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  • JAMA Internal Medicine August 1, 2017

    Figure 2: Dementia Probabilities Over Time From Back-Transformed Linear Mixed-Effects Modeling of Log Odds of Dementia Probability

    Trajectories displayed are at the mean of adjustment covariates, where relevant. Shaded areas indicate 95% confidence interval.
  • Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders

    Abstract Full Text
    JAMA Intern Med. 2017; 177(8):1146-1153. doi: 10.1001/jamainternmed.2017.1622

    This longitudinal, population-based cohort study uses Health and Retirement Study data to investigate the association between persistent pain and memory decline and dementia.

  • Association of a Communication Training Program With Use of Antipsychotics in Nursing Homes

    Abstract Full Text
    JAMA Intern Med. 2017; 177(6):846-853. doi: 10.1001/jamainternmed.2017.0746

    This quasi-experimental longitudinal study quantifies the influence of a large-scale communication training program on nursing home antipsychotic use.

  • JAMA Internal Medicine February 1, 2017

    Figure 2: Subgroup Analyses of the Effect of β-Blockers on Functional Decline and Death

    P values show the significance of effect modification on the multiplicative scale (determined using the Wald test). Values for additive effect modification are expressed as relative excess risk due to interaction (RERI). For the outcome of functional decline, RERI for moderate dependence in activities of daily living (ADL) is 0.11 (95% CI, −0.36 to 0.58; P = .65) and for high dependence in ADL, 0.66 (95% CI, 0.20 to 1.13; P < .01), indicating positive additive interaction for high ADL dependence. The RERI for worse cognitive performance score (CPS) is 0.08 (95% CI, −0.12 to 0.29; P = .42); for increased age, −0.14 (95% CI, −0.38 to 0.11; P = .27); and for intensive care unit or cardiac care unit (ICU/CCU) stay, −0.03 (95% CI, −0.29 to 0.24; P = .85). For the outcome of death, RERI for moderate dependence in ADL is −0.35 (95% CI, −0.70 to 0.01; P = .05), indicating potential negative additive interaction. The RERI for higher ADL dependence is −0.19 (95% CI, −0.54 to 0.17; P = .31); for worse CPS, −0.15 (95% CI, −0.42 to 0.12; P = .29); for increased age, 0.00 (95% CI, −0.21 to 0.22; P = .97); and for ICU/CCU stay, −0.05 (95% CI, −0.26 to 0.14; P = .60). HR indicates hazard ratio; OR, odds ratio.aAn ADL score less than 14 corresponds to independence or requiring limited assistance with ADLs; 14 to 19, requiring extensive assistance; and 20 or higher, requiring extensive dependence on others to perform ADLs.bA CPS score of 0 to 2 corresponds to normal to mildly impaired cognition, including mild dementia; 3 to 6, moderate or severe cognitive impairment (roughly equivalent to a Folstein Mini-Mental State Examination score of ≤14 of 30).
  • A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012

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    JAMA Intern Med. 2017; 177(1):51-58. doi: 10.1001/jamainternmed.2016.6807

    This population-based study uses data from the Health and Retirement Study to compare the prevalence of dementia in the United States in 2000 and 2012.

  • Dementia Trends in the United States: Read Up and Weigh In

    Abstract Full Text
    JAMA Intern Med. 2017; 177(1):58-60. doi: 10.1001/jamainternmed.2016.7073
  • Effect of the Goals of Care Intervention for Advanced Dementia: A Randomized Clinical Trial

    Abstract Full Text
    JAMA Intern Med. 2017; 177(1):24-31. doi: 10.1001/jamainternmed.2016.7031

    This randomized trial examines the effect of a decision aid intervention about goals of care vs usual care on improved communication, decision-making, and palliative care for patients with advanced dementia.

  • Supporting Family Decision Makers for Nursing Home Residents: A Promising Approach

    Abstract Full Text
    JAMA Intern Med. 2017; 177(1):32-33. doi: 10.1001/jamainternmed.2016.7065
  • Intensive Care Unit Bed Availability and Use of Mechanical Ventilation in Nursing Home Residents With Advanced Dementia: When We Build It, Why Do They Come?

    Abstract Full Text
    JAMA Intern Med. 2016; 176(12):1816-1817. doi: 10.1001/jamainternmed.2016.6415
  • Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

    Abstract Full Text
    JAMA Intern Med. 2016; 176(12):1809-1816. doi: 10.1001/jamainternmed.2016.5964

    This cohort study assessed the association of the use of mechanical ventilation in nursing home residents with advanced dementia and the increasing number of intensive care unit beds among claimants in the Medicare Minimum Data Set.

  • JAMA Internal Medicine December 1, 2016

    Figure: Mechanical Ventilation per 1000 Hospital Admissions of Patients and 1-Year Mortality of Patients With Advanced Dementia Receiving Mechanical Ventilation

    Mechanical ventilation and 1-year mortality are stratified by all admissions and those admissions with pneumonia or septicemia as the primary diagnosis.
  • States Worse Than Death Among Hospitalized Patients With Serious Illnesses

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    JAMA Intern Med. 2016; 176(10):1557-1559. doi: 10.1001/jamainternmed.2016.4362

    This cohort study examines how hospitalized patients with serious illnesses evaluate states of cognitive or functional debility relative to death.

  • Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare

    Abstract Full Text
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    JAMA Intern Med. 2016; 176(9):1371-1378. doi: 10.1001/jamainternmed.2016.3553

    This cohort study examines associations between medical clinician continuity and health care testing, utilization, and spending of older adults with dementia..

  • Medical Care When Memory Fails

    Abstract Full Text
    JAMA Intern Med. 2016; 176(9):1378-1379. doi: 10.1001/jamainternmed.2016.3566
  • Quality of End-of-Life Care Provided to Patients With Different Serious Illnesses

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    JAMA Intern Med. 2016; 176(8):1095-1102. doi: 10.1001/jamainternmed.2016.1200

    This cross-sectional study compares patterns of end-of-life care and family-rated quality of care for patients in the Veterans Affairs health system dying with different serious illnesses.

  • JAMA Internal Medicine July 1, 2016

    Figure 3: Risk Factors for Incident Severe Hypoglycemia During the 2 Years After the Index Hemoglobin A1c (HbA1c) Test

    High clinical complexity was defined as a composite measure of age of 75 years or older or high comorbidity burden defined by the presence of end-stage renal disease, dementia, or 3 or more chronic conditions (myocardial infarction, congestive heart failure, pulmonary disease, non–end-stage chronic renal disease, or cancer). Intensive treatment was defined as a composite measure of intensive baseline regimen (use of greater number of medications than recommended for a given index HbA1c level) and treatment intensification despite a low index HbA1c result. Error bars indicate 95% CIs.
  • JAMA Internal Medicine July 1, 2016

    Figure 2: Risk-Adjusted Probability of Hypoglycemia as a Function of Patient Clinical Complexity and Treatment Intensity

    High clinical complexity was defined as a composite measure of age of 75 years or older or high comorbidity burden defined by presence of end-stage renal disease, dementia, or 3 or more chronic conditions (myocardial infarction, congestive heart failure, pulmonary disease, non–end-stage chronic renal disease, or cancer). Intensive treatment was defined as a composite measure of intensive baseline regimen (use of greater number of medications than recommended for a given index hemoglobin A1c [HbA1c] level) and treatment intensification despite a low index HbA1c result. Risk-adjusted probabilities are adjusted for patient sex, race, household income, residency region, index HbA1c year, and specialty of treating health care professional. Error bars indicate 95% CIs.
  • The Horrible Taste of Nectar and Honey—Inappropriate Use of Thickened Liquids in Dementia: A Teachable Moment

    Abstract Full Text
    JAMA Intern Med. 2016; 176(6):735-736. doi: 10.1001/jamainternmed.2016.1384

    This Teachable Moment questions the routine use of thickened liquids to prevent pneumonia in patients with dementia.

  • JAMA Internal Medicine June 1, 2016

    Figure: Regression-Adjusted Trends in the Likelihood of a Coding for High Anesthesia Risk by Comorbid Condition From 2005 to 2013

    Probabilities of being coded as being at high risk were predicted by holding patient-level characteristics (procedure type, insurance type, age, sex, service setting, and geographic region) at their means and controlling for comorbid conditions other than the specific condition of interest, including respiratory conditions (sleep apnea, chronic obstructive pulmonary disease [COPD], asthma, and cystic fibrosis), cardiovascular conditions (prior cardiac arrest, congestive heart failure, and coronary artery disease), and other chronic conditions (anemia, cancer, cerebrovascular diseases, dementia, diabetes mellitus, gastrointestinal bleeding, hepatobiliary diseases, human immunodeficiency virus, hypertension, inflammatory bowel disease, pancreatic disease, peripheral artery diseases, psychiatric disorder, renal failure, and other neurological diseases).
  • Unwarranted Cancer Screening: A Teachable Moment

    Abstract Full Text
    JAMA Intern Med. 2016; 176(5):590-591. doi: 10.1001/jamainternmed.2016.0348

    This Teachable Moment demonstrates the cascade of events that can result from unnecessary testing for malignant disease, especially in patients with dementia.