[Medical specialist undertreatment in nursing home residents-Prevalence and extrapolation]

Prevalence and incidence of skin tear in older adults：A systematic review and meta-analysis

BACKGROUND

Skin tear (ST) is a public health problem in older adults; they substantially increase the risk of complications and cause serious adverse consequences and health care burden.

AIM

To estimate the pooled prevalence and incidence of ST among older adults.

METHODS

Ten databases were systematically searched from their inception to July 27, 2023. Two researchers performed a systematic review independently according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All inconsistencies were resolved by a principal researcher. The pooled prevalence and incidence of ST were estimated in R 4.3.1 program.

RESULTS

Thirteen studies were included in this review. The pooled prevalence of ST was 6.0 % (95 % confidence interval (CI): 3.0%-11.0 %, I2 = 98 %), and the pooled incidence was 11.0 % (95 % CI: 5.0%-19.0 %, I2 = 94 %). The prevalence of ST was 11.0 % (95 % CI: 5.0%-19.0 %, I2 = 95 %) in long-term care facilities, 5.0 % (95 % CI: 3.0%-9.0 %, I2 = 86 %) in Europe, and 7.0 % (95 % CI: 1.0%-16.0 %, I2 = 82 %) in the Skin Tear Audit Research classification system (STAR). It has stabilized at 6.0 % since 2021. The incidence of ST was 15.0 % (95 % CI: 11.0%-20.0 %, I2 = 66 %) in long-term care facilities in Japan and 4.0 % (95 % CI: 2.0%-6.0 %) in Canada.

CONCLUSIONS

Older adults are at a high risk for ST. Our findings emphasize the importance of epidemiologic studies and further exploring assessment tools for ST. Healthcare professionals should pay attention to ST, identify high-risk individuals and associated factors, and implement targeted prevention strategies for older adults.

[Hearing in the elderly: Employees' perspectives on hearing care in long-term care facilities. A qualitative study]

Hearing in the elderly: Employees' perspectives on hearing care in long-term care facilities. A qualitative study Abstract: Background: Hearing impairment is common among the elderly. More than half of individuals 80 years and older exhibit severe hearing loss, and few retain good hearing performance. This impairment significantly affects both community participation and nursing care. Aim: This study aimed to examine the impact of hearing impairment on everyday life of employees and residents at long-term care facilities. We further sought to identify how employees perceive hearing care in order to identify potential for improvement. Methods: This sub-project of a larger study comprised guided focus groups with employees of long-term care facilities. The sample included six focus groups of nurses and nursing care assistants from long-term care facilities (n = 42). Collected data were analyzed using qualitative content analysis. Results: Hearing impairment hinders elderly resident participation in the nursing process and complicates daily communication between residents and nursing staff. Hearing impaired residents are less able to take part in group activities and tend to withdraw from the community. Lack of an effective hearing support structure renders hearing care services inaccessible to some residents. Conclusions: Optimized service structures, targeted assistance and training opportunities for employees specific to hearing impairment can provide sustainable hearing care for the elderly.

[Medical care with or without cooperative agreements? A cross-sectional study in nursing homes in Bremen and Lower Saxony]

BACKGROUND

Empirical studies in nursing homes show that people in need of long-term care have less contact with medical specialists (except for neurologists) compared to those of the same age who are not in need of long-term care, which can be an indication of insufficient health care provision. Against this background, a cooperative agreement between medical specialists and nursing homes was first made legally possible, then requested and finally made mandatory (section 119b SGB V [Social Code Book V] in the currently valid version). The aim of this study is to investigate to what extent contact density to physicians and the needs-based medical treatment of nursing home residents in nursing homes with and without a cooperative agreement differ from each other and, hence, how effective such cooperation agreements are in this context.

METHODOLOGY

Using data from 396 people in need of care from 44 nursing homes in Lower Saxony and Bremen we compared facilities with and without cooperative agreements with respect to the number of home visits, practice visits and telephone contacts and the realization of adequate specialist medical treatment. At the time of the survey, 26 of the 44 nursing homes had cooperative agreements with dentists, 17 with general practitioners and 7 with neurologists.

RESULTS

The number of personal contacts to general practitioners tends to be higher if cooperation agreements between general practitioners and nursing homes exist. In nursing homes having cooperation agreements with dentists the number of home visits is twice as high as in nursing homes without such an agreement, whereas cooperation agreements with neurologists have no effect on the number of contacts with these specialists. Furthermore, cooperation agreements with dentists promote appropriate dental care.

CONCLUSIONS

The results show that cooperation agreements can be a useful instrument to ensure medical care in nursing homes. To guarantee the effectiveness of the cooperation agreements, however, the number of medical visits should be stipulated in the agreements.

Prevalence and associations of xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo in aged nursing home residents: A representative prevalence study

BACKGROUND

The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of vulnerable skin, is an essential part of daily nursing practice in long-term residential settings. For many years, the research focus has been on individual skin problems including xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo, although people may be affected by several at the same time.

OBJECTIVES

Aim of the present study was to describe the prevalence and associations of skin conditions relevant to nursing practice in aged nursing home residents.

DESIGN

Analysis of baseline data of a cluster-RCT in long-term residential settings.

SETTING

The study was conducted in a representative sample of n = 17 nursing homes in the federal state of Berlin, Germany.

PARTICIPANTS

Care dependent nursing home residents being 65+ years.

METHODS

A random sample of all eligible nursing homes was drawn. Demographic and health characteristics were collected and head-to-toe skin examinations conducted by dermatologists. Prevalence estimates and intracluster correlation coefficients were calculated, and group comparisons conducted.

RESULTS

Three hundred fourteen residents with a mean age of 85.4 (SD 7.1) years were included. The majority was affected by xerosis cutis (95.9%, 95% CI 93.6 to 97.8), followed by intertrigo 35.0% (95% CI 30.0 to 40.1), incontinence-associated dermatitis 21.0% (95% CI 15.6 to 26.3), skin tears 10.5% (95% CI 7.3 to 13.8), and pressure ulcers 8.0% (95% CI 5.1 to 10.8). In total, more than half of the nursing home residents were affected by two or more skin conditions at the same time. Several associations between skin conditions and mobility, care dependency, or cognitive impairment were observed. There were no associations between xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers or intertrigo.

CONCLUSIONS

The adverse skin and tissue conditions xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo are very common in long-term residential settings, placing a high burden on this population. Although care receivers share similar risk factors and may be affected by several skin conditions at the same time, there are no associations indicating separate aetiological pathways.

REGISTRATION

This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).

[Oral health in nursing homes as an interprofessional task : Results of qualitative interviews with nurses and dentists on their current and future collaboration]

BACKGROUND

People with long-term care needs have significantly poorer oral health than their peers without care needs. Internationally, this is increasingly being addressed through interprofessional collaboration and expanded roles of nurses. This article investigates the perspectives of dentists and nurses in Germany on the current status and future of their collaboration in nursing homes.

METHODS

A total of eight expert interviews were conducted with four practising dentists and nurses from the Westphalia-Lippe region via Zoom or by telephone. The fully transcribed interview material was analyzed by thematic coding on a case-specific and cross-case basis.

RESULTS

From the perspective of the interviewees, collaboration of dentists and nurses is indispensable for promoting the oral health of nursing home residents. They describe a lack of time and competence in the oral and dental care of home residents, which should be countered with new roles of responsibility for specially qualified nurses in cooperation with dentists. At the same time, they advocate a stronger anchoring and embedding of (dental) medical care in the routines of nursing homes.

CONCLUSION

New forms of cooperation between dentists and nurses in nursing homes should be piloted and further developed in Germany.

Nursing Home-Sensitive Hospitalizations and the Relevance of Telemedicine: A Scoping Review

The aging of society is increasing the number of hospitalizations of nursing home residents. Telemedicine might help reduce the frequency of these potentially risk-associated hospitalizations. This scoping review looked for evidence of a change in the rate of hospitalization and, if mentioned, any cost savings and/or staff acceptance of the use of telemedicine in a nursing home setting. To identify available evidence, the electronic databases PubMed, Livivo, EBSCO and JSTOR were searched (without time or regional constraints) for comparative primary research studies on this topic in peer-reviewed journals. A total of 1127 articles were retrieved and 923 titles and abstracts were screened, with 16 studies published between 2001 and 2022 being included. Telemedicine consultation reduced the hospitalization of nursing home residents in 14/16 and care costs in 8/11 articles. Staff satisfaction was mentioned positively in five studies. Most studies used telemedicine involving medical diagnostic technologies (10), (electronic) health records (9), specialists (9) and specialized nursing staff (11). Few studies had a higher level of evidence: only one randomized clinical trial was included. There is the need for high credibility studies, using guidelines on protocol and reporting, to better understand the hindering and facilitating factors of telemedicine provision in the healthcare of nursing home residents.

Contacts with general practitioners, dentists, and medical specialists among nursing home residents: a cross-sectional study in 44 German nursing homes

Background

Nursing home residents have high medical care needs. Their medical care utilization is, however, lower compared to community-dwelling elderly and varies widely among nursing homes. This study quantified the utilization of general practitioners (GPs), dentists, and medical specialists among nursing homes and residents, and investigated whether dentist utilization is associated with individual and nursing home characteristics.

Methods

Forty-four nursing homes invited 2124 residents to participate in a cross-sectional study. For 10 medical specialties, data on contacts in nursing homes, practices, and by telephone in the last 12 months were assessed at individual and nursing home level. The proportion of nursing homes and residents with any form of contact, and the median number and interquartile range (IQR) of contacts among individuals with contact were determined. Using multilevel logistic regression, associations between the probability of individual dental care utilization and sex, age, LTC grade, years of residence, sponsorship, number of nursing home beds, and transport and medical escort services for consultations at a practice were investigated.

Results

The proportion of nursing homes with any form of contact with physicians ranged from 100% for GPs, dentists, and urologists to 76.7% for gynecologists and orthopedists. Among the nursing homes, 442 residents participated (20.8% response). The proportion of residents with any contact varied from 97.8% for GPs, 38.5% for neurologists/psychiatrists, and 32.3% for dentists to 3.0% for gynecologists. Only for GPs, neurologists/psychiatrists, dentists, otorhinolaryngologists, urologists, and dermatologists, the proportion was higher for nursing home contacts than for practice and telephone contacts. Among residents with any contact, the median number of contacts was highest for GPs (11.0 [IQR 7.0-16.0]), urologists (4.0 [IQR 2.0-7.0]), and neurologists/psychiatrists (3.0 [IQR 2.0-5.0]). Dentist utilization varied widely among nursing homes (median odds ratio 2.5) and was associated with higher age.

Conclusions

Almost all residents had regular contact to GPs, but only one third had contact with dentists. Lower proportions with contact were found for medical specialists, except for neurologists/psychiatrists. Reasons for the large variations in dental care utilization among nursing homes should be identified.

Trial registration

DRKS00012383 [2017/12/06].