health systems. Future research should examine mechanisms underlying increased readmissions and assess long-term outcomes and cost-effectiveness.

Rising eldercare expenditures and rapid aging of the US population have intensified pressures on families, who increasingly provide both direct "hands-on" care and financial support ("transfers") to aging relatives. To elucidate how population aging is reflected in families' financial caregiving roles, this study characterizes national trends in out-of-pocket financial transfers to parents. Repeated cross-sectional analysis from the Health and Retirement Study (2002-2018). Eight thousand eight hundred fifty-nine US households in which either the respondent or their spouses reported providing financial assistance to a parent or a parent-in-law. Outcomes included (1) whether households provided any financial transfer (&#x2265;$500) and (2) the total transfer amount (in 2018 dollars) among those that provided support. Caregiving subgroups were defined by parental need for assistance with activities of daily living, the presence of dementia, and coresidence. We used generalized linear models with household survey weights to estimate nationally representative time trends and conducted subgroup analyses by caregiving subgroups. Coresiding households had disproportionately lower income and wealth, yet consistently displayed the highest probability of providing financial transfers, exceeding 30% in most years. Households assisting with activities of daily living or supporting a parent with dementia were also more likely to contribute financially and reported higher annual transfers. Adjusted mean contributions peaked at $10,614 in 2008 but overall remained relatively consistent through 2018, including among households with heightened parental care needs. Families continue to shoulder a substantial share of aging-related care expenses, with financial burdens disproportionately concentrated among households providing intensive caregiving and those with fewer economic resources. These findings underline the hidden costs of population aging that are borne inequitably across socioeconomic status and signal the need for policy solutions that mitigate the financial burden on families supporting aging parents.

To assess the utility of point-of-care ultrasound (PoCUS) in the clinical evaluation of older adults within intermediate and long-term care (LTC) settings. Retrospective cross-sectional, single-center study. Individuals aged 65 years or older who underwent PoCUS during the study period (March 1, 2022-March 31, 2025) within an intermediate care center and its affiliated LTC units. A geriatrician trained in multiorgan PoCUS performed the ultrasounds at the request of the attending physicians, all of whom were directly involved in the patient's care at a post-acute and long-term care (PALTC) facility. Each case followed an individualized PoCUS protocol based on specific clinical questions to be answered. Clinical, functional, frailty, and ultrasound data were collected from medical records for analysis. Among 2563 individuals treated at PALTC, 315 PoCUS scans were conducted on 244 patients (mean age, 86 &#xb1; 8.6 years). Most exams (62%) were done in the subacute unit, with 19% performed in LTC and 14% in the functional recovery unit. PoCUS was mainly used to support physical examinations (23%); its findings confirmed clinical suspicion in about one-third of cases, ruled clinical suspicion out in another third, led to new and unsuspected diagnoses in a quarter of patients, and was used for follow-ups or guided procedures in the rest. PoCUS led to treatment changes in 56% of cases, avoided 47 (17%) unnecessary transfers to the emergency department, and avoided the performance of 35 (11%) of invasive procedures. Attending physicians indicated a reduction in clinical uncertainty in 96% of cases. PoCUS supports the clinical assessment and management of older adults in PALTC settings, potentially improving clinical decision-making, identifying new pathologies, guiding treatment, promoting safer procedures, and reducing unnecessary referrals and interventions. However, effective use and feasibility depend on adequate training and education.

Polypharmacy and anticholinergic burden (AB) are highly prevalent among older adults and have been linked to adverse health outcomes. However, their associations with systemic inflammation remain insufficiently characterized. Population-based cross-sectional study. Data were obtained from the US National Health and Nutrition Examination Survey (1999-2020). A total of 11,647 adults aged 65 years or older who reported prescription medication use were included. Polypharmacy was defined by prescription medication count, and AB was evaluated using multiple established AB scales. Systemic inflammation was evaluated using C-reactive protein (CRP), high-sensitivity CRP, fibrinogen, and 6 composite indices derived from blood cell counts. Correlation matrices and weighted multivariable linear regression models were used to examine associations. After full adjustment, hyperpolypharmacy was associated with approximately 40% higher CRP levels (P < .001), whereas polypharmacy alone was not independently associated with CRP (P = .113). Higher AB assessed using the Anticholinergic Cognitive Burden Scale, Anticholinergic Drug Scale, and Anticholinergic Risk Scale, as well as anticholinergic medication use, was associated with approximately 16% to 44% higher CRP levels (all P < .050). Associations with high-sensitivity CRP were observed primarily for the Anticholinergic Cognitive Burden Scale (P = .004), whereas associations with fibrinogen were most evident for the Anticholinergic Drug Scale (P = .030). Joint-effect analyses further showed that polypharmacy without AB was not associated with CRP, whereas the co-occurrence of polypharmacy and AB was associated with the highest CRP levels. Among US older adults, AB was consistently associated with elevated systemic inflammation, particularly in the context of polypharmacy. These findings underscore the importance of considering anticholinergic properties in geriatric pharmacotherapy.

Neurodegenerative diseases pose increasing challenges to aging societies, requiring medical care models that extend beyond hospital-centered services. This article summarizes the development and implementation of Taiwan's home-based medical care (HBMC) model for people with neurodegenerative diseases. Narrative policy review and descriptive synthesis. Taiwan's nationwide HBMC program is under the National Health Insurance system. This brief communication synthesizes Taiwan policy developments, programmatic structures, and implementation outcomes of HBMC, including its integration with advance care planning, acute care, home health care, post-acute care, and the hospital-at-home model. Taiwan's HBMC has evolved through 3 stages, beginning with National Health Insurance-supported home health care in 1995, expanding into the integrated home-based medical care program in 2016, and advancing to the digitally enabled hospital-at-home model in 2024. The program demonstrates substantial structural capacity, effective care processes supported by telemedicine and point-of-care testing, and favorable outcomes, including reduced hospital utilization, lower healthcare expenditures, and effective targeting of functionally impaired older adults. Vertical integration across acute, post-acute, and long-term care services, together with horizontal collaboration among multidisciplinary teams, enables coordinated, continuous, and patient-centered care across the disease trajectory. Taiwan's experience highlights the feasibility and effectiveness of integrated home-centered care for neurodegenerative diseases and offers transferable insights for health care systems facing rapid population aging.

To develop and validate machine learning models for predicting clinician-determined follow-up interval categories in home care services among older adults enrolled in the YASAM (Healthy Aging Team Supported Home Care Services) program. Secondary analysis of a multicenter observational cohort study. A total of 4783 community-dwelling adults aged &#x2265;80 years enrolled in the YASAM program between 2023 and 2024. The primary outcome was follow-up frequency time, defined as the planned interval between consecutive face-to-face home care visits determined by an interdisciplinary geriatric care team following comprehensive geriatric assessment and used as the reference standard for model development. Follow-up frequency time was categorized into short (&#x2264;30 days), medium (31-90 days), and long (>90 days) follow-up intervals. Seventeen candidate predictors representing demographic, clinical, cognitive, functional, nutritional, mood-related, frailty, and physical performance domains were evaluated. After correlation-based feature selection, 8 core predictors were retained. Missing data were handled using feature-wise imputation. Random forest, extreme gradient boosting, and feed-forward artificial neural network models were developed using a 70/15/15 training-validation-test split. Model performance was assessed using accuracy, precision, recall, F1 score, and confusion matrices. Extreme gradient boosting demonstrated the highest classification performance, achieving an accuracy of 83%, a precision of 0.83, a recall of 0.82, and an F1 score of 0.82. Random forest achieved an accuracy of 81%, whereas the neural network achieved an accuracy of 78%. Misclassifications occurred predominantly between adjacent follow-up interval categories. SHapley Additive exPlanation-based analyses identified physical performance, cognitive function, nutritional status, and frailty-related measures as major contributors to follow-up interval prediction. Machine learning models demonstrated substantial predictive performance with interdisciplinary team-determined follow-up interval categories among community-dwelling older adults. Explainable artificial intelligence analyses highlighted the contribution of multidimensional geriatric assessment domains to individualized follow-up planning. These findings support the potential role of artificial intelligence-assisted decision support in home-care scheduling, although external validation is required before routine clinical implementation.

Recreational activities are crucial for enhancing the well-being of persons living with dementia (PLwD), yet designing and implementing high-quality activities impose substantial demands on recreational activity staff (hereafter, activity leaders) who facilitate activities in dementia care settings. Moreover, while developing effective group activities requires attention to the needs of both PLwD and activity leaders, no prior research has examined how the use of enhanced, preprepared activity materials contributes to activity leaders' professional experience. Enhanced group activity kits (EGAKs) were developed to optimize group activities for PLwD and have previously been shown to positively affect PLwD. This study examines the impact of EGAKs use on activity leaders who facilitated these recreational group activities. Mixed-methods pilot study. This study included 14 activity leaders from 10 dementia care units who implemented EGAKs during routine group activities. Participants completed a post-intervention questionnaire and/or a follow-up questionnaire after using EGAKs. Four questions were analyzed quantitatively, and the primary analysis involved an inductive content analysis of open-ended responses. Both authors iteratively reviewed and refined the categories to ensure analytic rigor and credibility. Activity leaders reported that using EGAKs had a substantial professional impact, including a deeper understanding of participating PLwD and enhanced skills for facilitating group activities. They attributed these effects to the combined experience of using EGAKs and completing outcome and fidelity-to-principles questionnaires. Additional themes pertained to improved relationships with participants and personal benefits from the experience. Using EGAKs, especially when paired with reflective questionnaires, served as a valuable training experience that improved activity leaders' professional insights and skills. EGAKs were perceived as more enjoyable and easier to use than designing high-quality recreational activities independently. Given their modest costs and perceived benefits, broader dissemination of EGAKs warrants further exploration.

To examine the efficacy of exercise in reversing prefrailty in exclusively prefrail older adults. A systematic review. The older adults (&#x2265;60 years old) in the prefrailty period. In this systematic review of randomized controlled trials (RCTs), 6 international databases were systematically searched. We employed the revised Cochrane risk of bias tool for RCT quality appraisal. Due to substantial heterogeneity of the included studies, we did not conduct meta-analyses. Instead, for each included study, we extracted the data on postintervention frailty status to calculate the odds ratio for improvement in frailty status in the intervention vs the control group. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence bodies. Eight RCTs were included. It is found that professionally supervised exercise was safe and well accepted for prefrail older adults. However, on the efficacy of exercise in reversing prefrailty, the observed positive effects were primarily supported by low-certainty bodies of evidence, whereas the more methodologically rigorous evidence largely showed nonfavorable results, particularly for sustained benefits. Given the inconsistent findings and the limited certainty of the available evidence, it remains uncertain whether exercise has immediate and sustained effects on reversing prefrailty in older adults. Professionally supervised exercise is safe for older adults; it should, however, be approached with caution as a standalone strategy to reverse prefrailty. To provide more scientific guidance for practice, we recommend future high-quality RCTs with both intention-to-treat and per-protocol analyses, rigorous handling of missing data, and well-defined, tailored exercise regimens for prefrail older adults.

In light of the very restricted knowledge, we aimed to examine future nursing home (NH) preferences regarding LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other sexual and gender minority) issues among heterosexuals and sexual minorities in Germany. Representative sample of the German general adult population. Individuals residing in Germany aged 18 to 74 years (n = 2518; average age was 47 years). Regarding future NH preferences, outcomes focused on the importance of tolerance toward LGBTQIA+ individuals, offering LGBTQIA+ friendly services and treatments, and openness to the concerns of LGBTQIA+ individuals. The main independent variable was sexual orientation (heterosexual; sexual minorities encompassing homosexual, bisexual, or other). Several sociodemographic and health-related covariates were incorporated in the regression model. Overall, 8.7% of the respondents belonged to the group of sexual minorities. Regarding future NH preferences, unadjusted and adjusted regressions showed that sexual minorities had a higher importance of tolerance toward LGBTQIA+ individuals (&#x3b2; = 1.44; P < .001), offering LGBTQIA+ friendly services and treatments (&#x3b2; = 1.15; P < .001), and openness to the concerns of LGBTQIA+ individuals (&#x3b2; = 1.29; P < .001). Our results were mainly driven by differences between heterosexuals and homosexuals. The identified differences in the preferences regarding LGBTQIA+ issues between heterosexual and sexual minority people showed the particular significance of these factors for the group of sexual minorities (and homosexuals in particular). Taking such factors into account might probably contribute to the satisfaction of sexual minorities in NHs. Moreover, our results are important for NH operators and health policymakers.

To identify trajectories of frailty as older men age and to assess the associations between sociodemographic, lifestyle, and health factors with those trajectories. Community-based cohort study. Data from 1319 men aged 71 years or older, residing in Western Australia and participating in the Health in Men Study. Frailty was assessed on at least 2 occasions between 2001 and 2019 using the five-point FRAIL scale that measures fatigue, resistance, ambulation, illnesses, and weight loss. Latent frailty trajectories over age were identified using a group-based trajectory model with an extension to allow for participant attrition because of death. Multinomial logistic regression was used to assess differences in sociodemographic, lifestyle, and health factors between the frailty trajectory groups. Sensitivity analyses were performed to assess the impact of including/excluding participants who dropped out. During follow-up, 999 (66.9%) participants died. Four distinct frailty trajectories were identified: prefrail to frail (11.7%), steady decline (39.2%), slower decline (37.2%), and sustained nonfrailty (11.9%). Smokers, those with less than 150 minutes of physical activity per week, or those having a diagnosis of cardiovascular disease or diabetes by age 70, were all more likely to be in the prefrail to frail trajectory than the sustained nonfrailty group. Sensitivity analyses showed similar results when those who were lost to follow-up were included in the analysis; however, when limiting the data set to only those who continued to participate throughout the study period, the most severe frailty trajectory was no longer detected. We identified heterogeneity in frailty progression as men age. Frailty interventions may need to focus on lifestyle modifications and addressing or preventing underlying medical conditions prior to the age of 70. Adjustment for nonrandom attrition of participants is required to determine the long-term impact of frailty.

To examine the association between self-reported sleep duration and incidence of long-term care insurance (LTCI) certification in older Japanese adults. Prospective cohort study. Nonlinear associations were explored using restricted cubic spline (RCS) modeling. We prospectively followed 9576 community-dwelling adults (3267 men; 6309 women; mean age, 71.1 years) for a mean of 10.3 years. Sleep duration was categorized into six 1-hour increments. The incidence of LTCI certification was identified via municipal records. Cox proportional hazards models and RCS analysis were adjusted for sociodemographic, lifestyle, and clinical factors. Same analyses were conducted by sex and age group (65-74 vs &#x2265;75 years). In multivariable-adjusted models, using 7 to <8 hours/d as the reference category, long sleep duration (&#x2265;9 hours/d) was consistently linked to a higher risk of incident LTCI certification (hazard ratio [HR], 1.17; 95% CI, 1.03-1.32 for 9 to <10 hours/d; HR, 1.26; 95% CI, 1.11-1.42 for &#x2265;10 hours/d). Although short sleep duration (<6 hours/d) was associated with elevated LTCI risk in partially adjusted models, the association was attenuated and no longer statistically significant in the fully adjusted model (HR, 1.21; 95% CI, 0.99-1.48). RCS analysis indicated a nonlinear association between sleep duration and LTCI risk (P for nonlinearity <.001), although the association was more pronounced for long sleep duration. This nonlinear pattern was more evident among women and adults aged 65-74 years but less pronounced in men and those 75 years or older. A similar tendency was also observed for severe cases (care need level &#x2265;2). A nonlinear pattern suggested increased LTCI risk at the extremes of sleep duration, with a more pronounced risk at longer sleep durations. These findings suggest that sleep patterns represent modifiable risk factors for functional decline and long-term care needs in older adults.

California conducts audits of skilled nursing facilities (SNFs) to ensure required staffing levels. We examined facility characteristics associated with failing these staffing audits, trends before and during the COVID-19 pandemic, and the impact of waiver policies. Longitudinal repeated cross-sectional, multivariate logistic regression with a difference-in-differences framework. Three thousand nine hundred sixty-four staffing audit observations of the Centers for Medicare and Medicaid Services-certified California SNFs from July 2018 to June 2022. We merged California Department of Public Health data to federal data sources. We analyzed associations between audit outcomes, facility characteristics (eg, waiver status [applied for, approved, and denied], ownership, chain affiliation, size, average occupancy rate, share of residents enrolled in Medicaid, and resident racial/ethnic composition) before, during, and after the COVID-waiver periods. Audit failures increased from 7% in fiscal year 2019 to 55% in fiscal year 2021. The odds of failing rose over time (Q1-Q14; adjusted odds ratio [aOR], 1.581; 95% CI, 1.480-1.690). Odds differed significantly in the pre-COVID, COVID-waiver, and post-COVID-waiver periods. In multivariable regression, failure was associated with for-profit, chain-affiliation facilities vs nonprofit, independent facilities (aOR, 2.634; 95% CI, 1.757-3.947), rural location (aOR, 3.237; 95% CI, 1.925-5.443), and Medicaid share (aOR, 1.178; 95% CI, 1.079-1.285). Waivers lowered the odds of failure, but SNF applicants denied workforce shortage waivers were not more likely to fail. SNFs with higher proportions of Asian residents had lower failure odds (aOR, 0.853; 95% CI, 0.780-0.933), whereas SNFs with more Black residents had higher odds (aOR, 1.101; 95% CI, 1.015-1.195). While the audit failure rate was climbing before the pandemic, the shallower failure trajectory post-COVID waivers reflects a new, rather than continuing, trend. As workforce shortage waiver denials were not associated with audit failure, the California Department of Public Health policy effectively determined SNFs that did not need a waiver. Associations between SNF racial composition and audit failure, controlling for other characteristics, warrant further study.