Factors favoring a degradation or an improvement in activities of daily living (ADL) performance among nursing home (NH) residents: A survival analysis

The effect of corrective exercises on musculoskeletal disorders among the older adults residing in a nursing home in Rasht, Guilan, Iran

BACKGROUND

Ageing causes changes in the function of musculoskeletal systems and disability, and injury among older adults. This study aimed to determine the effect of corrective exercises on musculoskeletal disorders among older adults residing in a nursing home in Iran.

METHOD

This controlled clinical trial study was conducted on 58 older adults (29 samples in each group). The intervention group performed corrective exercises for 8 weeks and three sessions per week and each session lasted for one hour. The pre-test was performed one week before intervention and the post-test one week after the 8-week intervention. The research instruments included Nordic Musculoskeletal Questionnaire (NMQ), and the pain visual analog scale (VAS). Descriptive and inferential (Chi-square, Mann-Whitney, Wilcoxon, and McNemar test) statistics were used to analyze the data using SPSS software version 19.

RESULTS

the majority of the participants were males (67.2%) and in the age range of 60-74 years (82.8%). The mean age of samples in intervention and control groups was 68.45 (SD = 5.38) and 69.17 (SD = 5.86), respectively. The results showed that the prevalence of musculoskeletal disorders (MSDs) was decreased in the intervention group after the intervention (%Δ = -34.68, p < .05). The results also showed a statistically significant decrease in pain intensity of musculoskeletal in the intervention group, after the intervention (%Δ = -68.34, p < .001).

CONCLUSIONS

Corrective exercises reduce the prevalence of MSDs and the pain intensity among older adults. It is recommended to pay attention to these exercises to improve physical health and reduce the prevalence of MSDs among older adults.

Cognitive, physical and emotional determinants of activities of daily living in nursing home residents-a cross-sectional study within the PROCARE-project

BACKGROUND

Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents.

METHODS

The study included n = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant's demographics, frailty, number of falls, and participating institutions' socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05).

RESULTS

Indices showed (Chi2(148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance.

DISCUSSION AND CONCLUSION

Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance.

TRIAL REGISTRATION

Trial registration number: DRKS00014957.

Association between upper limb movements during drumming and cognition in older adults with cognitive impairment and dementia at a nursing home: a pilot study

Background

Despite the association between motor dysfunction and dementia, quantitative assessment of dementia-related specific motor dysfunction in patients with severe dementia is difficult. Thus, this study aimed to develop a new method to measure upper limb motor function in people with dementia.

Methods

We examined the relationship between dementia severity and dementia-related specific motor dysfunction using the Mini-Mental State Examination (MMSE), a dementia screening test. Participants comprised 16 nursing home residents with a mean age of 86 years and MMSE score of 14.56 (range, 1-23) Points. Participants were seated in a circle and instructed to play a drum that was placed in their lap using mallets (drumsticks) in their dominant hand. Acceleration and gyroscopic sensors were attached to their wrists to collect data on arm movements while drumming. Upper limb motor characteristics were confirmed by recording acceleration and arm movement during drumming and analyzing the correlation with handgrip strength.

Results

Handgrip strength was correlated with arm elevation angle during drumming. The arm elevation angle displayed a significant regression equation with the MMSE score and showed the best regression equation along with handgrip strength (adjusted R² = 0.6035, p = 0.0009).

Conclusion

We developed a new method using drums to measure upper limb motor function in people with dementia. We also verified that the average arm elevation angle during drumming could predict cognitive dysfunction. This system may be used to monitor people with dementia in a simple and safe way.

Nationwide Database Analysis of Risk Factors Associated with Decreased Activities of Daily Living in Patients with Alzheimer's Disease

BACKGROUND

Preserving activities of daily living (ADL) is the key issue for Alzheimer's disease (AD) patients and their caregivers.

OBJECTIVE

To clarify the ADL level of AD patients at diagnosis and the risk factors associated with decreased ADL during long-term care (≤3 years).

METHODS

Medical records of AD patients in a Japanese health insurance claims database were analyzed retrospectively to determine ADL using the Barthel Index (BI) and identify the risk factors associated with decreased ADL.

RESULTS

A total of 16,799 AD patients (mean age at diagnosis: 83.6 years, 61.5% female) were analyzed. Female patients were older (84.6 versus 81.9 years; p < 0.001) and had lower BI (46.8 versus 57.6; p < 0.001) and body mass index (BMI) (21.0 versus 21.7 kg/m2; p < 0.001) than male patients at diagnosis. Disability (BI≤60) increased at age≥80 years and was significantly higher in females. Complete disability was most frequent for bathing and grooming. Risk factors for decreased ADL were determined separately by sex through comparing the ADL-preserved and ADL-decreased groups using propensity score matching by age and BI and multivariable logistic regression analysis. In males, decreased ADL was significantly associated with BMI < 21.5 kg/m2, stroke, and hip fracture, and inversely associated with hyperlipidemia. In females, decreased ADL was significantly associated with BMI < 21.5 kg/m2 and vertebral and hip fractures, and inversely associated with lower back pain.

CONCLUSION

AD patients with low BMI, stroke, and fractures had increased risks of decreased ADL; such patients should be identified early and managed appropriately, including rehabilitation to preserve ADL.

Efficacy of therapeutic exercise on activities of daily living and cognitive function among older residents in long-term care facilities: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities.

DATA SOURCES

PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018.

STUDY SELECTION

Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes.

DATA EXTRACTION

Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer.

DATA SYNTHESIS

A total of 11 RCTs with 1,280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD] = 0. 22, 95% confidence interval [CI]: 0.02, 0.42, p = 0.03)]. Subgroup analyses indicated that interventions were conducted ≥ 3 days per week [SMD = 0.42, 95% CI 0.02, 0.82, p = 0.04]. For cognitive function, group exercise and ≥ 3 days/week of intervention had a significant benefit (group exercise: mean difference [MD] = 3.36, 95% CI 0.91, 5.80, p = 0.007; ≥ 3 days/week of intervention: MD = 2.28, 95% CI 0.07, 4.49, p = 0.04).

CONCLUSIONS

Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

Identifying the Service Capability of Long-Term Care Facilities in China: An e-Delphi Study

Objective

This study develops a group of service capability indicators for long-term care facilities to assess their current conditions and makes it the first step toward the improvement of service capability in China.

Methods

We constructed an initial indicator framework based on the characteristics of long-term care services and a literature review. Potential indicators were collected, and a 2-round modified web-based Delphi process was conducted by a national multidisciplinary expert panel to construct a service capability evaluation index system. The accepted competencies of indicators were established with mean scores in all three scoring criteria (importance, feasibility, and sensitivity) ≥ 4.0, consensus rate reached 70.0%, and a coefficient of variation ≤ 0.25.

Results

A new indicator framework covering 2 dimensions of inputs and activities was developed in this study. The initial 35 indicators formed an indicator pool for the Delphi questionnaire. According to the final consensus of the expert panel, the Delphi consultation resulted in an index system comprised 31 tertiary indicators across six subdimensions (i) staffing; (ii) facilities and equipment; (iii) funding; (iv) medical inspection services; (v) health management services; (vi) institutional standard management.

Conclusion

This study developed a set of indicators suitable for the long-term care system in China and is expected to be applied to measure and improve the service capability of long-term care facilities. In addition, these indicators can be used for comparisons between different LTCFs and provide an evidence basis for the further development of capability assessment tools.

Effects of an individualised nutritional intervention to tackle malnutrition in nursing homes: a pre-post study

PURPOSE

Individualised interventions are recommended to tackle malnutrition in older adults, but approaches for nursing home (NH) residents are scarce. This study investigated the effects of an individualised nutritional intervention in NH residents with (risk of) malnutrition.

METHODS

In a pre-post study, 6 weeks (w) of usual care were followed by 6w of intervention. The intervention consisted of up to three supplement modules (sweet and savoury protein creams and protein-energy drink, single or combined) and, if required, reshaped texture-modified meals (RTMM).

RESULTS

Fifty residents completed the study (84 ± 8 years, 74% female). One-third (32%) received RTMM. Additional 258 ± 167 kcal/day and 23 ± 15 g protein/day were offered. Mean daily energy intake increased by 207 (95%CI 47-368, p = 0.005) kcal and protein intake by 14 (7-21, p < 0.001) g (w12 vs w1). Quality of life (QoL) increased in the subscale "care relationship" (+ 9 (3-15) points, p = 0.002, w12 vs w6). Body weight, handgrip strength, and other QoL subscales did not change.

CONCLUSION

Our intervention improved dietary intake and one QoL subscale in NH residents with (risk of) malnutrition. As a next step, randomized controlled trials are needed to investigate the impact of individualised interventions more comprehensively.

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

Background

Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care.

Methods

The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis.

Results

Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters.

Conclusions

Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

Predictors of Functional Decline in Nursing Home Residents: The Shelter Project

BACKGROUND

The aim of our study was to identify independent predictors of functional decline in older nursing home (NH) residents, taking into account both resident and facility characteristics.

METHODS

Longitudinal observational study involving 1,760 older (≥65 y) residents of NH participating in the SHELTER* study (57 NH in eight countries). All residents underwent a comprehensive geriatric assessment using the interRAI LTCF. Functional decline was defined as an increase of at least one point in the MDS Long Form ADL scale during a 1 year follow-up. Facility and country effects were taken into account.

RESULTS

During the study period 891 (50.6%), NH residents experienced ADL decline. Residents experiencing ADL decline were older, had lower disability at baseline, were more frequently affected by severe dementia and by urinary incontinence, and used more antipsychotics. In the mixed-effect logistic regression model, factors independently associated with a higher risk of functional decline were dementia and urinary incontinence, whereas the presence of a geriatrician was a protective factor.

CONCLUSIONS

Both resident and facility characteristics are associated with the risk of functional decline in NH residents. Increasing the quality of healthcare by involving a geriatrician in residents' care might be an important strategy to improve the outcome of this vulnerable population.

Prediction of Adverse Outcomes in Nursing Home Residents According to Intrinsic Capacity Proposed by the World Health Organization

BACKGROUND

This study aimed to evaluate the predictive value of the domains of intrinsic capacity (ie, cognition, locomotion, sensory, vitality, and psychosocial) proposed by the World Health Organization (WHO) on the 3-year adverse health outcomes of nursing home residents.

METHODS

A 3-year incidence of mortality, falls, repeated falls, and autonomy decline (ie, a one-unit increase in the Katz score) was assessed in a cohort of Belgian nursing home residents. Cognition was assessed using the Mini-Mental State Examination (MMSE). For locomotion, balance, gait speed and chair stand performance were evaluated by the Short Physical Performance Battery test. The sensory domain was measured using the Strawbridge questionnaire for audition and vision. For vitality, abdominal circumference, body mass index, nutritional status (by Mini Nutritional Assessment [MNA]) and handgrip strength were assessed. Psychosocial status was evaluated by the EQ-5D and the Center for Epidemiological Studies Depression scale. Missing data were handled by multiple imputations. Cox proportional hazard models, logistic regressions, and analysis of variance were used for the analyses.

RESULTS

In the multivariable model, a one-unit increase in balance performance and in the nutrition score decreased the probability of death by 12% (Hazard ratio [HR] = 0.88; 95% confidence interval [CI] 0.78-0.99) and 4% (HR = 0.96; 95% CI 0.93-0.99), respectively. The risk of falling decreased when there was a one-unit increase in balance performance (HR = 0.87, 95% CI 0.79-0.96) and in the nutrition score (HR = 0.96, 95% CI 0.93-0.98). No association was found for intrinsic capacity and repeated falls. Low scores in nutrition (odds ratio = 0.86, 95% CI 0.77-0.96) were associated with a higher probability of autonomy decline.

CONCLUSION

Some domains of intrinsic capacity predicted health outcomes among nursing home residents. Nutrition and balance should be regularly checked among this population.

The Relationship Between Depression and Cognitive Deterioration in Elderly Persons

Abstract The objective of this research is to describe the relationship between depressive disorder and cognitive deterioration in residentialized elderly people. This is a descriptive and correlational study with 70 elderly. The variables have been assessed with a Psychosocial Variables Questionnaire, CAMCOG and GDS. Depression was significantly correlated with cognitive level in the non-assisted elderly sample (r=0.471, p=0.004). Participants’ age is negatively associated with the score obtained in the CAMCOG of non-assisted sample (r=-0.352, p=0.038). Depression is more frequent in institutions that care for older people when they are more dependent.

Course of activities of daily living in nursing home residents with dementia from admission to 36-month follow-up

Background

Dementia is affecting both the person with the disease and the family members. It is associated with nursing home admission, and a reduced ability to perform personal activities of daily living (P-ADL). The aim of this study was to examine the association between the severity of dementia and P-ADL function, and to study if additional factors such as neuropsychiatric symptoms, type of nursing home unit, and use of medication were associated with P-ADL function.

Methods

A total of 582 nursing home residents with dementia, included at admission to the nursing home, were followed with biannual assessments for 36 months. P-ADL was assessed using the Physical Self-Maintenance scale, and severity of dementia was measured with the Clinical Dementia Rating scale. In addition, neuropsychiatric symptoms, general physical health, and use of medications were assessed at the same time points. Demographic information was collected at baseline. Linear mixed models were estimated.

Results

There was a significant (p < 0.05) non-linear decline in P-ADL function over time in analysis not adjusting for any characteristics. More severe dementia at baseline and at the follow-up assessments was associated with lower P-ADL function (p < 0.001), with the association being stable over time. A higher level of neuropsychiatric symptoms, not using anti-dementia medication, being in a regular care unit as compared to a special care unit and having poor/fair general physical health as compared to good/excellent, were associated with a lower P-ADL function.

Conclusion

The association between more severe dementia and lower P-ADL function was stable over a 36-month follow-up period of nursing home residents with dementia. Health care planners and clinicians should be aware of this when planning for and treating nursing home residents.

Nursing home residents' ADL status, institution-dwelling and association with outdoor activity: a cross-sectional study

Introduction

The Norwegian regulations for nursing homes consider access to meaningful activities to be an indicator for the quality of nursing homes. Activities of daily living (ADL) provide important basic self-care skills for nursing home residents. Due to the physical changes caused by ageing and comorbidities, nursing home residents may experience functional decline over time, which may affect their ability to perform meaningful ADL, such as outdoor activity, which is considered a valuable and meaningful activity in Norwegian culture. This study aimed to investigate the association between ADL status, institution-dwelling and outdoor activity among nursing home residents.

Methods

This cross-sectional study included 784 residents aged >67 years living in 21 nursing homes in 15 Norwegian municipalities between November 2016 and May 2018. The Barthel Index was used to assess the nursing home residents' ADL status. Other variables collected were age, gender, body weight and height, visits per month, institution, ward, and participation in weekly outdoor activities. Descriptive statistics were used to provide an overview of the residents' characteristics. A Poisson regression model was used to test the association between the outdoor activity level as the dependent variable and ADL score, institution, and other control variables as independent variables.

Results

More than half (57%) of the nursing home residents in this sample did not go outdoors. More than 50% of the residents had an ADL score <10, which indicates low performance status. Further, we found that residents' ADL status, institution, ward, and number of visits had an impact on how often the residents went outdoors.

Discussion

The nursing home residents in this study rarely went outdoors, which is interesting because Norwegians appreciate this activity. Differences in the number of visits might explain why some residents went outdoors more often than other residents did. Our findings also highlight that the institutions impact the outdoor activity. How the institutions are organized and how important this activity is considered to be in the institutions determine how often the activity is performed.

Conclusion

The low frequency of the outdoor activities might be explained by a low ADL score. More than 50% of the residents had an ADL score <10, which indicates low performance status. Despite regulations for nursing home quality in Norway, this result suggests that organizational differences matter, which is an important implication for further research, health policy and practice.

An investigation and analysis of the activities of daily living of older adults living at home in Ningxia Hui Autonomous Region of China: a cross-sectional study

Background

To investigate the current situation regarding the activities of daily living (ADL) of older adults living at home in Ningxia Hui Autonomous Region of China and to analyze the associated factors of ADL performance so that we can provide references for the implementation of pension policies and long-term care insurance of older adults living at home.

Methods

We surveyed a total of 1040 older adults who live at home and receive home-based care in Ningxia Hui Autonomous Region by a face-to-face evaluation. A logistic regression model was used to analyze the factors associated with ADL performance.

Results

In the study, 82.79% of the older adults living at home can live independently. A total of 11.92% of the older adults have mild dysfunction, 4.33% have moderate dysfunction, and 0.96% have severe dysfunction. Multiple logistic analyses indicated that older adults with very difficult economic conditions (OR 3.212; 95% CI(1.209–8.534)) and without a spouse (OR 1.616; 95% CI(1.098–2.377)) were significantly associated with ADL limitations. In addition, the risks of ADL limitations in older adults aged 60–69 years and 70–79 years were 0.187 and 0.4307 times, respectively, that of older adults over 80 years old. The risk of ADL limitations in older adults of the Han nationality was 0.605 times that of the minority population. More highly educated and older adults without diseases have a lower risk of ADL limitations.

Conclusions

Compared with the national average in China, the number of ADL limitations of older adults in Ningxia is greater and is associated with advanced age, ethnic minority status, low education level, low income, lacking a spouse and having diseases. As the number of older adults increases, maintaining and improving their ability to perform ADL and providing comfortable pension services and health services urgently need to be solved.

The Association Between Pain Perception and Care Dependency in Older Nursing Home Residents: A Prospective Cohort Study

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.

Drum Communication Program Intervention in Older Adults With Cognitive Impairment and Dementia at Nursing Home: Preliminary Evidence From Pilot Randomized Controlled Trial

Introduction: Inactivity and consequent deterioration of cognitive and physical function is a major concern among older adults with the limited walking ability and need a high level of care in nursing homes. We aimed to test whether a drumming communication program (DCP) that uses the rhythmic response function of the elderly with cognitive impairment, dementia, and other debilitating disorders would improve their cognitive and physical function. Methods: We conducted a Randomized Controlled Trial (RCT) to investigate the effects of the DCP in 46 nursing home residents who needed high levels of nursing care. The participants were randomly assigned to an intervention and control group. The intervention group attended 30 min of the DCP thrice a week for 3 months. Cognitive function was measured using the Mini-Mental State Examination-Japanese (MMSE-J) and Frontal Assessment Battery (FAB). Physical function was measured using grip strength and active upper limb range of motion with the dominant hand. Body composition was measured using bioelectrical impedance analysis (BIA). These measures were analyzed before and after the DCP intervention period, and data for the two groups were compared thereafter. Results: Initially, the participants had low scores on the MMSE-J, and 84.78% of them used wheelchairs. Following the DCP intervention, the MMSE-J and FAB scores of the DCP group improved significantly. In terms of motor function, the active range of motion of the wrist palmar and the shoulder flexion improved in the intervention group. Regarding body composition, the skeletal muscle mass index, total body protein, and the dominant hand muscle mass that was adding physical load decreased. Conclusions: The DCP provided the participants with an opportunity to engage in continued exercise for 3 months. The intervention group exhibited improved cognitive function and upper limb motion range, and changes in body composition. The results suggest that DCP can be used as an intervention method to promote exercise and improve various health and cognitive functions. Trial Registration: This trial was registered at the University Hospital Medical Information Network Clinical Trial Registry (UMIN000024714) on 4 November 2016. The URL is available at https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000028399.

Factors associated with risk of care dependency in disabled geriatric patients

INTRODUCTION

The growing number of elderly people results in the intensification of disability, reduced level of independency and quality of life as well as augmented demand on medical and social services. The aim of the study was to identify factors associated with probability of care dependency in disabled geriatric patients.

MATERIALS AND METHODS

The study involved 200 patients aged 60 or over, consecutively admitted to the Geriatrics Unit. A cross-sectional quantitative study design. The study carried out using the questionnaire evaluating the patients' biopsychosocial needs and level of care dependency: the Polish version of the Care Dependency Scale (CDS). Data regarding the patients' self-care, locomotor function, emotional status, cognitive function, vision, hearing, the risk of pressure sores or falls, self-assessed health status and the sense of loneliness were obtained from medical documentation using selected elements of the CGA (Comprehensive Geriatric Assessment).

RESULTS

The mean CDS score (15-75) for all the evaluated patients was 55.3 ± 15.1-43.4 ± 11.9 in the category of dependent patients and 67.5 ± 4.6 in the category of independent of care, respectively (p < 0.001). The participants' mean age was 81.8 ± 6.6 (in the dependent category, 83.3, and in the independent category, 80.2). The final model produced statistically significant independent factors: cognitive ability, Instrumental-ADL performance, locomotive ability and age.

CONCLUSIONS

The progressing care dependency increased with the worsening of cognitive functions, difficulties performing I-ADL, locomotion impairment and advanced age. To support independent living of elderly people, healthcare professionals should recognise the situation in the community to carry out interventions aimed at preventing and minimising disability and delaying institutionalisation.

Long-Term Care Residents' Geriatric Syndromes at Admission and Disablement Over Time: An Observational Cohort Study

Background

Disablement occurs when people lose their ability to perform activities of daily living (ADLs) like bathing and dressing, and is measured as the rate of increasing disability over time. We examined whether balance impairment, cognitive impairment, or pain among residents at admission to long-term care homes were predictive of their rate of disablement over the subsequent 2 years.

Methods

Linked administrative databases were used to conduct a longitudinal cohort study of 12,334 residents admitted to 633 long-term care (LTC) homes between April 1, 2011 and March 31, 2012, in Ontario, Canada. Residents received an admission assessment of disability upon admission to LTC using the RAI-MDS 2.0 ADL long-form score (ADL LFS, range 0–28) and at least two subsequent disability assessments. Multivariable regression models estimated the adjusted association between balance impairment, cognitive impairment, and pain present at admission and residents’ subsequent disablement over 2 years.

Results

This population sample of newly admitted Ontario long-term care residents had a median disability score of 13 (interquartile range [IQR] = 7, 19) at admission. Greater balance impairment and cognitive impairment at admission were significantly associated with faster resident disablement over 2 years in adjusted models, while daily pain was not.

Conclusions

Balance impairment and cognitive impairment among newly admitted long-term care home residents are associated with increased rate of disablement over the following 2 years. Further research should examine the mechanisms driving this association and identify whether they are amenable to intervention.

Nutrition care quality indicators in hospitals and nursing homes: A systematic literature review and critical appraisal of current evidence

OBJECTIVE

Quality indicators (QIs) can be used to assess and improve the quality of care in health care institutions. Although QIs about nutrition care in hospitals and nursing homes have been used in studies, no systematic catalogue exists to date. This systematic literature review identifies nutrition care QIs in hospitals and nursing homes and maps them according to QI type, stakeholder level and nutrition care theme. We also assess the level of consensus between studies and critically appraise the QIs presented therein based on two conceptual frameworks.

METHODS

Ovid, Scopus and grey literature were searched from 1995 to 2016 including studies in English and German. Papers were considered if they presented, developed, assessed, rated or applied nutrition care QIs in hospitals or nursing homes. We used Donabedian's framework to define structure, process and outcome indicators, the WHO (World Health Organization) definition to describe stakeholder levels, and a structured table to map indicators within themes. Further, we used the Institute of Medicine (IOM) and the Organisation for Economic Cooperation and Development (OECD) frameworks' key dimensions to measure the conceptual quality of the QIs. Results are summarised and presented tabulated and narratively.

RESULTS

From 536 identified studies, 46 were included. Eight hundred and twenty-two QIs were extracted and mapped into 19 themes and 151 sub-themes. Half were process indicators (49%) and about a quarter were outcome (28%) and structure (23%) indicators, respectively. The vast majority (71%) targeted micro level, while 28% meso level and only 1% macro level information. The nutrition themes meals/mealtimes (12%), treatment (adherence) (12%), nutrition screening (7%), assessment (7%) and monitoring (7%) were most frequently covered. 69% of indicators were cited by more than one study. Most frequent framework dimensions were patient-centeredness (33%), timeliness (30%), validity (30%) and actionability/feasibility (30%).

CONCLUSION

The large number of nutrition care QIs in hospitals and nursing homes indicates the high interest in and importance of better nutrition care provision in institutions. However, the great variability indicates little consensus of the nutrition community on how to best assess and measure the quality of nutrition care. The limited methodological and conceptual validity of presented QIs and the low representation of QIs at macro and meso levels make international consensus finding complicated. Increased efforts including all stakeholder levels and using conceptual frameworks to define a limited number of key QIs with high methodological validity, actionability and stakeholder relevance are needed. Registration in clinicaltrials.gov: Identifier: NCT02820246.

Self-feeding dependence incidence and predictors among nursing home residents: Findings from a 5 year retrospective regional study

The aim of this regionally-based, retrospective study was to describe the incidence of self-feeding dependence and predictors among elderly patients admitted from 2008 to 2013 to 105 Italian nursing homes. Data reported in a regional database collected at the time of nursing home admission and every 6 months up to the resident's death were accessed. The self-feeding degree of dependence was the dependent variable; at the individual and nursing home levels, explanatory variables were those collected at nursing home admission and every 6 months. The structural equation model and the ordinal polynomial logit regression analysis were performed. A total of 13 175 records of residents when admitted to the nursing home and their following 69 341 records, were included. At the time of nursing home admission, 6496 residents (49.3%) reported a certain degree of dependence in self-feeding and showed slight worsening in their dependence every 6 months. At the individual level, the increased functional dependence raised the proportional odds ratios of approximately 4.36 times of an increased dependence in self-feeding; the degree of cognitive impairment, the lack of social interactions, the occurrence of pressure sores, comorbidities, as well as the clinical instability and time all raised the risk of self-feeding dependence progression. At the nursing home level, an increased number of beds emerged as a factor also increasing the proportional odds of dependence in self-feeding. Factors affecting self-feeding dependence are multi-faceted at the individual and at the nursing home levels.

Cognitive and functional deficits in people with schizophrenia: Evidence for accelerated or exaggerated aging?

Cognitive and functional deficits are commonly seen in people with schizophrenia. The profile of these impairments has a resemblance to the cognitive changes seen in healthy aging. In specific, many of the cognitive ability domains that change the most with aging in healthy people are the most salient of these deficits seen in people with schizophrenia, including prominent deficits in processing speed, working memory, and episodic memory. Functional deficits seen in schizophrenia are also similar to those seen in healthy aging. There is a relationship between multiple psychotic relapses and treatment resistance and longitudinal cognitive and functional changes in schizophrenia, with this relationship starting early in the course of illness. Cognitive performance in people with schizophrenia may be consistent with accelerated or premature aging. People with schizophrenia perform similarly to healthy people who are 3 or more decades older on indices of both cognition and their everyday functional skills. Some people with schizophrenia show exaggerated cognitive changes as well. Cognitive and functional performance worsens at the outset of the illness in schizophrenia compared to premorbid functioning, meaning that these deficits are not due to development disabilities. There are multiple medical and substance abuse comorbidities in schizophrenia and although these comorbidities affect cognitive functioning, they are not completely responsible for age-related changes.

The Heterogeneity of Disability Trajectories in Later Life: Dynamics of Activities of Daily Living Performance Among Nursing Home Residents

Objective: This study investigated the variability in activities of daily living (ADL) trajectories among 6,155 nursing home residents using unique and rich observational data. Method: The impairment in ADL performance was considered as a dynamic process in a multi-state framework. Using an innovative mixture model, such states were not defined a priori but inferred from the data. Results: The process of change in functional health differed among residents. We identified four latent regimes: stability or slight deterioration, relevant change, variability, and recovery. Impaired body functions and poor physical performance were main risk factors associated with degradation in functional health. Discussion: The evolution of disability in later life is not completely gradual or homogeneous. Steep deterioration in functional health can be followed by periods of stability or even recovery. The current condition can be used to successfully predict the evolution of ADL allowing to set and target different care priorities and practices.

A Deterioration in Hearing Is Associated With Functional and Cognitive Impairments, Difficulty With Communication, and Greater Health Instability

Objectives: To examine the relationship between hearing deterioration and several health-related outcomes among home care clients in Ontario. Design: Longitudinal analysis was completed for clients with at least two comprehensive assessments. Hearing status, based on a single item, ranged from zero (no impairment) to three (highly impaired). Hearing deterioration was defined as at least a 1-point decline between subsequent assessments. Results: Seven percent experienced a 1-point deterioration in hearing and roughly 1% had a 2/3-point decline. After adjusting for other covariates, increasing age (odds ratio = 1.94; 95% confidence intervals [CIs] = [1.45, 2.61]) and a diagnosis of Alzheimer’s disease (1.37; CI = [1.04, 1.80]) and other dementias (1.32; CI = [1.07, 1.63]) increased the risk of a 2/3-point deterioration. Conclusion: These findings can assist home care professionals and policy makers in creating and refining interventions to meet the needs of older adults with hearing difficulties.

Nutritional supplementation for activities of daily living and functional ability of older people in residential facilities: A systematic review

AIM

To review the best available evidence on nutritional supplementation for activities of daily living and functional ability of older people in residential facilities.

METHODS

Electronic searches were carried out using CENTRAL, MEDLINE and EMBASE databases for the years 2006-2016. Randomized controlled trials and cluster-randomized controlled trials that examined the effects of nutrition interventions aimed at improving the energy or protein intake alone or both in combination were included. Two authors independently reviewed all potential studies for inclusion against the eligibility criteria. We reviewed studies for outcome relevance and methodological rigor. Any disagreement was resolved by discussion.

RESULTS

A total of eight studies were included, containing four randomized controlled trials and four cluster-randomized controlled trials involving 698 participants. There was significant improvement in handgrip strength (mean difference 1.65 kg, 95% confidence interval 0.09-3.22 kg, P = 0.04), but no difference in activities of daily living (mean difference 2.06, 95% confidence interval -18.28-22.40, P = 0.84), balance (mean difference -1.10, 95% confidence interval -3.04-0.84, P = 0.27), gait velocity (mean difference 0.00, 95% confidence interval -0.03-0.03, P = 1.00) and death (RR 1.90, 95% confidence interval 0.61-5.99, P = 0.27).

CONCLUSIONS

Nutritional intervention with older people in residential facilities was effective in improving handgrip strength, but did not significantly improve scores for activities of daily living, balance, gait velocity or preventing death. Further studies with larger sample sizes and of high quality are required to investigate appropriate intervention methods and specific target participants. Geriatr Gerontol Int 2018; 18: 197-210.

Activities of daily living trajectories among institutionalised older adults: A prospective study

AIMS AND OBJECTIVES

To examine activities of daily living trajectory groups among older residents in Taiwan, and to determine the relative risks of demographic characteristics and health status in explaining the trajectory group of activities of daily living.

BACKGROUND

Activity of daily living is a crucial indicator of health status for institutionalised older adults. activities of daily living is a dynamic process and has differences in trajectory groups.

DESIGN

This study was a 3-year longitudinal analysis of long-term care facility residents in Taiwan.

METHODS

A total of 364 older residents completed the entire research process. We used group-based trajectory modelling and multinomial logistic models for statistical analysis.

RESULTS

The result of this study revealed that three activities of daily living trajectory groups among older residents exhibited high dependency with gradually declining function (Group 1, 22.53%), low dependency with gradually declining function (Group 2, 43.13%) and persistent independent function (Group 3, 34.34%). Compared with Group 3, Group 1 was related to the following potential risk factors: older age, female, nonmainland China born and a married status. After considering resident health status in the analysis, three significant factors emerged for Group 1: the number of chronic diseases (odds ratio = 2.45), depressive symptoms (odds ratio = 1.71) and cognitive status (odds ratio = 83.11). Compared with Group 3, Group 2 was related to older age. After adding resident health status to the analysis, two significant factors of Group 2 emerged: the number of chronic diseases (odds ratio = 1.68) and depressive symptoms (odds ratio = 1.74).

CONCLUSION

The findings of this study indicated that health factors, including the number of chronic diseases, cognitive status and depressive symptoms, were more likely to contribute to the development of a decline pattern of activities of daily living.

RELEVANCE TO CLINICAL PRACTICE

Appropriate exercise programmes and physical activities, according to residents' personal characteristics and activities of daily living status, is crucial for improving physical functioning, alleviating depression and cognitive defects in institutionalised older adults.

Functional decline in nursing home residents: A prognostic study

Aim

To verify the probability of maintaining functional capacity in basic activities of daily living and identify the prognostic factors of functional decline in institutionalized older adults.

Methods

A longitudinal study is presented herein, with 5 waves every 6 months, throughout 2 years (2013–2015), conducted with individuals ≥60 years old in 10 nursing homes in the city of Natal-RN (Brazil). Functional capacity was assessed by the items ‘eating’, ‘personal hygiene’, ‘dressing’, ‘bathing’, ‘transferring’, ‘toileting’ and ‘walking’, through a 5-item Likert scale. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time dependent variables included continence decline, cognitive decline, increase in the number of medication, and incidences of falls, hospitalizations and fractures. The actuarial method, the log-rank test and Cox's regression were applied as statistical methods.

Results

The cumulative probability of functional maintenance was 78.2% (CI 95%: 72.8–82.7%), 65.1% (CI 95%: 58.9–70.5%), 53.5% (CI 95%: 47.2–59.5%) and 44.0% (CI 95%: 37.7–50.2%) at 6, 12, 18 and 24 months, respectively. Predicting factors for functional decline were: severe cognitive impairment (HR = 1.96; p = 0.001), continence decline (HR = 1.85; p = 0.002) and incidence of hospitalizations (HR = 1.62; p = 0.020), adjusted by the incidence of depression, age, education level, presence of chronic diseases and low weight.

Conclusions

The cumulative probability of maintaining functional capacity in institutionalized older adults was only 44% at the 2-year follow-up. Prognostic factors for functional decline included severe cognitive impairment, continence decline and incidence of hospitalizations.

Urinary incontinence and its association with functional physical and cognitive health among female nursing home residents in Switzerland

Background

Specific knowledge of urinary incontinence (UI) and its interrelation with physical and cognitive health is essential to working towards prevention of UI and to improving quality of treatment and care. The purpose of this study was to determine the association between UI and the activities of daily living (ADL) hierarchy scale, the cognitive performance scale (CPS) and comorbid conditions.

Methods

The cross-sectional retrospective analysis of 357 nursing homes in Switzerland was based on data of the Minimum Data Set of the Resident Assessment Instrument 2.0 (RAI-MDS). The analysis examined the effect of ADL hierarchy scale, CPS, joint motion and comorbidities on UI. Women ≥65 years were included (n = 44’811; January 2005 to September 2014) at the time of admission to a nursing home. Statistical analysis was done by means of descriptive statistics and logistic regression analysis.

Results

The prevalence of UI was 54.7%, the mean ADL hierarchy scale (± SD) 2.42 ± 3.26 (range = 0–6), the mean CPS 1.95 ± 1.67 (range = 0–6). There was a gradual increase in the odds ratio (OR) for UI depending on the ADL hierarchy scale, from the hierarchy scales of “supervised” to “total dependence” of 1.43 – 30.25. For CPS, the OR for UI from “borderline intact” to “very severe impairment” was 1.35 – 5.99. Considering the interaction between ADL and CPS, all ADL hierarchies remained significantly associated with UI, however for CPS this was the case only in the lower hierarchies. Of the 11 examined comorbid conditions, only diabetes mellitus (OR 1.19), dementia (OR 1.01) and arthrosis/arthritis (OR 1.53) were significantly associated with UI.

Conclusion

The study indicated that impairment in ADL performance is strongly associated with UI, more than CPS performance and comorbidities. Physical more than cognitive training in order to improve or at least stabilize ADL performance could be a way to prevent or reduce the process of developing UI.

Hearing loss and use of health services: a population-based cross-sectional study among Finnish older adults

Background

Older adults with hearing difficulties face problems of communication which may lead to underuse of health services. This study investigated the association of hearing loss and self-reported hearing difficulty with the use of health services and unmet health care needs in older adults.

Methods

Data on persons aged 65 and older (n = 2144) drawn from a population-based study, Health 2000, were analyzed. Hearing loss was determined with screening audiometry (n = 1680). Structured face-to-face interviews were used to assess self-reported hearing difficulty (n = 1962), use of health services (physician and nurse visits, health examinations, mental health services, physical therapy, health promotion groups, vision test, hearing test, mammography, PSA test) and perceived unmet health care needs. Multivariable logistic regression analyses were used.

Results

After adjusting for socio-economic and health-related confounders, persons with hearing loss (hearing level of better ear 0.5–2 kHz > 40 dB) were more likely to have used mental health services than those with non-impaired hearing (OR = 3.2, 95 % CI 1.3–7.9). Self-reported hearing difficulty was also associated with higher odds for mental health service use (OR = 2.1 95 % CI 1.2–3.5). Hearing was not associated with use of the other health services studied, except presenting for a hearing test. Persons with self-reported hearing difficulty were more likely to perceive unmet health care needs than those without hearing difficulty (OR = 1.7, 95 % CI 1.4–2.1).

Conclusions

Older adults with hearing loss or self-reported hearing difficulty are as likely to use most health services as those without hearing loss. However, self-reported hearing difficulty is associated with experiencing unmet health care needs. Adequate health services should be ensured for older adults with hearing difficulties.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0356-5) contains supplementary material, which is available to authorized users.

nutritionDay in Nursing Homes-The Association of Nutritional Intake and Nutritional Interventions With 6-Month Mortality in Malnourished Residents

OBJECTIVES

Malnutrition in older persons is associated with an increased risk of mortality. Useful strategies to counteract malnutrition are nutritional interventions, such as fortified diets, oral nutritional supplements (ONS), tube feeding, and parenteral nutrition. Presently, it is not known if these strategies can reduce mortality risk of nursing home (NH) residents who are malnourished or at risk of malnutrition. Thus, the aim of this study was to investigate if nutritional intake and interventions are associated with mortality in this specific population.

DESIGN

One-day cross-sectional study with outcome evaluation after 6 months, repeated in yearly intervals since 2007.

SETTING

A total of 507 NH units from 15 countries.

PARTICIPANTS

NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older with a poor nutritional status (body mass index <20 kg/m² or weight loss >5 kg in the last year or at risk of malnutrition or malnourished according to NH staff).

MEASUREMENTS

Data on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents' nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents' nutritional status, general residents' characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P < .01) included in a multivariate analysis.

RESULTS

Six-month mortality rate of the included 4857 NH residents was 20.3%. Univariate analysis identified residents' diet, use of ONS, intake at lunch, and 14 confounders as predictors of mortality. Intake at lunch and 7 confounders remained in the multivariate model [area under the receiver operating curve = 0.687; 95% confidence interval (CI) 0.669-0.706; P < .001]. The less residents ate for lunch, the higher was the risk of mortality, with the highest odds ratio (OR) for residents who ate nothing (OR 3.38; 95% CI 2.58-4.42). Mortality risk was OR 2.36; 95% CI 1.91-2.92, and OR 1.64; 95% CI 1.29-2.07 times higher for immobile and partially mobile compared with mobile residents. Cancer, dysphagia, weight loss >5 kg in the last year, body mass index <20 kg/m², residents' country region, and increasing age were also associated with a higher mortality risk.

CONCLUSIONS

Poor intake at lunch on nutritionDay was a strong predictor of mortality, whereas the use of nutritional interventions was not associated with 6-month mortality in NH residents who are malnourished or at risk of malnutrition. The reasons for these findings need to be clarified.

Functional Decline in Residents Living in Nursing Homes: A Systematic Review of the Literature

OBJECTIVES

To describe the functional dependence progression over time in older people living in nursing homes (NHs).

DESIGN

A systematic review of the literature was performed. Studies involving individuals 65 years and older living in NHs, describing their functional decline, improvement or stability in activities of daily living (ADLs), were eligible. The search strategy was applied in MedLine, Cochrane, CINAHL, and SCOPUS databases; aimed at identifying an unbiased and complete list of studies, searching by hand was also performed. The methodological quality of the 27 studies included was assessed.

RESULTS

Functional trajectories were documented mainly through multicenter study design including sample size ranging from 2 to 9336 NHs, from 1983 to 2011 throughout a single or multiple follow-ups (>20). The average rate of decline was expressed in different metrics and periods of time: from 3 months with a decline of -0.13 points of 28, to 6 months (-1.78 points of 2829) to 1.85 years (-0.5 points of 6). Eating and toileting were the most documented ADLs and the decline is approximately 0.4 points and 0.2 to 0.4 points of 5 a year, respectively. Among the covariates, individual factors, such as cognitive status, were mainly considered, whereas only 13 studies considered facility-level factors.

CONCLUSIONS

Findings report the slow functional decline mainly in women living in US NHs, in years when residents were admitted with a low or medium degree of functional dependence. Considering that in recent years residents have been admitted to NHs with higher-level functional dependence, studies measuring each single ADL, using standardized instruments capable of capturing the signs of decline, stability, or improvement are strongly recommended. Among the covariates, evaluation of both individual and facility-level factors, which may affect functional decline, is also suggested.

Self-Reported Hearing Status Is Associated with Lower Limb Physical Performance, Perceived Mobility, and Activities of Daily Living in Older Community-Dwelling Men and Women

OBJECTIVES

To explore the associations between self-reported hearing problems and physical performance and self-reported difficulties in mobility and activities of daily living (ADLs) in community-dwelling older adults.

DESIGN

Cross-sectional cohort study.

SETTING

Community.

PARTICIPANTS

Men and women aged 75 to 90 (N = 848).

MEASUREMENTS

Structured face-to-face interviews to assess perceived hearing problems in the presence of noise, mobility difficulties (moving indoors, stair-climbing, 0.5-km walk, 2-km walk), and difficulties in ADLs and instrumental ADLs. The Short Physical Performance Battery (SPPB) was administered. Age; years of education; cognitive functioning; and self-reported cardiac, circulatory, and locomotor diseases were used as covariates.

RESULTS

Persons who reported major hearing problems had a lower SPPB total score than those who reported good hearing (mean 9.8 vs 10.9, P = .009), indicating poorer performance, and more difficulties in ADLs (mean 1.8 vs 1.4, P = .002) and IADLs (mean 4.6 vs 3.4, P = .002), after controlling for covariates. They were also more likely to have more difficulty in stair-climbing (odds ratio (OR) = 2.8, P < .001) and walking 2 km (OR = 2.1, P = .003) and tended to have more difficulty in walking 0.5 km (OR = 1.7, P = .05) but not moving indoors (P = .18). Persons who reported only some hearing problems did not differ from those who reported good hearing in any of the variables studied.

CONCLUSION

Perceived major hearing problems in older adults may contribute to poorer lower limb performance and difficulties in mobility and ADLs. Longitudinal studies are needed to determine whether poor hearing is a risk factor for decline in physical performance.

Prevalence of fecal incontinence (FI) and associated factors in institutionalized older adults

The objective of this work is to determine the prevalence of FI and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December 2013, in 10 nursing homes (NHs) of the city of Natal (Northeast Brazil). Individuals over the age of 60 were included in the study, while those hospitalized or in terminal phase were excluded. Data collection included sociodemographic information, FI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). FI was verified through the Minimum Data Set (MDS) 3.0, which was also used to assess toileting programs. The Chi-square test and the linear Chi-square test were performed for bivariate analysis, as well as logistic regression for multivariate analysis. The final sample consisted of 321 elderly, mostly females, with mean age of 81.5 years. The prevalence of FI was 42.68% (CI 95%, 37.39-48.15). Most residents presenting FI were always incontinent (83.9%) and the most frequent incontinence type was total FI (solid and liquid stools). Incontinence control measures were applied only to 9.7% of the residents. The final model revealed a statistically significant association between FI and functional and cognitive impairments. It is concluded that FI is a health issue that affects almost half of the institutionalized elderly, and is associated with functional and cognitive disability.

Malnutrition in the nursing home

PURPOSE OF REVIEW

Malnutrition in the nursing home is increasingly recognized as a major international research priority, given the expanding geriatric populations, serious consequences, and challenges conducting research in nursing homes. This review examines the recent literature and suggests implications for research and practice.

RECENT FINDINGS

Across the recent studies, approximately 20% of nursing home residents had some form of malnutrition. However, malnutrition definitions were variable and prevalence ranged from 1.5 to 66.5%. Depression, cognitive impairment, functional impairment, and swallowing difficulty were consistently associated with malnutrition. Mortality was the major consequence of malnutrition among nursing home residents, whereas higher BMIs had lower risks of mortality. Beneficial interventions to reduce malnutrition in the nursing home included dietary supplements, greater resident role in food choice, and staff training programs.

SUMMARY

To truly tackle the issue of malnutrition in the nursing home setting, a consistent definition is needed. We strongly recommend that an expert consensus panel identify a standard set of measures to more accurately compare the prevalence across countries. Given the mortality consequences of malnutrition and the paucity of intervention studies, research on interventions for malnutrition in the nursing home needs to be a higher priority for facilities, researchers, and funding agencies.

Life Space Assessment in Older Women Undergoing Non-Surgical Treatment for Urinary Incontinence

OBJECTIVES

Urinary incontinence (UI) impacts all aspects of life activities. This study aims to characterize change in mobility within the community utilizing the Life Space Assessment (LSA) questionnaire in women undergoing non-surgical UI treatment.

DESIGN

Prospective cohort study, performed from July 2007 to March 2009, which followed women seeking non-surgical UI treatment and assessed their mobility and symptoms using LSA, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) at baseline and 2, 6, and 12 months post-treatment. Estimated Percent Improvement (EPI) and Patient Satisfaction Question (PSQ) were obtained post-treatment.

SETTING

Outpatient tertiary-care clinic.

PARTICIPANTS

70 ambulatory, community-dwelling women, aged 65 years or older, seeking non-surgical care for UI.

INTERVENTION

Multi-component behavioral and/or pharmacologic therapies.

MEASUREMENTS

We hypothesized LSA would improve with treatment. Repeated measures analysis with Tukey's HSD and backwards selection linear regression model were performed.

RESULTS

LSA score decreased from baseline to 2 months (mean±SD; 63±29 to 56±28, p<0.001) and was sustained at 6 and 12 months (54±28, 54±28). UDI scores improved from 36±23 to 25±24, p<0.001, at 2 months, and improvement persisted at 6 and 12 months (22±22, 21±24). Improvements in UDI and patient perceived improvement in UI were not associated with LSA change. Age, race, and depression impacted LSA, which decreased 1-point for each additional year of age (p=0.004), 6-points for each point higher on the Geriatric Depression Scale (GDS) (p=0.002), and 6-points for African American race (p=0.048).

CONCLUSION

Decreased mobility represented by LSA was related to age, depression, and race, but not UI symptom improvement.

Natural course of care dependency in residents of long-term care facilities: prospective follow-up study

BACKGROUND

Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality.

METHODS

A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79-88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15-75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months.

RESULTS

At baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P < 0.001); participants in the low CDS group stayed longer, had more frequent urine incontinence and more dementia. They had also the highest mortality rate (log rank 32.2; df = 2; P for trend <0.001). Per point lower in CDS score, the mortality risk increased with 2% (95% CI 1%-3%). Adjustment for age, gender, cranberry use, LTCF, length of stay, comorbidity and dementia showed similar results. A one point decrease in CDS score between 0 and 6 months was related to an increased mortality risk of 4% (95% CI 3%-6%).At the 6-month follow-up, 10% improved to a higher CDS group, 65% were in the same, and 25% had deteriorated to a lower CDS group; a similar pattern emerged at 12-month follow-up. Gender, age, urine incontinence, dementia, cancer and baseline care dependency status, predicted an increase in care dependency over time.

CONCLUSION

The majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

What characteristics predispose to continence in nursing home residents?: a population-based cross-sectional study

Aims

To compare characteristics of both continent and incontinent residents in Nursing Homes (NHs) and to explore what predicts continence and severity of incontinence.

Methods

A population-based cross-sectional study was performed in nursing homes in one Norwegian municipality. Registered nurses filled in a questionnaire on behalf of the patients.

Results

We found that 25.4% of the NH residents were continent, 31.8% had urinary incontinence alone, 2.6% had fecal incontinence alone and 40.2% had double incontinence. Continent residents were characterized by being in short-term care, shorter stay in NH, less cognitive and physical impairment, less Parkinson's disease, stroke, constipation, and less diarrhea and more independence in activities of daily living (ADL). Residents with fecal incontinence alone were characterized by more diarrhea, less cognitive impairment and less dependency in ADL such as feeding and grooming. Residents with urinary incontinence alone were characterized by having some degree of ADL dependency, less diarrhea, and less diabetes. Residents with double incontinence were characterized by being in long-term care, a longer length of stay in NH, cognitive impairment, stroke, constipation, diarrhea, and dependency in ADL. Severity of incontinence was associated with dependency in ADL and cognitive impairment, diarrhea, length of stay in NH and lower age.

Conclusions

About 25% of NH residents were continent. Double incontinence and urinary incontinence only were prevalent conditions in NHs, while FI alone was rarer. With the exception of diarrhea as a cause of FI, it appears that FI alone, UI alone, and DI may have common causes and development. Neurourol. Urodynam. 34:362–367, 2015. © 2014 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.