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Schlögl M, Riese F, Little MO, Blum D, Jox RJ, O'Neill L, Pautex S, Piers R, Way D, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Cognitive Impairment and Institutional Care. J Palliat Med 2020; 23:1525-1531. [PMID: 32955961 DOI: 10.1089/jpm.2020.0552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Most long-term care (LTC) residents are of age >65 years and have multiple chronic health conditions affecting their cognitive and physical functioning. Although some individuals in nursing homes return home after receiving therapy services, most will remain in a LTC facility until their deaths. This article seeks to provide guidance on how to assess and effectively select treatment for delirium, behavioral and psychological symptoms for patients with dementia, and address other common challenges such as advanced care planning, decision-making capacity, and artificial hydration at the end of life. To do so, we draw upon a team of physicians with training in various backgrounds such as geriatrics, palliative medicine, neurology, and psychiatry to shed light on those important topics in the following "Top 10" tips.
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Affiliation(s)
- Mathias Schlögl
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland.,University Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zurich, Switzerland
| | - Florian Riese
- Psychiatric University Hospital Zurich, Zurich, Switzerland.,University Research Priority Program: Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Milta O Little
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Ralf J Jox
- Palliative and Supportive Care Service, Chair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lynn O'Neill
- Division of Palliative Medicine, Department of Family & Preventive Medicine, Atlanta Veterans Health Care System and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sophie Pautex
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.,University of Geneva, Geneva, Switzerland
| | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Deborah Way
- Department of Palliative Care, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Steenbeek ED, Ramspek CL, van Diepen M, Dekker FW, Achterberg WP. The Association Between Pain Perception and Care Dependency in Older Nursing Home Residents: A Prospective Cohort Study. J Am Med Dir Assoc 2020; 22:676-681. [PMID: 32868249 DOI: 10.1016/j.jamda.2020.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/05/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Maintenance of independence is a challenge for nursing home residents whose pain is often substantial. The objective of this study was to explore the relationship between pain perception and care dependency in a population of Dutch nursing home residents. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Dutch nursing home residents aged 65 or older, excluding residents with a severe cognitive impairment. METHODS The Numeric Rating Scale (NRS) was used to rate pain perception from 0 to 10 in half-point increments and the Care Dependency Scale (CDS) to measure care dependency, with scores ranging from 15 (completely care dependent) to 75 (fully independent). Both measurements were repeated after a 2-month follow-up. Multiple linear regression analysis was used to adjust for potential confounders. Missing data were dealt with by performing tenfold multiple imputation. RESULTS A total of 1256 residents (65% women, mean age 83 years) were included. At baseline, the median NRS pain score was 3.0 (interquartile range 0.0-6.0) and the mean CDS score was 55.9 (SD 11.5). Cross-sectionally, for 1-point increase in pain score, care dependency increased 0.65 points [95% confidence interval (CI) 0.46-0.83]. More pain at baseline was associated with slightly lower care dependency after 2 months (beta 0.20, 95% CI 0.01-0.39). Compared with residents whose pain decreased over 2 months, residents with stable pain or increased pain had a 2.27-point (95% CI 0.83-3.70) and 2.39-point (95% CI 0.87-3.90) greater increase in care dependency, respectively. CONCLUSIONS AND IMPLICATIONS Pain perception and care dependency are associated in a population of older nursing home residents, and stable or increased pain is associated with increased care dependency progression. The findings of this study emphasize that pain and care dependency should not be assessed nor treated independently.
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Affiliation(s)
- Esli D Steenbeek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Chava L Ramspek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Schulz M, Tsiasioti C, Czwikla J, Schwinger A, Gand D, Schmidt A, Schmiemann G, Wolf-Ostermann K, Rothgang H. Claims data analysis of medical specialist utilization among nursing home residents and community-dwelling older people. BMC Health Serv Res 2020; 20:690. [PMID: 32711516 PMCID: PMC7382069 DOI: 10.1186/s12913-020-05548-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/15/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Most older people, and especially those in need of long-term care, suffer from one or more chronic diseases. Consequently, older people have an increased need of medical care, including specialist care. There is little evidence as yet whether older people with greater medical care needs obtain adequate medical care because existing studies do not sufficiently control for differences in morbidity. In this study we investigate whether differences in medical specialist utilization exist between older people with and without assessed long-term care need in line with Book XI of the German Social Code, while at the same time controlling for individual differences in morbidity. METHODS We used data from the 11 German AOK Statutory Health and Long-term Care Insurance funds of 100,000 members aged 60 years or over. Zero-inflated Poisson regression analyses were applied to investigate whether the need for long-term care and the long-term care setting are associated with the probability and number of specialist visits. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner (GP) utilization. RESULTS Older people in need of long-term care are more likely to have no specialist visit than people without the need for long-term care. This applies to nearly all medical specialties and for both care settings. Yet, despite these differences in utilization probability the number of specialist medical care visits between older people with and without the need for long-term care is similar. CONCLUSION Older people in need of long-term care might face access barriers to specialist care. Once a contact is established, however, utilization does not differ considerably between those who need long-term care and those who don't; this indicates the importance of securing an initial contact.
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Affiliation(s)
- Maike Schulz
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | | | - Jonas Czwikla
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Antje Schwinger
- WIdO - AOK Research Institute, P.O. Box 11 02 46, 10832 Berlin, Germany
| | - Daniel Gand
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Annika Schmidt
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Guido Schmiemann
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Karin Wolf-Ostermann
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Heinz Rothgang
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
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Levy-Storms L, Chen L. Communicating emotional support: family caregivers' visits with residents living with dementia in nursing homes. J Women Aging 2020; 32:389-401. [PMID: 32684113 DOI: 10.1080/08952841.2020.1787787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study characterized emotional connections between largely female caregivers and female care recipients with dementia living in nursing homes with the research question: How does interpersonal communication between family caregivers and older adults with dementia convey enacted emotional support? Ten dyads (8 with at least one female) of regularly-involved family caregivers (7 female; 3 male) and their relatives with dementia (5 female; 5 male) were videotaped. Qualitatively, three themes emerged: 1) distinct conversational topics, 2) shared physical proximity and silence, and 3) catalysts for natural interaction. These findings may help improve the quality of life of these predominantly female dyads.
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Affiliation(s)
- Lené Levy-Storms
- Departments of Social Welfare & Medicine/Geriatrics, UCLA, USA.,Department of Social Work, School of Social Development and Public Policy, Fudan University , China
| | - Lin Chen
- Departments of Social Welfare & Medicine/Geriatrics, UCLA, USA.,Department of Social Work, School of Social Development and Public Policy, Fudan University , China
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The relationship between care dependency and pain in nursing home residents. Arch Gerontol Geriatr 2020; 90:104166. [PMID: 32645562 DOI: 10.1016/j.archger.2020.104166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Pain is a common health problem experienced by up to 57 % of nursing home residents which has many negative side effects, including a reduced quality of life. Several studies have been carried out on the prevalence of pain and pain management. However, these study findings remain controversial. OBJECTIVES Therefore, the aim of this study was to compare care dependent and care independent nursing home residents with regard to their (1) pain prevalence and levels and (2) their pain management. METHODS This cross-sectional study is conducted annually in Austrian nursing homes. We measured pain prevalence and levels by asking questions about the pain experienced and pain level measured in the seven days prior to the interview, as well as the pain experienced at the time of this interview. RESULTS The study sample comprised 81.1 % of the 1528 residents of Austrian nursing homes. Overall, pain prevalence was higher in care dependent residents than in care independent residents. Care dependent residents experienced more often mild/moderate pain than care independent residents. Both, prevalence and levels of pain were not statistically significant different between the levels of care dependency. Care dependent residents who suffered from pain received a statistically significantly higher number of non-pharmacological interventions as compared to care independent residents who suffered from pain. CONCLUSIONS We identified a higher prevalence of pain among care dependent residents. Furthermore, the found differences in pain relief seem to be correlated with different degrees of care dependency, an aspect that requires further investigation.
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Rodacki ALF, Boneti Moreira N, Pitta A, Wolf R, Melo Filho J, Rodacki CDLN, Pereira G. Is Handgrip Strength a Useful Measure to Evaluate Lower Limb Strength and Functional Performance in Older Women? Clin Interv Aging 2020; 15:1045-1056. [PMID: 32636619 PMCID: PMC7335282 DOI: 10.2147/cia.s253262] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/29/2020] [Indexed: 01/15/2023] Open
Abstract
Aim This study aimed to determine the association of handgrip strength with isometric and isokinetic strength (hip, knee and ankle extensor/flexor muscles), and functional capacity in older women. Methods The handgrip strength and lower limb strength of 199 older women (60–86 years) were measured using JAMAR and BIODEX dynamometers, respectively. Time Up and Go, Five-times-sit-to-stand and 6m-walk functional tests were evaluated. Pearson correlations were used to determine the relationship between variables. Regression analysis was applied to identify if HS was able to predict TUG performance. The effect of age was analyzed by splitting the participants in a group of older women (OLD; from 60 to 70 years old) and very old women (from 71 to 86 years old). Results The HS and isometric/isokinetic strength correlations were negligible/low and, in most cases, were non-significant. The correlation between handgrip strength and functional tests also ranged predominantly from negligible (r=0.0 to 0.3) to low (r=0.3 to 0.5), irrespective of the group age. The handgrip strength was not able to explain the variance of the TUG performance. Conclusion Generalizing handgrip strength as a practical and straightforward measure to determine lower limbs and overall strength, and functional capacity in older women must be viewed with caution. Handgrip strength and standard strength measures of the lower limbs and functional tests present a negligible/low correlation.
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Affiliation(s)
| | - Natália Boneti Moreira
- Department of Physiotherapy Prevention and Rehabilitation, Federal University of Parana, Curitiba, Brazil
| | - Arthur Pitta
- Department of Physical Education, Federal University of Parana, Curitiba, Brazil
| | - Renata Wolf
- Department of Physical Education, Federal University of Parana, Curitiba, Brazil
| | - Jarbas Melo Filho
- Department of Physical Education, Federal University of Parana, Curitiba, Brazil
| | - Cintia de Lourdes Nahhas Rodacki
- Department of Physical Education, Federal University of Parana, Curitiba, Brazil.,Department of Physical Education, Paraná Technological Federal University, Paraná, Curitiba, Brazil
| | - Gleber Pereira
- Department of Physical Education, Federal University of Parana, Curitiba, Brazil
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Roitto HM, Öhman H, Salminen K, Kautiainen H, Laurila J, Pitkälä KH. Neuropsychiatric Symptoms as Predictors of Falls in Long-Term Care Residents With Cognitive Impairment. J Am Med Dir Assoc 2020; 21:1243-1248. [PMID: 32467074 DOI: 10.1016/j.jamda.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents with cognitive impairment. Despite the high prevalence of falls and NPS, little is known about their association. The aim of our study was to explore how NPS, particularly the severity of NPS and specific NPS subgroups, are associated with falls and how psychotropics modify this association. DESIGN Longitudinal cohort study. SETTING AND PARTICIPANTS In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland. METHODS NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants were grouped into 3 groups: no significant NPS (NPI points 0‒3), low NPS burden (NPI 4‒12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. RESULTS Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries, 42 hospitalizations, and 20 fractures. Falls and injuries increased significantly with NPS burden (P < .001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group (n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis and hyperactivity were associated with a higher incidence rate ratio of falls, whereas apathy had a protective association even after adjustment for age, sex, and mobility. Affective symptoms were not associated with falls. Psychotropics did not modify the association between NPS burden and falls. CONCLUSIONS AND IMPLICATIONS The results of this study show that NPS, especially NPS severity, may predict falls and fall-related negative consequences. Severity of NPS should be taken into account when assessing fall risk in long-term care residents with cognitive impairment.
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Affiliation(s)
- Hanna-Maria Roitto
- Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland.
| | - Hannareeta Öhman
- Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
| | - Karoliina Salminen
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Jouko Laurila
- Center for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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Senior physical activity contests in nursing homes: a feasibility study. Aging Clin Exp Res 2020; 32:869-876. [PMID: 32189244 DOI: 10.1007/s40520-020-01529-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Competition has been shown to improve motivation and physical performance in young people. This method has been rarely studied in older people. AIMS To evaluate the feasibility of senior physical activity (PA) contests between two nursing homes and to assess changes in the motivational level and physical performance of the residents over time. METHODS Residents from two Belgian nursing homes were invited to participate in PA contests. A pretest and three contest sessions were organized over a period of 3 months. The activities proposed were body balance, gait speed, sit-to-stand performance, arm curl and address tests. Feasibility was measured by contest session adherence (expected score > 80%), difficulty scores (expected score < 40%) and appreciation scores (expected score > 80%). Motivational questionnaires were administered: the BREQ-2 (assessing amotivation, introjected regulation, identified regulation, intrinsic motivation and external motivation) and the A-PMCEQ (assessing ego- and task-involving climates). Friedman's analysis of variance was performed to evaluate the changes in physical performance and motivational levels. RESULTS Of the 24 participants, seven did not complete all sessions because of medical or personal reasons not related to the study. During the three sessions, the adherence was 86%, the mean difficulty score was 30.8% and the satisfaction score was 87%. After three sessions, residents experienced a significant decrease ranged from 3 to 0 point for amotivation (p = 0.03), 1 to 0 point for external motivation (p = 0.03) and 2.5 to 2 points for ego-involving climate (p = 0.02) and a significant improvement ranged from 0.7 to 0.9 m/s for gait speed (p < 0.001), 18.5 to 15.6 s for sit-to-stand performance (p < 0.001) and 11.5 to 15 curls for arm curl scores (p < 0.001). CONCLUSIONS In nursing home settings, senior PA contests are feasible and may improve the motivational climate and physical performance.
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Cebrián PD, Cauli O. Analysis of Functional and Cognitive Impairment in Institutionalized Individuals with Movement Disorders. Endocr Metab Immune Disord Drug Targets 2020; 19:1022-1031. [PMID: 30854981 DOI: 10.2174/1871530319666190311104247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/20/2019] [Accepted: 03/27/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Many neurological disorders lead to institutionalization and can be accompanied in their advanced stages by functional impairment, and progressive loss of mobility, and cognitive alterations. OBJECTIVE We analyzed the relationship between functional impairment and cognitive performance and its related subdomains in individuals with Parkinson's disease, Alzheimer's disease accompanied by motor dysfunction, and with other neurological disorders characterized by both motor and cognitive problems. METHODS All participants lived in nursing homes (Valencia, Spain) and underwent cognitive evaluation with the Mini-Mental State Examination; functional assessment of independence in activities of daily living using the Barthel score and Katz index; and assessment of mobility with the elderly mobility scale. RESULTS The mean age of the subjects was 82.8 ± 0.6 years, 47% of the sample included individuals with Parkinson's disease, and 48 % of the sample presented severe cognitive impairment. Direct significant relationships were found between the level of cognitive impairment and functional capacity (p < 0.01) and mobility (p < 0.05). Among the different domains, memory impairment was not associated with altered activities of daily living or mobility. The functional impairment and the risk of severe cognitive impairment were significantly (p<0.05) higher in female compared to male patients. Among comorbidities, overweight/obesity and diabetes were significantly (p < 0.05) associated with poor cognitive performance in those individuals with mild/moderate cognitive impairment. CONCLUSION In institutionalized individuals with movement disorders there is an association between functional and cognitive impairment. Reduction of over-weight and proper control of diabetes may represent novel targets for improving cognitive function at such early stages.
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Affiliation(s)
- Paula D Cebrián
- Department of Nursing, University of Valencia, Valencia, Spain
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain
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Brennan PL, SooHoo S. Effects of Mental Health Disorders on Nursing Home Residents' Nine-Month Pain Trajectories. PAIN MEDICINE 2020; 21:488-500. [PMID: 31407787 DOI: 10.1093/pm/pnz177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the key classes of nursing home residents' nine-month pain trajectories, the influence of residents' mental health disorders on membership in these classes, and nine-month health-related outcomes associated with pain trajectory class membership. METHODS Four times over a nine-month period, the MDS 3.0 resident assessment instrument was used to record the demographic characteristics, mental health disorder diagnoses, pain characteristics, and health and functioning outcomes of 2,539 Department of Veterans Affairs Community Living Center (VA CLC) residents. Growth mixture modeling was used to estimate the key classes of residents' nine-month pain trajectories, the influence of residents' mental health disorders on their pain trajectory class membership, and the associations of class membership with residents' health and functioning outcomes at nine-month follow-up. RESULTS Four-class solutions best described nursing home residents' nine-month trajectories of pain frequency, severity, and interference. Residents with dementia and severe mental illness diagnoses were less likely, and those with depressive disorder, PTSD, and substance use disorder diagnoses more likely, to belong to adverse nine-month pain trajectory classes. Membership in adverse pain frequency and pain severity trajectory classes, and in trajectory classes characterized by initially high but steeply declining pain interference, portended more depressive symptoms but better cognitive and physical functioning at nine-month follow-up. CONCLUSIONS Nursing home residents' mental health disorder diagnoses help predict their subsequent pain frequency, severity, and interference trajectories. This may be clinically useful information for improving pain assessment and treatment approaches for nursing home residents.
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Affiliation(s)
- Penny L Brennan
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
| | - Sonya SooHoo
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
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Schulz M, Czwikla J, Tsiasioti C, Schwinger A, Gand D, Schmiemann G, Schmidt A, Wolf-Ostermann K, Kloep S, Heinze F, Rothgang H. Differences in medical specialist utilization among older people in need of long-term care - results from German health claims data. Int J Equity Health 2020; 19:22. [PMID: 32033606 PMCID: PMC7006141 DOI: 10.1186/s12939-020-1130-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. METHODS We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. RESULTS We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. CONCLUSION The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.
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Affiliation(s)
- Maike Schulz
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Jonas Czwikla
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Chrysanthi Tsiasioti
- Research Institute of the Local Health Care Funds (WIdO), P.O. Box 11 02 46, 10832 Berlin, Germany
| | - Antje Schwinger
- Research Institute of the Local Health Care Funds (WIdO), P.O. Box 11 02 46, 10832 Berlin, Germany
| | - Daniel Gand
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Guido Schmiemann
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Annika Schmidt
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Karin Wolf-Ostermann
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Stephan Kloep
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, High-Profile Area Health Sciences, Bremen, Germany
| | - Franziska Heinze
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Heinz Rothgang
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
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Westerlind B, Östgren CJ, Midlöv P, Marcusson J. Diagnostic Failure of Cognitive Impairment in Nursing Home Residents May Lead to Impaired Medical Care. Dement Geriatr Cogn Disord 2020; 47:209-218. [PMID: 31269489 DOI: 10.1159/000499671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES Dementia and cognitive impairment are common in nursing homes. Few studies have studied the impact of unnoted cognitive impairment on medical care. This study aimed to estimate the prevalence of diagnostic failure of cognitive impairment in a sample of Swedish nursing home residents and to analyze whether diagnostic failure was associated with impaired medical care. METHOD A total of 428 nursing home residents were investigated during 2008-2011. Subjects without dementia diagnosis were grouped by result of the Mini Mental State Examination (MMSE), where subjects with <24 points formed a possible dementia group and the remaining subjects a control group. A third group consisted of subjects with diagnosed dementia. These three groups were compared according to baseline data, laboratory findings, drug use, and mortality. RESULTS Dementia was previously diagnosed in 181 subjects (42%). Among subjects without a dementia diagnosis, 72% were cognitively impaired with possible dementia (MMSE <24). These subjects were significantly older, did not get anti-dementia treatment, and had higher levels of brain natriuretic peptide compared to the diagnosed dementia group, but the risks of malnutrition and pressure ulcers were similar to the dementia group. CONCLUSIONS Unnoted cognitive impairment is common in nursing home residents and may conceal other potentially treatable conditions such as heart failure. The results highlight a need to pay increased attention to cognitive impairment among nursing home residents.
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Affiliation(s)
- Björn Westerlind
- Department of Geriatrics, County Hospital Ryhov, Region Jönköping County, Jönköping, Sweden, .,Geriatric Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden,
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Marcusson
- Geriatric Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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63
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Ferreira AR, Simões MR, Moreira E, Guedes J, Fernandes L. Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs. Arch Gerontol Geriatr 2020; 86:103919. [DOI: 10.1016/j.archger.2019.103919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/01/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023]
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64
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Bökberg C, Behm L, Wallerstedt B, Ahlström G. Evaluating person-centredness for frail older persons in nursing homes before and after implementing a palliative care intervention. Nurs Open 2020; 7:439-448. [PMID: 31871729 PMCID: PMC6917927 DOI: 10.1002/nop2.408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 11/05/2022] Open
Abstract
Aim To evaluate person-centeredness in nursing homes from the perspective of frail older persons, before and after implementing an educational intervention about palliative care. Design A crossover design. Methods Forty-four older persons living in nursing homes were interviewed. A convergent mixed-method was used to analyse data. Results The older persons expressed feelings of unsafety related to shortcomings in staff. These shortcomings implied that the responsibilities of everyday activities and making the residents' existence more bearable were transferred to the next of kin. The dropout rate related to death and not enough energy was considerably high (51%) even though one of the inclusion criteria was to have enough energy to manage a 1-hr interview. This result supports previous research describing the difficulties in retaining older persons in research and indicated that the dose of the intervention was not sufficient to improve person-centred care.
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Affiliation(s)
- Christina Bökberg
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Lina Behm
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Birgitta Wallerstedt
- Department of Health and Caring SciencesFaculty of Health and Life SciencesCentre for Collaborative Palliative Care Linnaeus UniversityVäxjöSweden
| | - Gerd Ahlström
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
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65
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Hatcher D, Chang E, Schmied V, Garrido S. Holding momentum: a grounded theory study of strategies for sustaining living at home in older persons. Int J Qual Stud Health Well-being 2019; 14:1658333. [PMID: 31451098 PMCID: PMC6720313 DOI: 10.1080/17482631.2019.1658333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2019] [Indexed: 11/05/2022] Open
Abstract
Purpose: Government strategies are putting increasing emphasis on sustaining the capacity of older persons to continue living independently in their own homes to ease strain on aged care services. The aim of this study was to understand the experiences and strategies that older people utilize to remain living at home from their own perspective. Methods: A grounded theory methodology was used to explore the actions and strategies used by persons over the age of 65 to enable them to remain living in their own homes. Data were collected from 21 women and men in three focus group discussions and 10 in-depth semi-structured interviews. Results: The data revealed that the central process participants used to hold momentum and sustain living at home involves a circular process in which older people acknowledge change and make ongoing evaluations and decisions about ageing at home. Conclusion: These findings have implications for informing policy and service provision by identifying appropriate resources and services to promote successful ageing at home.
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Affiliation(s)
- Deborah Hatcher
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
| | - Sandra Garrido
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Richmond, Australia
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66
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Sævareid TJL, Thoresen L, Gjerberg E, Lillemoen L, Pedersen R. Improved patient participation through advance care planning in nursing homes-A cluster randomized clinical trial. PATIENT EDUCATION AND COUNSELING 2019; 102:2183-2191. [PMID: 31200952 DOI: 10.1016/j.pec.2019.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To improve patient participation in advance care planning in nursing homes where most patients have some degree of cognitive impairment. METHODS This was a pair-matched cluster randomized clinical trial with eight wards in eight Norwegian nursing homes. We randomized one ward from each of the matched pairs to the intervention group. We included all patients above 70. The primary outcome was prevalence of documented patient participation in end-of-life treatment conversations. The intervention included implementation support using a whole-ward approach where regular staff perform advance care planning and invite all patients and next of kin to participate. RESULTS In intervention group wards the patients participated more often in end-of-life treatment conversations (p < 0.001). Moreover, the patient's preferences, hopes AND worries (p = 0,006) were more often documented, and concordance between provided TREATMENT and patient preferences (p = 0,037) and next of kin participation in advance care planning with the patient (p = 0,056) increased. CONCLUSION Improved patient participation - also when cognitively impaired - is achievable through advance care planning in nursing homes using a whole-ward approach. PRACTICE IMPLICATIONS Patients with cognitive impairment should be included in advance care planning supported by next of kin. A whole-ward approach may be used to implement advance care planning. TRIAL REGISTRATION ISRCTN registry (ID ISRCTN69571462) - retrospectively registered.
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Affiliation(s)
- Trygve J L Sævareid
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Lisbeth Thoresen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway; Department of Health Sciences, University of Oslo, Forskningsveien 3A Harald Schjelderups hus, 0373, Oslo, Norway.
| | - Elisabeth Gjerberg
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Lillian Lillemoen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
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67
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Bökberg C, Behm L, Ahlström G. Quality of life of older persons in nursing homes after the implementation of a knowledge-based palliative care intervention. Int J Older People Nurs 2019; 14:e12258. [PMID: 31298499 PMCID: PMC6900068 DOI: 10.1111/opn.12258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The goals of palliative care are to relieve suffering and promote quality of life. Palliative care for older persons has been less prioritised than palliative care for younger people with cancer, which may lead to unnecessary suffering and decreased quality of life at the final stage of life. AIM To evaluate whether a palliative care intervention had any influence on the perceived quality of life of older persons (≥65 years). METHODS This study was conducted as a complex intervention performed with an experimental crossover design. The intervention was implemented in 20 nursing homes, with a six-month intervention period in each nursing home. Twenty-three older persons (≥65 years) in the intervention group and 29 in the control group were interviewed using the WHOQOL-BREF and WHOQOL-OLD questionnaires at both baseline and follow-up. The collected data were analysed using the Wilcoxon signed-rank test to compare paired data between baseline and follow-up. RESULTS In the intervention group, no statistically significant increases in quality of life were found. This result contrasted with the control group, which revealed statistically significant declines in quality of life at both the dimension and item levels. Accordingly, this study showed a trend of decreased health after nine months in both the intervention and control groups. CONCLUSION It is reasonable to believe that quality of life decreases with age as part of the natural course of the ageing process. However, it seems that the palliative care approach of the intervention prevented unnecessary quality of life decline by supporting sensory abilities, autonomy and social participation among older persons in nursing homes. From the ageing perspective, it may not be realistic to strive for an increased quality of life in older people living in nursing homes; maybe the goal should be to delay or prevent reduced quality of life. Based on this perspective, the intervention prevented decline in quality of life in nursing home residents. IMPLICATIONS FOR PRACTICE The high number of deaths shows the importance to identify palliative care needs in older persons at an early stage to prevent or delay deterioration of quality of life.
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Affiliation(s)
- Christina Bökberg
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - Lina Behm
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
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68
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Dirk K, Rachor GS, Knopp-Sihota JA. Pain Assessment for Nursing Home Residents: A Systematic Review Protocol. Nurs Res 2019; 68:324-328. [PMID: 31261236 DOI: 10.1097/nnr.0000000000000348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of pain in nursing homes is substantial; however, pain assessment for both acute and chronic conditions remains inadequate, resulting in inappropriate or inadequate treatment. Complexities in assessing resident pain have been attributed to factors (barriers and facilitators) arising at the resident, healthcare provider, and healthcare system levels. OBJECTIVES In this systematic review protocol, we identify our research approach that will be used to critically appraise and synthesize data in order to assess barriers and facilitators to pain assessment in nursing home residents aged ≥65 years. METHODS This is a Cochrane style systematic review protocol adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols reporting standards. This review will include primary (original) qualitative literature concerning either barriers or facilitators to pain assessment in older adult nursing home residents. A thematic analysis approach will be employed in collating and summarizing included data and will be categorized into resident, healthcare provider, and system-level factors. Database searches will include Abstracts in Social Gerontology, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and Web of Science. DISCUSSION The identification of barriers and facilitators to pain assessment in older adult nursing home residents may assist healthcare providers across all platforms and levels of education to improve pain assessment among nursing home residents. Improving the assessment of pain has the potential to improve quality of care and ultimately quality of life for older adult nursing home residents.
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Affiliation(s)
- Kennedy Dirk
- Kennedy Dirk, is Research Assistant, Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. Geoffrey S. Rachor, BA, is Research Assistant, Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. Jennifer A. Knopp-Sihota, PhD, NP, is Associate Professor, Faculty of Health Disciplines, Athabasca University; Associate Adjunct Professor, University of Alberta; and Co-Investigator, Translating Research in Elder Care (TREC) Program, University of Alberta, Edmonton, AB, Canada
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69
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Effect of an Educational and Organizational Intervention on Pain in Nursing Home Residents: A Nonrandomized Controlled Trial. J Am Med Dir Assoc 2019; 19:1118-1123.e2. [PMID: 30471802 DOI: 10.1016/j.jamda.2018.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To determine whether an intervention based on education and professional support to nursing home (NH) staff would decrease the number of residents with a pain complaint, and to determine whether the intervention would improve pain management. DESIGN Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong intervention group consisting in audit, feedback, and collaborative work on quality indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting in audit and feedback only. SETTING One hundred fifty-nine NHs located in France. PARTICIPANTS A subgroup of 3722 residents. MEASURES Information on pain complaint and pain-related covariates at the resident-related and at the NH level were recorded by NH staff at baseline and 18 months later. These covariates were included in a mixed-effects logistic regression on resident's pain complaint. Pain management was compared between intervention groups by chi-square tests. RESULTS A greater reduction of residents with a pain complaint after the strong intervention (odds ratio 0.69, 95% confidence interval 0.53, 0.90) and a better pain management (47.6% gold standard, vs 30.6% in the LIG, P < .001) than controls. CONCLUSION/IMPLICATIONS Combining educational and organizational measures, evaluating pain as a patient-reported outcome and as a process endpoint, and implementing a broad-spectrum intervention were original approaches to improve quality of care in NHs. Our results support nonspecific, collaborative, educational, and organizational interventions in NHs to decrease residents' pain complaint and improve pain management.
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70
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Backman A, Ahnlund P, Sjögren K, Lövheim H, McGilton KS, Edvardsson D. Embodying person-centred being and doing: Leading towards person-centred care in nursing homes as narrated by managers. J Clin Nurs 2019; 29:172-183. [PMID: 31612556 DOI: 10.1111/jocn.15075] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/29/2019] [Accepted: 09/29/2019] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To explore how managers describe leading towards person-centred care in Swedish nursing homes. BACKGROUND Although a growing body of research knowledge exists highlighting the importance of leadership to promote person-centred care, studies focused on nursing home managers' own descriptions of leading their staff towards providing person-centred care is lacking. DESIGN Descriptive interview study. COREQ guidelines have been applied. METHODS The study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis. RESULTS Leading towards person-centred care involved a main category; embodying person-centred being and doing, with four related categories: operationalising person-centred objectives; promoting a person-centred atmosphere; maximising person-centred team potential; and optimising person-centred support structures. CONCLUSIONS The findings revealed that leading towards person-centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co-ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person-centred philosophy into synchronised care actions. RELEVANCE TO CLINICAL PRACTICE The findings can be used to inspire nursing home leaders' practices and may serve as a framework for implementing person-centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person-centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person-centred care.
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Affiliation(s)
| | - Petra Ahnlund
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Katherine S McGilton
- Toronto Rehabilitation Institute University Health Network & University of Toronto, Toronto, ON, Canada
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
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71
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Dahlkvist E, Engström M, Nilsson A. Residents' use and perceptions of residential care facility gardens: A behaviour mapping and conversation study. Int J Older People Nurs 2019; 15:e12283. [PMID: 31670913 PMCID: PMC7027578 DOI: 10.1111/opn.12283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/27/2022]
Abstract
AIM To describe the gardens and their use by individuals living at residential care facilities (RCFs) with high ratings on restorative values. BACKGROUND Being outdoors has been described as important to older people's well-being. Use of outdoor gardens may increase residents' well-being through experiences of restorative qualities such as being away and fascination. Thus far, there has been little research on restorative experiences of gardens in the care of older people. DESIGN A descriptive design using behaviour mapping observations integrated with qualitative field notes and recorded conversations. METHODS A criterion sampling of two gardens (out of a total of 87) was made based on residents' ratings of restorative values; the two with the highest values were chosen. Eleven residents at the two RCFs took part. Data were collected through behaviour mapping observations, field notes and conversations on five occasions in the respective facilities during residents' visits to the garden. RESULTS The observations revealed that the main uses of the gardens were to socialise and relax. The conversations also showed that the garden stimulated residents' senses and evoked memories from the past. These restorative values were interpreted as a sense of being away and fascination. Not having opportunities for outdoor visits was reported to result in disappointment and reduced well-being. CONCLUSIONS The findings showed that two basic gardens with different characteristics and views could stimulate residents' senses and evoke memories from the past; this supports the call for residents to be able to spend time in gardens to promote their well-being. IMPLICATIONS FOR PRACTICE First-line managers, nurses and healthcare staff in the care of older people should consider that regular opportunities to spend time outdoors may promote older people's well-being through feelings of being away and fascination.
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Affiliation(s)
- Eva Dahlkvist
- Department of Public Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Maria Engström
- Department of Public Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Nursing Department, Medicine and Health College, Lishui University, Lishui, China
| | - Annika Nilsson
- Department of Public Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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72
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Severity of both neuropsychiatric symptoms and dementia is associated with quality of life in nursing home residents. Eur Geriatr Med 2019; 10:793-800. [PMID: 34652697 DOI: 10.1007/s41999-019-00213-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The primary focus in long-term care is to maintain quality of life. The aim of this study was to investigate the association of severity of neuropsychiatric symptoms (NPS) and health-related quality of life (HRQoL) and their interaction with dementia severity among institutionalized older people with dementia. METHODS 352 long-term care residents aged 65 years or over with dementia participated in this cross-sectional study. NPS were measured with Neuropsychiatric Inventory (NPI). HRQoL was measured with 15D. Dementia severity was measured with Clinical Dementia Rating (CDR). RESULTS The severity of NPS was significantly associated with better HRQoL in 15D. Residents with severe dementia (CDR 3) had worse HRQoL than residents with mild-moderate dementia (CDR < 3). There was a significant interaction between NPI and CDR (p = 0.037 for NPI, p < 0.001 for CDR, p < 0.001 for interaction). HRQoL correlated positively with all NPS subgroups in residents with severe dementia, but in residents with mild-moderate dementia, no significant correlation existed. In severe dementia, higher NPI correlated positively with such dimensions of 15D as mobility, vision, eating, speech, excretion, usual activities, mental functions, and vitality, whereas in residents with mild-moderate dementia only with mobility. In mild-moderate dementia, NPI correlated negatively with depression, distress and vitality. CONCLUSION Dementia severity and NPS burden are important determining factors of HRQoL in long-term care. NPS have a distinct impact on HRQoL at different stages of dementia. In severe dementia, higher NPS and better HRQoL indicate better functioning and higher vitality.
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73
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Hahnel E, Blume‐Peytavi U, Kottner J. Associations of dry skin, skin care habits, well-being, sleep quality and itch in nursing home residents: Results of a multicentre, observational, cross-sectional study. Nurs Open 2019; 6:1501-1509. [PMID: 31660178 PMCID: PMC6805713 DOI: 10.1002/nop2.351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/11/2019] [Accepted: 07/10/2019] [Indexed: 11/09/2022] Open
Abstract
AIM Dry skin is one of the most frequent cutaneous problems in aged long-term care residents. Although it is clinically relevant, the impact on quality of life is unclear. The objective was to measure well-being, sleep quality and itch in nursing home residents being 65 years and older and to explore possible associations with demographics, dry skin and skincare habits. DESIGN Multicentre, observational, cross-sectional. METHODS Sleep quality was assessed with the Richards-Campbell Sleep Quality Questionnaire, well-being with the WHO-Five Well-being Index and itch with the 5-D Itch scale. Skin dryness was measured using the Overall Dry Skin score. RESULTS A total of 51 residents were included. The item scores of the sleep quality and itch questionnaires were strongly associated with each other. Demographics, dry skin and skincare habits were not associated with the questionnaires. It is unclear whether basic skincare activities can improve the quality of life in this population.
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Affiliation(s)
- Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité‐Universitätsmedizin BerlinBerlinGermany
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and MidwiferyGhent UniversityGhentBelgium
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74
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Czwikla J, Schulz M, Heinze F, Kalwitzki T, Gand D, Schmidt A, Tsiasioti C, Schwinger A, Kloep S, Schmiemann G, Wolf-Ostermann K, Gerhardus A, Rothgang H. Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study. BMJ Open 2019; 9:e025614. [PMID: 31471429 PMCID: PMC6720143 DOI: 10.1136/bmjopen-2018-025614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/11/2019] [Accepted: 08/01/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Nursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate. METHODS AND ANALYSIS First, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER DRKS00012383.
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Affiliation(s)
- Jonas Czwikla
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Maike Schulz
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Franziska Heinze
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Thomas Kalwitzki
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Daniel Gand
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Annika Schmidt
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | | | | | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Competence Center for Clinical Trials (KKSB), University of Bremen, Bremen, Germany
| | - Guido Schmiemann
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Karin Wolf-Ostermann
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Ansgar Gerhardus
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
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Baxter R, Lövheim H, Björk S, Sköldunger A, Lindkvist M, Sjögren K, Sandman PO, Bergland Å, Winblad B, Edvardsson D. The thriving of older people assessment scale: Psychometric evaluation and short-form development. J Adv Nurs 2019; 75:3831-3843. [PMID: 31441533 DOI: 10.1111/jan.14180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/11/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the psychometric properties and performance of the 32-item Thriving of Older People Assessment Scale (TOPAS) and to explore reduction into a short-form. BACKGROUND The 32-item TOPAS has been used in studies of place-related well-being as a positive measure in long-term care to assess nursing home resident thriving; however, item redundancy has not previously been explored. DESIGN Cross-sectional study. METHOD Staff members completed the 32-item TOPAS as proxy raters for a random sample of Swedish nursing home residents (N = 4,831) between November 2013 - September 2014. Reliability analysis, exploratory factor analysis and item response theory-based analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing, means comparison and model fit evaluation confirmed scale equivalence. RESULTS Psychometric properties of the 32-item TOPAS were satisfactory and several items were identified for scale reduction. The proposed short-form TOPAS exhibited a high level of internal consistency (α = 0.90) and strong correlation (r = 0.98) to the original scale, while also retaining diversity among items in terms of factor structure and item difficulties. CONCLUSION The 32-item and short-form TOPAS' indicated sound validity and reliability to measure resident thriving in the nursing home context. IMPACT There is a lack of positive life-world measures for use in nursing homes. The short-form TOPAS indicated sound validity and reliability to measure resident thriving, providing a feasible measure with enhanced functionality for use in aged care research, assessments and care planning for health-promoting purposes in nursing homes.
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Affiliation(s)
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Sabine Björk
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | | | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing & Midwifery, La Trobe University, Melbourne, Vic., Australia
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76
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Schenell R, Ozanne A, Strang S, Henoch I. Balancing between maintaining and overriding the self: Staff experiences of residents' self-determination in the palliative phases. Int J Older People Nurs 2019; 14:e12255. [PMID: 31276307 DOI: 10.1111/opn.12255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/22/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate, from the staff perspective, residents' self-determination during the palliative phase while in residential care. BACKGROUND Residential care facilities have a high prevalence of palliative care needs and dependency. The ability of residents to make and execute decisions may be hindered by their cognitive and physical limitations. There is a need to investigate how residents' self-determination is affected during the palliative phase in residential care. METHOD Twenty individual, semi-structured interviews with Registered Nurses, enrolled nurses and physicians working in residential care facilities were analysed with inductive qualitative content analysis. FINDINGS The overarching main theme, Balancing between maintaining and overriding the residents' self, illuminated how strengthened self-determination affected the residents' self in a positive way, while undermined self-determination affected the residents' self in a negative way. Factors that strengthened self-determination were facilitating the residents' own decision making, acting in accordance with the residents' wishes and acting as the residents' spokesperson when necessary. Factors that undermined self-determination were residents' dependence, others setting the terms, for example, being controlled by routines, insufficient communication, for example, lacking end-of-life care planning and others crossing the boundaries of one's personal sphere. CONCLUSION There are serious threats to residents' self-determination but also strategies to cope with these threats. Physical and cognitive frailty and other people setting the terms hinder both making and executing decisions. However, staff can strengthen residents' self-determination and assist in the presentation of residents' self by adopting a relational view of autonomy and by taking personal preconditions into account. There is a need to come to terms with the lack of end-of-life care planning and to give residents a voice in these matters. Implementing a palliative approach early in the illness trajectory could facilitate communication about end-of-life care both within the group of staff and among the residents, relatives and staff. IMPLICATIONS FOR PRACTICE To maintain residents' self-determination and protect their self, staff need knowledge about residents' life stories and personal preconditions. This in turn requires continuity of care and spending time with residents to build relationships. Implementing an early palliative approach with a focus on factors that promote quality of life for each resident might facilitate communication and enhance decision making both in everyday life and in planning for end-of-life care.
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Affiliation(s)
- Ramona Schenell
- Institute of Health and Care Sciences, The Sahlgrenska Academy, Gothenburg, Sweden.,Health Care Unit, Centrum City District Committee, Gothenburg, Sweden
| | - Anneli Ozanne
- Institute of Health and Care Sciences, The Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susann Strang
- Institute of Health and Care Sciences, The Sahlgrenska Academy, Gothenburg, Sweden
| | - Ingela Henoch
- Institute of Health and Care Sciences, The Sahlgrenska Academy, Gothenburg, Sweden.,Angered Hospital, Gothenburg, Sweden
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77
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Wade DT. Determining whether someone has mental capacity to make a decision: clinical guidance based on a review of the evidence. Clin Rehabil 2019; 33:1561-1570. [DOI: 10.1177/0269215519853013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Valid consent to healthcare treatments depends upon a person having the capacity to give it. The Mental Health Act not only requires a presumption of capacity but also expects clinicians to take reasonable steps to establish whether the patient lacks capacity. The facts are that (1) lack of capacity is common among hospital inpatients and people in the community needing care, but is often not recognized. (2) Capacity must not be judged on the basis of the decision made: an unwise decision is not evidence of a lack of capacity, and a decision expected by the clinician is not evidence of capacity. Capacity is decision-specific and must be considered critically without preconceptions. There is no valid other test. (3) Clinically people will fall into four groups: (a) obviously lack capacity and will not recover it, (b) obviously lack capacity but will recover soon, (c) obviously have capacity, (d) capacity is in doubt and major healthcare decision needed. Only the last group need more detailed attention. (4) Capacity is (a) relative to the complexity of the information; (b) on a spectrum, not categorical; (c) decided using clinical judgement; and (d) subject to disagreement among assessors. The recommendations are as follows: (1) capacity should always be considered within the decision-making process, and the outcome should be documented, with sufficient information to understand the opinion given. (2) Detailed assessment should be reserved for situations when (a) a major decision is needed and (b) there is time to assess and discuss the assessment.
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Affiliation(s)
- Derick T Wade
- OxINMAHR and Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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78
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Domenech-Cebrían P, Martinez-Martinez M, Cauli O. Relationship between mobility and cognitive impairment in patients with Alzheimer's disease. Clin Neurol Neurosurg 2019; 179:23-29. [PMID: 30798193 DOI: 10.1016/j.clineuro.2019.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 02/05/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) is usually accompanied by impairments to mobility, performance of the basic activities of daily life (ADL), and progressive cognitive decline. We analyzed the relationship between cognitive performance and related cognitive subdomains and mobility. PATIENTS AND METHODS All AD patients of the recruited individuals were living in nursing homes; they underwent a blood analysis, cognitive examination by using the Mini-Mental State Examination, functional evaluation of independence in the ADLs with Barthel score and Katz index, and mobility assessment with the elderly mobility scale. RESULTS The mean sample age was 84 years and majority were women; more than 60% of the participants had severe cognitive impairment. Statistically significant relationships were found between the severity of cognitive impairment and functional capacity (p < 0.01) and their degree of mobility (p < 0.05). Among the different domains, memory impairment was not associated with impaired mobility or ability to perform the ADLs. Women had lower scores in the ADL and mobility assessments (p < 0.05) and an increased ratio of severe cognitive impairment (OR = 3.03 95% CI: [1.30, -7.05]) compared to men. Being overweight or obese and high blood levels of HDL cholesterol were directly (p < 0.05) and inversely (p < 0.01) associated with poor cognitive performance in individuals with mild to moderate cognitive dysfunction, respectively. CONCLUSIONS This study shows that better functional capacity and mobility are generally, but not exclusively, correlated with better cognitive function, depending on the severity of cognitive impairment. In contrast, lipid profile alterations might play a role in cognitive deficits in individuals with mild to moderate cognitive impairment who are overweight. Further longitudinal studies will be required to explore this possibility.
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Affiliation(s)
| | | | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain.
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79
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Westbury J, Gee P, Ling T, Kitsos A, Peterson G. More action needed: Psychotropic prescribing in Australian residential aged care. Aust N Z J Psychiatry 2019; 53:136-147. [PMID: 29488403 DOI: 10.1177/0004867418758919] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE For at least two decades, concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged care facilities, due to their modest therapeutic benefit and increased risk of falls and mortality. To date, the majority of prevalence data has been collected in Sydney exclusively and it is not known if recent initiatives to promote appropriate psychotropic prescribing have impacted utilisation. Thus, we aimed to comprehensively analyse psychotropic use in a large national sample of residential aged care facility residents. METHOD A cross-sectional, retrospective cohort study of residents from 150 residential aged care facilities distributed nationally during April 2014-October 2015. Antipsychotic, anxiolytic/hypnotic and antidepressant utilisation was assessed, along with anticonvulsant and anti-dementia drug use. Negative binomial regression analysis was used to examine variation in psychotropic use. RESULTS Full psychotropic prescribing data was available from 11,368 residents. Nearly two-thirds (61%) were taking psychotropic agents regularly, with over 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines. Over 30% and 11% were charted for 'prn' (as required) benzodiazepines and antipsychotics, respectively. More than 16% of the residents were taking sedating antidepressants, predominantly mirtazapine. South Australian residents were more likely to be taking benzodiazepines ( p < 0.05) and residents from New South Wales/Australian Capital Territory less likely to be taking them ( p < 0.01), after adjustment for rurality and size of residential aged care facility. Residents located in New South Wales/Australian Capital Territory were also significantly less likely to take antidepressants ( p < 0.01), as were residents from outer regional residential aged care facilities ( p < 0.01). Antipsychotic use was not associated with State, rurality or residential aged care facility size. CONCLUSION Regular antipsychotic use appears to have decreased in residential aged care facilities but benzodiazepine prevalence is higher, particularly in South Australian residential aged care facilities. Sedating antidepressant and 'prn' psychotropic prescribing is widespread. Effective interventions to reduce the continued reliance on psychotropic management, in conjunction with active promotion of non-pharmacological strategies, are urgently required.
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Affiliation(s)
- Juanita Westbury
- 1 Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Peter Gee
- 2 Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Tristan Ling
- 2 Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Alex Kitsos
- 3 Health Services Innovation Tasmania, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gregory Peterson
- 3 Health Services Innovation Tasmania, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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80
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McConnell ES, Meyer J. Assessing Quality for People Living With Dementia in Residential Long-Term Care: Trends and Challenges. Gerontol Geriatr Med 2019; 5:2333721419861198. [PMID: 31321255 PMCID: PMC6628510 DOI: 10.1177/2333721419861198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/25/2019] [Accepted: 06/03/2019] [Indexed: 11/23/2022] Open
Abstract
The global prevalence of dementia is growing rapidly, driving an increased use of residential long-term care (LTC) services. Performance indicators for residential LTC should support targeting of limited resources to promote person-centered care, health, and well-being for both patients and caregivers (formal and informal), yet many performance indicators remain focused on structure, process, or outcome measures that are only assumed to support personally relevant outcomes for those with dementia, without direct evidence of meaningfulness for these individuals. In this article, two complementary approaches to assessing quality in residential LTC serve as a lens for examining a series of tensions related to assessment in this setting. These include measurement-focused approaches using generic psychometrically valid instruments, often used to monitor quality of services, and meaning-focused approaches using individual subjective assessment of personally relevant outcomes, often used to monitor care planning. Examples from the European and U.S. literature suggest an opportunity to strengthen an emphasis on personally meaning-focused outcomes in quality assessment.
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Affiliation(s)
- Eleanor S. McConnell
- Duke University School of Nursing, Durham, NC,
USA
- Geriatric Research Education and Clinical
Center, Durham Veterans Affairs Healthcare System, NC, USA
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81
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Sint A, Baumbach SF, Böcker W, Kammerlander C, Kanz KG, Braunstein M, Polzer H. Influence of age and level of activity on the applicability of a walker orthosis - a prospective study in different cohorts of healthy volunteers. BMC Musculoskelet Disord 2018; 19:453. [PMID: 30579348 PMCID: PMC6303910 DOI: 10.1186/s12891-018-2366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/03/2018] [Indexed: 12/01/2022] Open
Abstract
Background Walker orthosis are frequently prescribed as they are removable to allow wound control, body care and physiotherapy and are adaptable to the soft tissue conditions. The prerequisite for successful treatment with any walker orthosis is a correct use by the patient. Therefore, the aim of this study was to investigate patients’ handling of a commonly used walker. Methods Prospective observational study analyzing the applicability of a walker orthosis in different cohorts with varying age and level of activity. Volunteers were recruited from a mountain-biking-team (Sport), a cardiovascular-health-sports-group (Cardio) and a retirement home (Senior). The correct application was assessed following initial training (t0) and one week later (t1). Outcome parameters were an Application Score, strap tightness, vertical heel lift-off and subjective judgement of correct application. Results Thirty-three volunteers, 11 Sports group (31 ± 7a), 12 Cardio group (59 ± 11a), 10 Senior group, (82 ± 5a) were enrolled. No differences for any parameter could be observed between t0 and t1. Age showed a moderate correlation for all outcome parameters and the cohort influenced all variables. The Senior group presented significant inferior results to the Sport- and Cardio group for the Application Score (p = 0.002-p < 0.001) and strap tightness (p < 0.001). Heel lift-off was significantly inferior in the Cardio- and Senior- compared to the Sport group (p = 0.003-p < 0.001). 14% in the Sport-, 4% in the Cardio- and 83% in the Senior group achieved less than 9 points in the Application Score – which was considered insufficient. However, out of these 90% believed the application to be correct. Conclusions The elderly cohort living in a retirement home demonstrated an impaired handling of the walker orthosis. Further, participants were incapable to self-assess the correct handling. These aspects should be respected when initiating treatment with a walker orthosis. Trial registration Retrospectively registered on the 16th of February 2018: #DRKS00013728 on DRKS. Electronic supplementary material The online version of this article (10.1186/s12891-018-2366-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alena Sint
- Department of General-, Visceral-, Vascular- and Transplant- Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Sebastian Felix Baumbach
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr 20, 80336, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr 20, 80336, Munich, Germany
| | - Christian Kammerlander
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr 20, 80336, Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mareen Braunstein
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr 20, 80336, Munich, Germany
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr 20, 80336, Munich, Germany.
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Gagliese L, Gauthier LR, Narain N, Freedman T. Pain, aging and dementia: Towards a biopsychosocial model. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:207-215. [PMID: 28947182 DOI: 10.1016/j.pnpbp.2017.09.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 12/30/2022]
Abstract
Dementia is a progressive disease associated with irreversible impairment and loss of cognitive abilities. About half of older people with dementia experience pain. In this paper, we propose that pain in older people with dementia can be conceptualized as the final result of the interaction of three heterogeneous phenomena, pain, aging, and dementia, which are created and influenced by the interactions of predisposing, lifelong, and current biopsychosocial factors. We review pain assessment in people with dementia using both self-report and observational/behavioral measures. We then review the biological/sensory, psychological (cognitive and affective) and social dimensions of pain in dementia. The available data suggest that dementia does not impact pain threshold or tolerance. To date, there is little research on the social dimension of pain in dementia. Changes in the affective domain in response to experimental pain have been contradictory with evidence supporting both increased and decreased unpleasantness and emotional responsiveness in people with dementia compared to healthy controls. Clinically, depression is a significant burden for older people with dementia and chronic pain. The relationship between pain and other neuropsychiatric symptoms is controversial, and there is insufficient evidence on which to base conclusions. Some of the most important dementia-related changes may arise in the cognitive domain, including impairments of semantic and episodic memory for pain, executive function, and pain anticipation. Changes in brain activation and interconnectivity support many of these conclusions. Despite methodological limitations, we conclude there are compelling preliminary data to support a biopsychosocial framework of pain and dementia. Future research directions, especially the need for improved assessment tools, are highlighted.
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Affiliation(s)
- Lucia Gagliese
- School of Kinesiology and Health Science, York University, 4700 Keele St., Toronto M3J 1P3, Canada; Department of Anesthesia & Pain Management, Toronto General Hospital, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, Canada; Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, 200 Elizabeth St., Toronto M5G 2C5, Canada; Department of Anesthesia, Mount Sinai Hospital, 600 University Ave, Toronto M5G 1X5, Canada; Faculty of Medicine, University of Toronto, 1 King's College Cir #3172, Toronto M5S 1A8, Canada; Department of Psychiatry, Toronto General Hospital, Canada.
| | - Lynn R Gauthier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Québec G1V 0A6, Canada; l'Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, Canada; CHU de Québec-Université Laval Research Center, Oncology Research Axis, Canada; Université Laval Cancer Research Center, 9 Rue McMahon, Québec G1R 3S3, Canada
| | - Nadine Narain
- Department of Anesthesia & Pain Management, Toronto General Hospital, Canada
| | - Tamlyn Freedman
- Department of Anesthesia & Pain Management, Toronto General Hospital, Canada
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83
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Shahar I, Mendelson G, Gerbi S, Ben Natan M. Pain Assessment and Management by Nurses in a Geriatric Setting: Discrepancies between Guidelines and Documented Practice. Pain Manag Nurs 2018; 19:456-463. [DOI: 10.1016/j.pmn.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/26/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022]
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Björk S, Lindkvist M, Lövheim H, Bergland Å, Wimo A, Edvardsson D. Exploring resident thriving in relation to the nursing home environment: A cross-sectional study. J Adv Nurs 2018; 74:2820-2830. [PMID: 30043451 DOI: 10.1111/jan.13812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/15/2018] [Accepted: 07/11/2018] [Indexed: 11/30/2022]
Abstract
AIM To explore the extent to which environmental factors are associated with resident thriving. BACKGROUND Thriving is a concept that denotes experiences of well-being in relation to the living environment. Although there is a substantial body of research into quality of life in nursing homes, less is known about what contributes to thriving among residents. Recent research on resident thriving has focused mainly on resident characteristics and activities associated with thriving. Less attention has been given to explore associations with the physical and psychosocial environment of the nursing home. This study explores facility- and unit-level factors associated with resident thriving. DESIGN A cross-sectional national survey. METHODS Data on 4,205 residents, 3,509 staff, and environment of 147 nursing home facilities collected in 2013-2014 were analysed using descriptive statistics, multilevel simple, and multiple linear regression to explore resident thriving in relation to environmental factors. RESULTS Multilevel analysis revealed that residents' thriving varied significantly across nursing home units. Several environmental factors were associated with thriving in univariate analyses. However, a positive psychosocial climate of units, having access to newspapers, living in a special care unit, and living in an unlocked facility showed significant positive associations with resident thriving when controlling for resident characteristics. The psychosocial climate showed the strongest association of the environment variables with resident thriving. CONCLUSIONS Nursing home environments may have an impact on residents' thriving. A positive psychosocial climate of units seems to have an important role in facilitating thriving in nursing home residents.
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Affiliation(s)
- Sabine Björk
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
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85
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Auer SR, Höfler M, Linsmayer E, Beránková A, Prieschl D, Ratajczak P, Šteffl M, Holmerová I. Cross-sectional study of prevalence of dementia, behavioural symptoms, mobility, pain and other health parameters in nursing homes in Austria and the Czech Republic: results from the DEMDATA project. BMC Geriatr 2018; 18:178. [PMID: 30103672 PMCID: PMC6090593 DOI: 10.1186/s12877-018-0870-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022] Open
Abstract
Background This paper provides a first comparative exploratory analysis of our findings from DEMDATA, a collaborative project between Austria and the Czech Republic. Analysed here are data from the residents and the environment assessment protocol. Methods In a cross sectional study design, residents from randomly drawn and stratified nursing homes were investigated using a common study protocol. Results From a total resident pool of 1666 persons, 1085 (571 in Austria, 514 in the Czech Republic) persons signed a consent form and participated in the data collection. More than 70% of residents assessed were female and the population was on average 85 years old. A discrepancy between the presence of a medical diagnosis in the charts of the residents and the results of cognitive testing was found. In Austria, 85.2%, in the Czech Republic 53.0% of residents had cognitive impairment. In Austria 80.0%, and in the Czech Republic 56.7% had behavioural problems. With respect to pain, 44.8% in Austria, and 51.5% in the Czech Republic had mild to severe pain. 78.4% of Austrian and 74.5% of the residents had problems with mobility and both populations were in danger of malnutrition. Conclusions Most of the prevalence rates are comparable with previous studies also using direct resident assessment. Variations in prevalence rates seem to result mainly from the assessment technique (direct cognitive testing vs. medical chart review). The high prevalence rates for dementia, behavioural symptoms, pain and malnutrition indicate an immediate call for attention to further research and practice development.
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Affiliation(s)
- Stefanie R Auer
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria. .,MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria.
| | - Margit Höfler
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | | | - Anna Beránková
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
| | - Doris Prieschl
- MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria
| | - Paulina Ratajczak
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | - Michal Šteffl
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
| | - Iva Holmerová
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
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86
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Kijowska V, Szczerbińska K. Prevalence of cognitive impairment among long-term care residents: a comparison between nursing homes and residential homes in Poland. Eur Geriatr Med 2018; 9:467-476. [DOI: 10.1007/s41999-018-0062-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
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Rostad HM, Utne I, Grov EK, Småstuen MC, Puts M, Halvorsrud L. The impact of a pain assessment intervention on pain score and analgesic use in older nursing home residents with severe dementia: A cluster randomised controlled trial. Int J Nurs Stud 2018; 84:52-60. [PMID: 29763832 DOI: 10.1016/j.ijnurstu.2018.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/08/2018] [Accepted: 04/26/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pain is highly prevalent in older adults, especially those in institutional settings such as nursing homes. The presence of dementia may increase the risk of underdiagnosed and undertreated pain. Pain assessment tools are not regularly used in clinical practice, however, there are indications that the regular use of pain assessments tools may influence the recognition of pain by nursing staff and thereby affect pain management. OBJECTIVES To assess whether regular pain assessment using a pain assessment tool is associated with changes in i) pain scores and ii) analgesic use in nursing home residents with severe dementia. DESIGN Cluster-randomised controlled trial. SETTING The study was conducted in 16 nursing homes in four counties in Norway. PARTICIPANTS A total of 112 nursing home residents aged 65 years and older with dementia who lacked the capacity for self-reporting pain or were non-verbal. METHODS The experimental group were regularly assessed pain with a standardised pain scale (the Doloplus-2) twice a week for a 12-week intervention period. The control group received usual care. The primary outcome was pain score measured with the Doloplus-2, and the secondary outcome was analgesic use (oral morphine equivalents and milligram/day paracetamol). Data on the outcomes were collected at baseline and at the end of week 12. The nursing staff in both the experimental and the control groups received training to collect the data. Linear mixed models were used to assess possible between-group difference over time. RESULTS No overall effect of regular pain assessment was found on pain score or analgesic use. The mean score of Doloplus-2 and analgesic use remained unchanged and above the established cut-off in both groups. CONCLUSION The current intervention did not change analgesic use or pain score compared with the control condition. However, there is not sufficient evidence to conclude that regular pain assessment using a pain assessment tool is not clinically relevant. Furthermore, our results indicated that pain continued to be inadequately treated in nursing home residents with severe dementia. Therefore, further research on how standardised pain assessment can be used to support effective pain management in this population is needed.
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Affiliation(s)
| | - Inger Utne
- OsloMet - Oslo Metropolitan University, Oslo, Norway
| | | | | | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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88
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Creighton AS, Davison TE, Kissane DW. The Factors Associated With Anxiety Symptom Severity in Older Adults Living in Nursing Homes and Other Residential Aged Care Facilities. J Aging Health 2018; 31:1235-1258. [DOI: 10.1177/0898264318767781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to identify the biopsychosocial factors associated with anxiety among a residential aged care sample. Method: A total of 178 residents ( M age = 85.4 years, SD = 7.4 years) with mild cognitive impairment or normal cognition participated. Participants completed the Geriatric Anxiety Inventory (GAI) and a set of measures assessing cognition, depression, self-perceived health, mastery, attachment, perceived social support, social engagement, functional status, the experience of a fall, and other negative life events. Results: Unique correlates of GAI scores were depression, a preoccupied attachment style, lower mastery, cognitive impairment, and lower self-perceived health. Discussion: Most correlates that were uniquely associated with anxiety had little to do with the current environment. More variance was accounted for by stable and lifelong factors. This provides new insights into the characteristics of anxiety within aged care populations, and although preliminary, provides possible targets to prevent and treat anxiety within this setting.
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Affiliation(s)
| | - Tanya E. Davison
- Monash University, Clayton, Victoria, Australia
- Australian Catholic University, Melbourne, Victoria, Australia
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89
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Jakavonytė-Akstinienė A, Dikčius V, Macijauskienė J. Prognosis of Treatment Outcomes by Cognitive and Physical Scales. Open Med (Wars) 2018; 13:74-82. [PMID: 29607417 PMCID: PMC5874513 DOI: 10.1515/med-2018-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/30/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to assess the possibility of using scales for measuring cognitive and physical functions for a prognosis of care outcomes in elderly patients. Methodology. The survey was carried out in one of the Vilnius City Hospitals for Nursing and Support Treatment. A total number of 177 respondents were involved in the study. The Mini–Mental State Examination (MMSE), The Barthel Index (BI) and The Morse Fall Scale were used. Results. A statistically significant correlation was revealed between the scores of MMSE and BI (Pearson R = 0.41, p < 0.01); those with severe cognitive impairment were more dependent. A statistically significant correlation (Pearson R = −0.181, p < 0.01) was reported between the scores of MMSE and the Morse Fall Scale – the risk of falling was higher in patients with severe cognitive impairment. Conclusions. The Morse Fall Scale was not suitable for the prognosis of outcomes. The MMSE was suitable for the prognosis of a patient’s discharge. The Barthel Index should be considered as the most suitable tool for the prognosis of care outcomes: the sum-score of the Barthel Index above 25 may suggest that the patient would be discharged home; the sum-score below this level was associated with a higher likelihood of patient death.
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Affiliation(s)
- Agnė Jakavonytė-Akstinienė
- Department of Geriatrics, Faculty of Nursing, Medical Academy of the Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytautas Dikčius
- Marketing Department, Faculty of Economy of Vilnius University, Vilnius, Lithuania
| | - Jūratė Macijauskienė
- Department of Geriatrics, Faculty of Nursing, Medical Academy of the Lithuanian University of Health Sciences, Kaunas, Lithuania
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90
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Backman A, Sjögren K, Lövheim H, Edvardsson D. Job strain in nursing homes-Exploring the impact of leadership. J Clin Nurs 2018; 27:1552-1560. [PMID: 29148598 DOI: 10.1111/jocn.14180] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the association between nursing home managers' leadership, job strain and social support as perceived by direct care staff in nursing homes. BACKGROUND It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Leadership styles have been associated with job strain in the literature; however, the impact of perceived leadership on staff job strain and social support has not been clarified within nursing home contexts. DESIGN This study had a cross-sectional design. METHODS Participating staff (n = 3,605) completed surveys which included questions about staff characteristics, valid and reliable measures of nursing home managers' leadership, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted. RESULTS Nursing home managers' leadership were significantly associated with lower level of job strain and higher level of social support among direct care staff. A multiple regression analysis including an interaction term indicated individual and joint effects of nursing home managers' leadership and social support on job strain. CONCLUSIONS Nursing home managers' leadership and social support were both individually and in combination associated with staff perception of lesser job strain. Thus, nursing home managers' leadership are beneficial for the working situation and strain of staff. RELEVANCE TO CLINICAL PRACTICE Promoting a supporting work environment through leadership is an important implication for nursing home managers as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers can buffer adverse health effects among staff.
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Affiliation(s)
| | - Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
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91
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Björk S, Lövheim H, Lindkvist M, Wimo A, Edvardsson D. Thriving in relation to cognitive impairment and neuropsychiatric symptoms in Swedish nursing home residents. Int J Geriatr Psychiatry 2018; 33:e49-e57. [PMID: 28370353 DOI: 10.1002/gps.4714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/08/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to explore relations among thriving, cognitive function, and neuropsychiatric symptoms (NPS) in nursing home residents. METHODS A national, cross-sectional, randomized study of Swedish nursing home residents (N = 4831) was conducted between November 2013 and September 2014. Activities of daily life functioning, cognitive functioning, NPS, and thriving were assessed with the Katz activities of daily living, Gottfries' Cognitive Scale, Nursing Home version of the Neuropsychiatric Inventory, and Thriving of Older People Scale, respectively. Individual NPS were explored in relation to cognitive function. Simple linear and multiple regression models were used to explore thriving in relation to resident characteristics. RESULTS Aggression and depressive symptoms were identified as negatively associated with thriving regardless of resident cognitive functioning. At higher levels of cognitive functioning, several factors showed associations with thriving; however, at lower levels of cognitive functioning, only the degree of cognitive impairment and the NPS was associated with thriving. Most of the individual NPS formed nonlinear relationships with cognitive functioning with higher symptom scores in the middle stages of cognitive functioning. Exceptions were elation/euphoria and apathy, which increased linearly with severity of cognitive impairment. CONCLUSIONS The lower the cognitive functioning was, the fewer factors were associated with thriving. Aggression and depressive symptoms may indicate lower levels of thriving; thus, targeting these symptoms should be a priority in nursing homes. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sabine Björk
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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92
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Rostad HM, Utne I, Grov EK, Puts M, Halvorsrud L. Measurement properties, feasibility and clinical utility of the Doloplus-2 pain scale in older adults with cognitive impairment: a systematic review. BMC Geriatr 2017; 17:257. [PMID: 29096611 PMCID: PMC5667437 DOI: 10.1186/s12877-017-0643-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Doloplus-2 is a pain assessment scale for assessing pain in older adults with cognitive impairment. It is used in clinical practice and research. However, evidence for its measurement properties, feasibility and clinical utility remain incomplete. This systematic review synthesizes previous research on the measurement properties, feasibility and clinical utility of the scale. Method We conducted a systematic search in three databases (CINAHL, Medline and PsycINFO) for studies published in English, French, German, Dutch/Flemish or a Scandinavian language between 1990 and April 2017. We also reviewed the Doloplus-2 homepage and reference lists of included studies to supplement our search. Two reviewers independently reviewed titles and abstracts and performed the quality assessment and data abstraction. Results A total of 24 studies were included in this systematic review. The quality of the studies varied, but many lacked sufficient detail about the samples and response rates. The Doloplus-2 has been studied using diverse samples in a variety of settings; most study participants were in long-term care and in people with dementia. Sixteen studies addressed various aspects of the scale’s feasibility and clinical utility, but their results are limited and inconsistent across settings and samples. Support for the scale’s reliability, validity and responsiveness varied widely across the studies. Generally, the reliability coefficients reached acceptable benchmarks, but the evidence for different aspects of the scale’s validity and responsiveness was incomplete. Conclusion Additional high-quality studies are warranted to determine in which populations of older adults with cognitive impairment the Doloplus-2 is reliable, valid and feasible. The ability of the Doloplus-2 to meaningfully quantify pain, measure treatment response and improve patient outcomes also needs further investigation. Trial registration PROSPERO reg. no.: CRD42016049697 registered 20. Oct. 2016. Electronic supplementary material The online version of this article (10.1186/s12877-017-0643-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanne Marie Rostad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway. .,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway.
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Martine Puts
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
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93
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Ulbricht CM, Rothschild AJ, Hunnicutt JN, Lapane KL. Depression and cognitive impairment among newly admitted nursing home residents in the USA. Int J Geriatr Psychiatry 2017; 32:1172-1181. [PMID: 28544134 DOI: 10.1002/gps.4723] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/21/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of this study is to describe the prevalence of depression and cognitive impairment among newly admitted nursing home residents in the USA and to describe the treatment of depression by level of cognitive impairment. METHODS We identified 1,088,619 newly admitted older residents between 2011 and 2013 with an active diagnosis of depression documented on the Minimum Data Set 3.0. The prevalence of receiving psychiatric treatment was estimated by cognitive impairment status and depression symptoms. Binary logistic regression using generalized estimating equations provided adjusted odds ratios and 95% confidence intervals for the association between level of cognitive impairment and receipt of psychiatric treatment, adjusted for clustering of residents within nursing homes and resident characteristics. RESULTS Twenty-six percent of newly admitted residents had depression; 47% of these residents also had cognitive impairment. Of those who had staff assessments of depression, anhedonia, impaired concentration, psychomotor disturbances, and irritability were more commonly experienced by residents with cognitive impairment than residents without cognitive impairment. Forty-eight percent of all residents with depression did not receive any psychiatric treatment. Approximately one-fifth of residents received a combination of treatment. Residents with severe cognitive impairment were less likely than those with intact cognition to receive psychiatric treatment (adjusted odds ratio = 0.95; 95% confidence interval: 0.93-0.98). CONCLUSIONS Many newly admitted residents with an active diagnosis of depression are untreated, potentially missing an important window to improve symptoms. The extent of comorbid cognitive impairment and depression and lack of treatment suggest opportunities for improved quality of care in this increasingly important healthcare setting. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Christine M Ulbricht
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony J Rothschild
- Center for Psychopharmacologic Research and Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- UMassMemorial Health Care, Worcester, MA, USA
| | - Jacob N Hunnicutt
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts, Worcester, MA, USA
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94
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Evaluating the quality of care received in long-term care facilities from a consumer perspective: development and construct validity of the Consumer Choice Index – Six Dimension instrument. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17000861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThe Consumer Choice Index – Six Dimension (CCI-6D) is a new instrument designed specifically to evaluate the quality of care received in long-term care from a consumer perspective. This study aims to demonstrate the construct validity of the CCI-6D. Older residents living in long-term care facilities and proxy family carers (where severely impaired cognition precluded resident consent) participated as consumers of long-term care. Data collected included the CCI-6D instrument, quality of life, physical function and characteristics of the care facility. Relationships between these variables and the CCI-6D dimensions were assessed and analysed through chi-squared and Kruskal–Wallis tests to assess the construct validity of each dimension. Of 430 eligible consumers, a total of 253 completed the questionnaire, of whom 68 (27%) were residents and 185 (73%) were informal carer proxy participants. There was strong evidence of construct validity of the dimensions relating to adequacy of individual care time, access to outside and gardens, access to meaningful activities and flexibility of care. There was more moderate evidence of validity of the home-like own room and shared spaces items, which may be in part due to difficulty in identifying strong discriminatory variables for comparison with these items. The results also indicate a strong association between ‘processes’ of care delivery (as measured by the CCI-6D) and quality of life of care recipients.
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95
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Backman A, Sjögren K, Lindkvist M, Lövheim H, Edvardsson D. Characteristics of highly rated leadership in nursing homes using item response theory. J Adv Nurs 2017; 73:2903-2913. [DOI: 10.1111/jan.13353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Marie Lindkvist
- Department of Statistics; Umeå School of Business and Economics; Umeå University; Umeå Sweden
- Epidemiology and Global Health; Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation; Umeå University; Umeå Sweden
| | - David Edvardsson
- Department of Nursing; Umeå University; Umeå Sweden
- School of Nursing and Midwifery; La Trobe University; Melbourne Australia
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96
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Andersson S, Lindqvist O, Fürst CJ, Brännström M. Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes. Scand J Caring Sci 2017; 32:299-308. [DOI: 10.1111/scs.12462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/05/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | - Olav Lindqvist
- Department of Nursing; Umeå University; Umeå Sweden
- Department of Learning, Informatics, Management and Ethics/MMC; Karolinska Institutet; Stockholm Sweden
| | - Carl-Johan Fürst
- The Institute for Palliative Care; Lund University and Region Skåne; Lund Sweden
| | - Margareta Brännström
- Department of Nursing; Umeå University; Skellefteå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
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97
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Røen I, Selbæk G, Kirkevold Ø, Engedal K, Testad I, Bergh S. Resourse Use and Disease Couse in dementia - Nursing Home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homes. BMC Health Serv Res 2017; 17:365. [PMID: 28532443 PMCID: PMC5441072 DOI: 10.1186/s12913-017-2289-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/03/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home. METHODS We included 696 patients at admission to a nursing home and followed them with biannual assessments until death. Baseline data were collected between March 2012 and November 2014. In October 2016, patients had either completed an 18-month follow-up (n = 349), passed 18 months without assessments (n = 22), or left the study (n = 324). Data on demographics, cognition, NPS, activities of daily living (ADL) functioning, physical health, medication, Quality of Life (QoL), resource use, and caregiver burden, in addition to DNA samples were collected. RESULTS Mean age of the participants at inclusion was 84.5 years (SD 7.5, range 50 - 105), 63.9% were women. According to data collected in the study, 83.8% had dementia, but only 55.9% of them had a diagnosis of dementia registered in their records. The most frequent dementia diagnosis was Alzheimer's disease, which was present in 71% of those with dementia. Patients with dementia more often experienced delusions, hallucinations, agitation, anxiety, disinhibition, irritability, and aberrant motor behaviour compared to patients without dementia. Depression and anxiety were the most common NPS symptoms. CONCLUSIONS Dementia and NPS were highly prevalent among persons admitted to nursing homes. Only 55.9% of the patients with dementia had a diagnosis of dementia registered in their records.
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Affiliation(s)
- Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Geir Selbæk
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Kirkevold
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Norwegian University of Science and Technology (NTNU), Department of Health Science in Gjøvik, Gjøvik, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ingelin Testad
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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98
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Auer S, Linsmayer E, Beránková A, Pascher P, Firlinger B, Prischl D, Ratajczak P, Span E, Holmerova I. DEMDATA: The Austrian-Czech institutional long term care project - design and protocol of a two-centre cross sectional study. BMC Health Serv Res 2017; 17:296. [PMID: 28427396 PMCID: PMC5397749 DOI: 10.1186/s12913-017-2244-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/11/2017] [Indexed: 11/21/2022] Open
Abstract
Background The organization of long-term care is one of the main challenges of public health and health policies in Europe and worldwide, especially in terms of care concepts for people with dementia. In Austria and the Czech Republic the majority of elderly institutionalized persons with dementia are cared for in nursing homes. It is however unclear, how many persons living in nursing homes in Austria and in the Czech Republic are suffering from cognitive impairment and dementia. In addition, basic information on the nutritional status, the status of mobility and the medication prescription patterns are often missing. To facilitate new effective and evidenced based care concepts, basic epidemiological data are in urgent need. Thus, DEMDATA was initiated to provide important basic data on persons living in nursing homes in Austria and the Czech Republic for future care planning. Methods DEMDATA is a multicentre mixed methods cross-sectional study. Stratified and randomly drawn nursing homes in Austria and the Czech Republic are surveyed. The study protocol used in both study centres assesses four different domains: a) Resident, b) Care team, c) Relative and d) Environmental Factors. Resident’s data include among others health status, cognition, dementia, mobility, nutrition, behavioural symptoms, pain intensity and quality of life. A minimum of 500 residents per country are included into the study (N = 1000 residents). The care team is asked about the use of the person-centred care and their burden. The relatives are asked about the number of visits and proxy-rate the quality of life of their family member. All staff employed in the nursing homes, all residents and relatives can voluntary take part in the study. The environmental factors include among others the organisational category of the nursing home, number of residents, number of rooms, social activities and the care concept. The project started in March 2016 and will be concluded in February 2018. Discussion DEMDATA will provide important epidemiological data on four different nursing home domains in Austria and the Czech Republic, with a focus on the prevalence of dementia in this population. Thereby supplying decision and policy makers with important foundation for future care planning.
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Affiliation(s)
- Stefanie Auer
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria. .,MAS Alzheimerhilfe, Bad Ischl, Austria.
| | | | - Anna Beránková
- Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Patrick Pascher
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria.,MAS Alzheimerhilfe, Bad Ischl, Austria
| | - Bernadette Firlinger
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | | | - Paulina Ratajczak
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | | | - Iva Holmerova
- Faculty of Humanities, Charles University, Prague, Czech Republic
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99
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Rostad HM, Puts MTE, Cvancarova Småstuen M, Grov EK, Utne I, Halvorsrud L. Associations between Pain and Quality of Life in Severe Dementia: A Norwegian Cross-Sectional Study. Dement Geriatr Cogn Dis Extra 2017; 7:109-121. [PMID: 28553313 PMCID: PMC5425768 DOI: 10.1159/000468923] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/03/2017] [Indexed: 12/19/2022] Open
Abstract
Background/Aims Many variables influence the quality of life in older adults with dementia. We aim to quantify how the relationship between pain and quality of life in nursing home residents with severe dementia can be explained by neuropsychiatric symptoms, depressive symptoms, and activities of daily living. Methods This article presents cross-sectional baseline data from a cluster randomised controlled trial. Results The total and direct effects of pain on quality of life were statistically significant. Both neuropsychiatric and depressive symptoms partially mediated the relationship between pain and quality of life. Activities of daily living acted as a mediator only when modelled together with depressive symptoms. Conclusion Pain, neuropsychiatric symptoms, and depressive symptoms appear to be important factors that influence the quality of life for nursing home residents with severe dementia. Therefore, multidimensional interventions may be beneficial for maintaining or improving quality of life in this population.
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Affiliation(s)
- Hanne Marie Rostad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Björk S, Lindkvist M, Wimo A, Juthberg C, Bergland Å, Edvardsson D. Residents' engagement in everyday activities and its association with thriving in nursing homes. J Adv Nurs 2017; 73:1884-1895. [PMID: 28229474 DOI: 10.1111/jan.13275] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 01/17/2023]
Abstract
AIM To describe the prevalence of everyday activity engagement for older people in nursing homes and the extent to which engagement in everyday activities is associated with thriving. BACKGROUND Research into residents' engagement in everyday activities in nursing homes has focused primarily on associations with quality of life and prevention and management of neuropsychiatric symptoms. However, the mere absence of symptoms does not necessarily guarantee experiences of well-being. The concept of thriving encapsulates and explores experiences of well-being in relation to the place where a person lives. DESIGN A cross-sectional survey. METHOD A national survey of 172 Swedish nursing homes (2013-2014). Resident (n = 4831) symptoms, activities and thriving were assessed by staff using a study survey based on established questionnaires. Descriptive statistics, simple and multiple linear regression, and linear stepwise multiple regression were performed. RESULTS The most commonly occurring everyday activities were receiving hugs and physical touch, talking to relatives/friends and receiving visitors, having conversation with staff not related to care and grooming. The least commonly occurring everyday activities were going to the cinema, participating in an educational program, visiting a restaurant and doing everyday chores. Positive associations were found between activity engagement and thriving, where engagement in an activity program, dressing nicely and spending time with someone the resident likes had the strongest positive association with resident thriving. CONCLUSIONS Engagement in everyday activities can support personhood and thriving and can be conceptualized and implemented as nursing interventions to enable residents to thrive in nursing homes.
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Affiliation(s)
| | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Sweden.,Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | | | - Ådel Bergland
- Lovisenberg Diaconal University College, Oslo, Norway
| | - David Edvardsson
- Department of Nursing, Umeå University, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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