Literature Review

BREAKING: CMS issues ‘significant’ survey changes for 2025 [long-term care] McKnights Long-Term Care News; by Kimberly Marselas; 11/19/24 The Centers for Medicare & Medicaid Services on Monday issued “significant revisions” to its long-term care surveyor guidance, with changes affecting everything from admission and discharge standards to the use of psychotropic medications and newly adopted infection prevention practices. CMS released an advance copy of the 900-page document online, including new critical element pathways, to give providers and surveyors time to adjust to the new requirements before they go into effect Feb. 24, 2025. A significant portion of the changes is related to chemical restraints and unnecessary psychotropic medication.

There aren't enough dementia providers in Arizona. This unique campus offers training KJZZ Phoenix, AZ; by Kathy Ritchie; 11/15/24 Arizona has the fastest growth rate of Alzheimer’s disease in the country. Yet there are not enough paid caregivers or even geriatricians — only 92 in the entire state — for this population. So how do you educate, even inspire, health care students to care about dementia? As the saying goes, if you build it, they will come. Judy Ward is chatting with three nursing students from Creighton University when a group of preschoolers toddle on by. ... The children attend a care center located at Hospice of the Valley’s Dementia Care and Education Campus in Arcadia. That’s also where Judy’s adult day club for people living with dementia is situated, along with a 12-bed assisted living community and a hospice unit. ...

Alzheimer Disease—What’s in a name?JAMA Neurology; Ronald C. Petersen, PhD, MD; Elizabeth Mormino, PhD; Julie A. Schneider, MD, MS; 11/24Back in 2018, the National Institute on Aging (NIA)–AA [Alzheimer Association] group proposed a biological definition of AD [Alzheimer Disease] stating that if a person had the biomarker evidence of brain amyloid (A) and tau (T), the pathologic hallmarks of the disease, the patient had AD irrespective of the person’s clinical state. In their recent 2024 revision, they maintain a biological definition but have extended it to incorporate more recent biomarkers for AD; ... positivity on core 1 biomarkers that indicate the crossing of a specific amyloid threshold on amyloid positron emission tomography (PET), cerebrospinal fluid, and foreseeably, plasma biomarkers. A major question pertains to the requirement for tau in the definition [as] the AA group argues that the vast majority of individuals who have amyloid-positive PET scans have some tau pathology. Furthermore, the AA group proposes a clinical staging scheme that provides a framework to define the frequent mismatch between AD biomarker positivity (and underlying neuropathology) and the clinical expression of the disease, often an indicator of mixed pathologies or resilience. Importantly, although the AA group does base the AD diagnosis on biomarker positivity, they do not currently advise testing in asymptomatic persons in a clinical setting.

Veterans and Alzheimer's: 6 lifestyle tips for staving off the disease NOLA.com, New Orleans, Louisiana; by Dana Territo; 11/11/24 Are veterans more prone to Alzheimer’s disease? According to the U.S. Department of Veterans Affairs, veterans are more likely to develop Alzheimer's disease and other dementias than the general public, and the number of veterans with Alzheimer's is expected to grow. For instance, in 2021, an estimated 457,391 veterans had Alzheimer’s disease, and that number is projected to increase by 8.4% to more than 488,000 by 2033. Age is the biggest risk factor for Alzheimer’s disease as a whole, and veterans are more likely to have health conditions that further increase that risk, including high cholesterol, traumatic brain injury, post-traumatic stress disorder and depression. Additionally, homelessness contributes to that risk as homeless veterans are more likely to have an Alzheimer’s diagnosis than those who are stably housed.

Study: People with dementia more apt to be admitted to nursing homes with lower star ratings McKnights Long-Term News; by Kristen Fischer; 11/5/24 People living with dementia are less likely to be admitted to high-rated nursing homes compared to people who don’t have the disease, a new study finds. Researchers looked at admission to nursing homes with higher staffing ratings after hospitalization and how individuals fared in the nursing homes based on having or not having dementia. The report was published on Oct. 29 in Alzheimer’s & Dementia. The team evaluated traditional Medicare beneficiaries discharged to nursing homes between 2011 and 2017 along with the relationship between facility staffing star-ratings, short-term readmission and mortality. The number of vacant beds in nursing homes with high ratings was also considered. Data was derived from 5.6 million people who were discharged to nursing homes; 23.1% of the people had dementia.

Emergency department visits among patients with dementia before and after diagnosisJAMA Network Open; Cameron J. Gettel, MD, MHS; Yuxiao Song, MS; Craig Rothenberg, MPH; Courtney Kitchen, BA; Andrea Gilmore-Bykovskyi, PhD, RN; Terri R. Fried, MD; Abraham A. Brody, PhD, RN; Stephanie Nothelle, MD; Jennifer L. Wolff, PhD; Arjun K. Venkatesh, MD, MBA, MHS; 10/24Emergency department (ED) visits among persons living with dementia represent a substantial health care challenge, often necessitating targeted interventions to optimize care and support. We assessed changes in ED use before and after incident dementia diagnosis among Medicare beneficiaries aged 65 years and older. Within the entirety of the 12-month period assessed, having a diagnosis of dementia was associated with a 40% increase in the likelihood of having an ED visit.The observed changes in ED use, with peaks before and after dementia diagnosis, suggest that the diagnostic process may precipitate acute health care crises and increased health care–seeking behavior among individuals with dementia and their caregivers.

Mortality and function after widowhood among older adults with dementia, cancer, or organ failureJAMA Network Open; Rebecca Rodin, MD, MSc; Alexander K. Smith, MD, MS, MPH; Edie Espejo, MPH; Siqi Gan, MPH; W. John Boscardin, PhD; Lauren J. Hunt, PhD, RN; Katherine A. Ornstein, PhD, MPH; R. Sean Morrison, MD; 9/24In this cohort study including 13,824 participants in the Health and Retirement Study, widowhood was associated with functional decline and increased 1-year mortality in functionally impaired older adults with dementia and cancer. The study findings suggest that older adults with functional impairment and cancer or dementia are at risk of adverse outcomes following widowhood, including functional decline and a marked elevation in the risk of death, in the year after widowhood.

Patterns of migration following dementia diagnosisJAMA Network Open; Momotazur Rahman, PhD; Bishnu Bahadur Thapa, PhD; Christopher Santostefano, MPH, RN; Pedro Gozalo, PhD; Ulrike Muench, RN, PhD; Cyrus M. Kosar, PhD; Hyesung Oh, PhD; Elizabeth White, APRN, PhD; Vincent Mor, PhD; 10/24In this cohort study of more than 1 million Medicare fee-for-service beneficiaries, individuals with a diagnosis of dementia were almost twice as likely to migrate to another county or state compared with those with diagnoses of myocardial infarction, chronic obstructive pulmonary disease, or colon cancer. Of the excess migrations resulting from dementia diagnosis, 55% occurred in community settings, and 45% occurred in institutional settings. The marked increase in migration among patients following a dementia diagnosis highlights a distinctive need for policy and support interventions tailored to their unique migration patterns and care requirements.

Annual wellness visits and early dementia diagnosis among Medicare beneficiariesJAMA Network Open; Huey-Ming Tzeng, PhD; Mukaila A. Raji, MD, MS; Yong Shan, PhD; Peter Cram, MD, MBA; Yong-Fang Kuo, PhD' 10/24Optimal dementia care depends on early recognition of cognitive impairment and timely diagnosis of Alzheimer disease and related dementias (ADRD). Optimal dementia care should reflect what matters most to patients and adhere to evidence-informed ADRD stage-specific health care. These findings indicate that AWV [annual wellness visit] recipients had a timelier first MCI [mild cognitive impairment] diagnosis than those who did not receive an AWV, but first ADRD diagnosis differed little. This study suggests that the Medicare AWV health policy may increase MCI identification, prompting more specialized care.

Millions of aging Americans are facing dementia by themselves California Healthline; by Judith Graham; 10/15/24 Sociologist Elena Portacolone was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her. It seemed clear they had some type of cognitive impairment. Yet they were living alone. Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing? ... Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States. ... Imagine what this means. ...

Implementation and outcomes of a dementia-friendly training program in five hospitalsGeriatric Nursing; Ellen Roberts, Ellen C Schneider, Maureen Dale, Cristine B Henage, Casey J Kelley, Jan Busby-Whitehead; 10/24Hospitalized patients living with dementia (PLWD) age 65+ generally experience poor outcomes. This study's purpose was to implement dementia-friendly training with staff, track patient outcomes, and implement sustainable system changes. Positive changes in staff ratings from pre- to post- intervention were observed. Number of falls and readmissions did not change. The average number of stays per patient decreased ... Conclusions: Dementia-friendly hospital training is effective in improving staff recognition of the symptoms and needs of PLWD, and responding appropriately.

Is end-of-life care consistent with wishes of patients with dementia? Oklahoma University News, Oklahoma City, OK; by April Wilkerson; 10/8/24 Soon after a dementia diagnosis, many people document their preferences for medical care near the end of their lives, often stipulating that they want to avoid hospitalizations and aggressive interventions. A new University of Oklahoma study aims to discover whether the actual care they receive aligns with their preferences. Lee Jennings, M.D., a geriatrician and associate professor in the OU College of Medicine, recently received a $2.3 million grant from the National Institutes of Health to analyze the end-of-life experiences of about 550 people with dementia, as well as their caregivers. The findings will advance medical knowledge of how best to care for people with an incurable disease that often robs them of their cognition, causes swallowing disorders, and leads to immobility and falls. An estimated 5 million Americans are affected by Alzheimer’s disease and related dementias, a number that is expected to increase to 10.5 million over the next 25 years. 

One Senior Place: What legal steps should be taken after dementia diagnosis? Florida Today; by Brenda Lyle; 10/1/24 After a dementia diagnosis, preparing key legal documents early helps families focus on the quality of life for their loved one. ... Dementia is a term for many progressive neurodegenerative disorders that affect memory, thinking, and behavior. Alzheimer accounts for about 60% of all dementias. As the disease advances, individuals may lose the ability to make informed decisions about their health care, finances and other important aspects of life. Legal planning is absolutely crucial for ensuring that the wishes of the person with dementia are honored and that their affairs are managed appropriately. This planning also helps reduce stress for family members and caregivers. [Click on the title's link to continue reading for basics about Durable power of attorney, Heath care surrogate, Living will, Last will and testament, and Guardianship.]