1
|
Gombault-Datzenko E, Costa N, Mounié M, Tavassoli N, Mathieu C, Roussel H, Lagarrigue JM, Berard E, Rolland Y, Molinier L. Cost of care pathways before and after appropriate and inappropriate transfers to the emergency department among nursing home residents: results from the FINE study. BMC Geriatr 2024; 24:353. [PMID: 38641801 PMCID: PMC11027376 DOI: 10.1186/s12877-024-04946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate). METHODS This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant. RESULTS Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€. CONCLUSIONS Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents. TRIAL REGISTRATION clinicaltrials.gov, NCT02677272.
Collapse
Affiliation(s)
- E Gombault-Datzenko
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France.
| | - N Costa
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| | - M Mounié
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| | - N Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - C Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
- CREAI-ORS Occitanie, Toulouse, France
| | - H Roussel
- CNAM, DRSM Occitanie, 2 rue Georges Vivent, Toulouse, 31082, France
| | - J M Lagarrigue
- MSA Midi-Pyrénées Nord, 180 Avenue Marcel Unal, Montauban, 82000, France
| | - E Berard
- INSERM, UMR 1295, Toulouse, France
- Department of Epidemiology, University Hospital of Toulouse, 37 Allées Jules Guesde, Toulouse, 31000, France
| | - Y Rolland
- INSERM, UMR 1295, Toulouse, France
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - L Molinier
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| |
Collapse
|
2
|
Bouzid W, Cantet C, Berard E, Mathieu C, Hermabessière S, Houles M, Krams T, Qassemi S, Cambon A, McCambridge C, Tavassoli N, Rolland Y. Exploring Predictive Factors for Potentially Avoidable Emergency Department Transfers: Findings From the FINE Study. J Am Med Dir Assoc 2024; 25:572-579.e1. [PMID: 38159914 DOI: 10.1016/j.jamda.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To assess the prevalence of potentially avoidable transfers (PAT) and identify factors associated with these transfers to emergency departments (EDs) among nursing home (NH) residents. DESIGN This is a secondary outcome analysis of the FINE study, a multicenter observational study collecting data on NH residents, NH settings, and contextual factors of ED transfers. SETTINGS AND PARTICIPANTS NHs in the former Midi-Pyrénées region of the southwest of France (n = 312); a total of 1037 NH residents who experienced ED transfers (n = 1017) between January 2016 and December 2016. METHODS The analysis included resident baseline characteristics and NH and transfer decision-making characteristics. An expert group categorized the transfer status as either PAT or unavoidable. Multivariable analysis using a mixed logistic model, accounting for intra-NH correlation, was conducted to assess factors independently associated with PAT. RESULTS Among 1017 included transfers, 87.02% (n = 885) were identified as PAT and 12.98% (n = 132) unavoidable transfers. Multivariable analysis revealed that the following patient-related factors were associated with a likely high rate of PAT: usual behavior disturbances before transfer, including productive trouble (OR 2.04, 95% CI 1.25-3.33; P = .0044) and unusual symptom of falling during the week preceding the transfer (OR 4.55, 95% CI 1.76-11.82; P = .0019). On the other hand, distance between ED and NH (OR 0.98, 95% CI 0.97-0.998; P = .0231), NH staff trained in palliative care in the last 3 years (OR 0.52, 95% CI 0.29-0.95; P = .0324), the impossibility of direct hospitalization to an appropriate unit (OR 0.54, 95% CI 0.34-0.87; P = .0117), and the resident Charlson Comorbidity Index (OR 0.90, 95% CI 0.82-0.99; P = .0369) were associated with a lower probability of PAT. CONCLUSION AND IMPLICATIONS Transfers from NHs to hospital EDs were frequently potentially avoidable, meaning that there are still significant opportunities to reduce PAT. Our findings may help to specifically identify interventions that should be targeted at both NH and resident levels.
Collapse
Affiliation(s)
- Wafa Bouzid
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; Regional Health Agency of Occitanie, Toulouse, France.
| | | | - Emilie Berard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; UMR 1295 CERPOP, INSERM-Université de Toulouse III, Toulouse, France
| | - Celine Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Mathieu Houles
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Thomas Krams
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | | | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France
| |
Collapse
|
3
|
Bilal Ahmed S, Obieta A, Santos T, Ahmad S, Elliot Ibrahim J. Effects of Nonpharmacological Interventions on Disruptive Vocalisation in Nursing Home Patients With Dementia—A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:718302. [PMID: 36188852 PMCID: PMC9397760 DOI: 10.3389/fresc.2021.718302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
Background Vocally disruptive behaviour is a common and difficult to treat condition in older residents with dementia. The aim of this systematic review is to evaluate the efficacy of nonpharmacological interventions in its management in persons with dementia residing in a nursing home. Methodology A systematic search was conducted using Ovid MEDLINE, CINAHL, and Cochrane databases and reference lists from relevant publications on various nonpharmacological approaches to manage vocally disruptive behaviour in nursing home residents. The method of appraisal was through the National Institutes of Health scoring for the Quality Assessment of controlled intervention studies. Inclusion criteria included residents of nursing homes over the age of 65 with dementia and disruptive vocalisation. Only randomised controlled trials published in English were included. Results A total of 5,606 articles were identified, which cover 501 trials, of which 23 were selected. There were fourteen studies observed to have an impact of clinical and statistical significance with interventions including (i) a multidimensional approach with different nonpharmacological interventions, (ii) multisensory stimulation, (iii) staff education and training, (iv) personalised bathing, and (v) pain recognition and appropriate management. Seven studies demonstrated no observable effect whereas two showed worsening in vocally disruptive behaviour. Conclusions Many aspects of vocally disruptive behaviour management are poorly understood. Limited empirical evidence supports the use of several nonpharmacological interventions to reduce it. There is more robust evidence to support the use of a tailored approach to management over the universal approach.
Collapse
Affiliation(s)
- Saad Bilal Ahmed
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
- *Correspondence: Saad Bilal Ahmed
| | - Alfredo Obieta
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
| | - Tamsin Santos
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
| | - Saara Ahmad
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Joseph Elliot Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Sönnerstam E, Gustafsson M, Lövheim H. Potentially inappropriate medications in relation to length of nursing home stay among older adults. BMC Geriatr 2022; 22:70. [PMID: 35065614 PMCID: PMC8783464 DOI: 10.1186/s12877-021-02639-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the use of potentially inappropriate medications and their relation to the length of nursing home stay among older adults. Methods Questionnaire surveys using the Multi-Dimensional Dementia Assessment scale were sent out to all nursing homes in Västerbotten county in northern Sweden in 2007 and 2013. In total, 3186 adults (1881 from 2007 and 1305 from 2013) ≥65 years old were included and 71.8% of those had cognitive impairment. Potentially inappropriate medications were identified using drug-specific quality indicators according to Swedish National Board of Health and Welfare. Results Potentially inappropriate medications were used by 48.0% of the 2007 study sample and by 28.4% of the 2013 study sample. The prevalence of glibenclamide use 2007 and antipsychotic drug use 2013 increased linearly (β = 0.534E− 3, 95% CI: 0.040E− 3-0.103E− 2, p = 0.034 and β = 0.155E− 2, 95% CI: 0.229E− 3-0.288E− 2, p = 0.022, respectively) with the length of nursing home stay. No significant association was found between the prevalence of propiomazine, codeine, long-acting benzodiazepines, anticholinergics, NSAIDs, tramadol or the total use of potentially inappropriate medications and the length of stay in nursing homes in 2007 or 2013. Antipsychotics were the most commonly prescribed of the drug classes investigated and used by 22.6% of the residents 2007 and by 16.0% of the residents 2013. Conclusions These results indicate that treatment with potentially inappropriate medications is common among older adults living in nursing homes, but it seems to be related to the length of nursing home stay only to a smaller extent. Drug treatment should regularly be reviewed and followed-up among nursing home residents regardless of their length of nursing home stay, in order to prevent unnecessary adverse events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02639-3.
Collapse
|
5
|
Abstract
OBJECTIVES Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence. DESIGN Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia. SETTING AND PARTICIPANTS NH residents with dementia. MEASUREMENTS Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy. RESULTS Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07). CONCLUSIONS Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.
Collapse
|
6
|
Rolland Y, Mathieu C, Tavassoli N, Berard E, Laffon de Mazières C, Hermabessière S, Houles M, Perrin A, Krams T, Qassemi S, Cambon A, Magre E, Cantet C, Charpentier S, Lauque D, Azema O, Chicoulaa B, Oustric S, McCambridge C, Gombault-Datzenko E, Molinier L, Costa N, De Souto Barreto P. Factors Associated with Potentially Inappropriate Transfer to the Emergency Department among Nursing Home Residents. J Am Med Dir Assoc 2021; 22:2579-2586.e7. [PMID: 33964225 DOI: 10.1016/j.jamda.2021.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the factors associated with the potentially inappropriate transfer of nursing home (NH) residents to emergency departments (EDs) and to compare hospitalization costs before and after transfer of individuals addressed inappropriately vs those addressed appropriately. DESIGN Multicenter, observational, case-control study. SETTING AND PARTICIPANTS 17 hospitals in France, 1037 NH residents. MEASURES All NH residents transferred to the 17 public hospitals' EDs in southern France were systematically included for 1 week per season. An expert panel composed of family physicians, emergency physicians, geriatricians, and pharmacists defined whether the transfer was potentially inappropriate or appropriate. Residents' and NHs' characteristics and contextual factors were entered into a mixed logistic regression to determine factors associated independently with potentially inappropriate transfers. Hospital costs were collected in the national health insurance claims database for the 6 months before and after the transfer. RESULTS A total of 1037 NH residents (mean age 87.2 ± 7.1, 68% female) were transferred to the ED; 220 (21%) transfers were considered potentially inappropriate. After adjustment, anorexia [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.57-3.71], high level of disability (OR 0.90, 95% CI 0.81-0.99), and inability to receive prompt medical advice (OR 1.67, 95% CI 1.20-2.32) were significantly associated with increased likelihood of potentially inappropriate transfers. The existence of an Alzheimer's disease special care unit in the NH (OR 0.66, 95% CI 0.48-0.92), NH staff trained on advance directives (OR 0.61, 95% CI 0.41-0.89), and calling the SAMU (mobile emergency medical unit) (OR 0.47, 95% CI 0.34-0.66) were significantly associated with a lower probability of potentially inappropriate transfer. Although the 6-month hospitalization costs prior to transfer were higher among potentially inappropriate transfers compared with appropriate transfers (€6694 and €4894, respectively), transfer appropriateness was not significantly associated with hospital costs. CONCLUSIONS AND IMPLICATIONS Transfers from NHs to hospital EDs were frequently appropriate. Transfer appropriateness was conditioned by NH staff training, access to specialists' medical advice, and calling the SAMU before making transfer decisions. TRIAL REGISTRATION clinicaltrials.gov, NCT02677272.
Collapse
Affiliation(s)
- Yves Rolland
- Gérontopôle, Toulouse University Hospital, Toulouse, France; INSERM, UMR 1027, Toulouse, France
| | - Celine Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France; CREAI-ORS Occitanie, Toulouse, France
| | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France.
| | - Emilie Berard
- Service d'Epidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France, UMR 1027, INSERM-Université de Toulouse III, Toulouse, France
| | | | | | - Mathieu Houles
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Amélie Perrin
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Thomas Krams
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Elodie Magre
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Sandrine Charpentier
- Emergency Department, University Paul Sabatier Toulouse III, Toulouse University Hospital, INSERM, UMR 1027, Toulouse, France
| | - Dominique Lauque
- Emergency Department, University Paul Sabatier Toulouse III, Toulouse University Hospital, INSERM, UMR 1027, Toulouse, France
| | - Olivier Azema
- Observatoire Régional des Urgences d'Occitanie (ORU Occitanie), Toulouse University Hospital, Toulouse, France
| | - Bruno Chicoulaa
- Département Universitaire de Médecine Générale (DUMG), Université Toulouse III, Toulouse University Hospital, Toulouse, France
| | - Stéphane Oustric
- Département Universitaire de Médecine Générale (DUMG), Université Toulouse III, Toulouse University Hospital, Toulouse, France
| | | | | | - Laurent Molinier
- INSERM, UMR 1027, Toulouse, France; Department of Medical Information (DIM), Toulouse University Hospital, Toulouse, France
| | - Nadège Costa
- INSERM, UMR 1027, Toulouse, France; Department of Medical Information (DIM), Toulouse University Hospital, Toulouse, France
| | | |
Collapse
|
7
|
Callegari E, Benth JŠ, Selbæk G, Grønnerød C, Bergh S. Does Psychotropic Drug Prescription Change in Nursing Home Patients the First 6 Months After Admission? J Am Med Dir Assoc 2020; 22:101-108.e1. [PMID: 33077352 DOI: 10.1016/j.jamda.2020.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/25/2020] [Accepted: 08/24/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To explore the course of psychotropic drug (PTD) prescription from admission (BL) to 6-month follow-up (6m) in Norwegian nursing homes (NHs). To examine how clinical variables, such as neuropsychiatric symptoms (NPS), cognition, physical health, and NH characteristics at BL are associated with prescription rates at 6 months. DESIGN An observational longitudinal cohort study (data from the Resource Use and Disease Course in Dementia-Nursing Home study) designed to examine the course of dementia, psychiatric and somatic diseases, and drug prescriptions in NH patients during the first 6 months after admission. SETTING AND PARTICIPANTS We included 696 patients at admission to 47 representative Norwegian NHs. METHODS Demographic and clinical characteristics at BL and 6m are presented. Dementia severity was assessed by the Clinical Dementia Rating scale and the Functional Assessment Staging of Alzheimer's Disease scale. Final diagnosis was made by 2 of the authors (G.S. and S.B.) according to ICD-10 criteria. Prevalence, incidence, and persistence rates of PTD prescriptions for people with dementia are presented. Generalized mixed models were used to identify possible predictors for the course of PTD prescription from BL to 6m. RESULTS Prescription rates of antidepressants, antipsychotics, anxiolytics, sedatives, and hypnotics increased in people with dementia from BL (67.5% received at least 1 PTD) to 6m (74.0% received at least 1 PTD). Younger age and higher Neuropsychiatric Inventory-affective subsyndrome score at BL were associated with higher odds of antidepressant prescription, whereas patients with higher comorbidity at BL had lower odds of receiving antidepressants, both at BL and 6m. Higher Neuropsychiatric Inventory-affective subsyndrome scores at BL were associated with higher odds of sedative and hypnotic prescription at both assessment points. CONCLUSIONS AND IMPLICATIONS PTD prescription rates increase from BL to 6m. Medication appropriateness should be frequently evaluated after admission to optimize PTD prescriptions.
Collapse
Affiliation(s)
- Enrico Callegari
- Østfold Hospital Trust, Grålum, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway; Research Centre for age related functional decline and diseases, Innlandet Hospital Trust, Ottestad, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbæk
- Faculty of Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Faculty of Medicine, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Cato Grønnerød
- Østfold Hospital Trust, Grålum, Norway; Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- Research Centre for age related functional decline and diseases, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
8
|
Rolland Y, Tavassoli N, de Souto Barreto P, Perrin A, Laffon de Mazières C, Rapp T, Hermabessière S, Tournay E, Vellas B, Andrieu S. Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers: The IDEM Cluster Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200049. [PMID: 32101308 PMCID: PMC7137681 DOI: 10.1001/jamanetworkopen.2020.0049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Dementia is often underdiagnosed in nursing homes (NHs). This potentially results in inappropriate care, and high rates of emergency department (ED) transfers in particular. OBJECTIVE To assess whether systematic dementia screening of NH residents combined with multidisciplinary team meetings resulted in a lower rate of ED transfer at 12 months compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized trial with NHs as the unit of randomization. The IDEM (Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units) trial took place at 64 public and private NHs in France. Recruitment started on May 1, 2010, and was completed on March 31, 2012. Residents who were aged 60 years or older, had no diagnosed or documented dementia, were not bedridden, had lived in the NH for at least 1 month at inclusion, and had a life expectancy greater than 12 months were included. The residents were followed up for 18 months. The main study analyses were completed on October 14, 2016. INTERVENTION Two parallel groups were compared: an intervention group consisting of NHs that set up 2 multidisciplinary team meetings to identify residents with dementia and to discuss an appropriate care plan, and a control group consisting of NHs that continued their usual practice. During the inclusion period of 23 months, all residents of participating NHs who met eligibility criteria were included in the study. MAIN OUTCOMES AND MEASURES The primary end point (ED transfer) was analyzed at 12 months, but the residents included were followed up for 18 months. RESULTS A total of 64 NHs participated in the study and enrolled 1428 residents (mean [SD] age, 84.7 [8.1] years; 1019 [71.3%] female): 599 in the intervention group (32 NHs) and 829 in the control group (32 NHs). The final study visit was completed by 1042 residents (73.0%). The main reason for early discontinuation was death (318 residents [22.7%]). The intervention did not reduce the risk of ED transfers during the 12-month follow-up: the proportion of residents transferred at least once to an ED during the 12-month follow-up was 16.2% in the intervention group vs 12.8% in the control group (odds ratio, 1.32; 95% CI, 0.83-2.09; P = .24). CONCLUSIONS AND RELEVANCE This study failed to demonstrate that systematic screening for dementia in NHs resulted in fewer ED transfers. The findings do not support implementation of multidisciplinary team meetings for systematic dementia screening of all NH residents, beyond the national recommendations for dementia diagnosis, to reduce ED transfers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01569997.
Collapse
Affiliation(s)
- Yves Rolland
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de la Dépendance (ERVPD), Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM–Université de Toulouse III, Toulouse, France
| | - Neda Tavassoli
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de la Dépendance (ERVPD), Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM–Université de Toulouse III, Toulouse, France
| | - Amélie Perrin
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Clarisse Laffon de Mazières
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Thomas Rapp
- LIRAES (EA 4470) & Chaire AGEINOMIX, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Sophie Hermabessière
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Elodie Tournay
- Unité de Soutien Méthodologique à la Recherche, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de la Dépendance (ERVPD), Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM–Université de Toulouse III, Toulouse, France
| | - Sandrine Andrieu
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM–Université de Toulouse III, Toulouse, France
- Unité de Soutien Méthodologique à la Recherche, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Service d'Epidémiologie, Unité de Soutien Méthodologique à la Recherche, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| |
Collapse
|
9
|
The Temporal Trend in the Transfer of Older Adults to the Emergency Department for Traumatic Injuries: A Retrospective Analysis According to Their Place of Residence. J Am Med Dir Assoc 2019; 20:1462-1466. [DOI: 10.1016/j.jamda.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 01/07/2023]
|
10
|
Roitto HM, Kautiainen H, Aalto UL, Öhman H, Laurila J, Pitkälä KH. Fourteen-Year Trends in the Use of Psychotropic Medications, Opioids, and Other Sedatives Among Institutionalized Older People in Helsinki, Finland. J Am Med Dir Assoc 2019; 20:305-311. [DOI: 10.1016/j.jamda.2018.12.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
|
11
|
Arrighi-Allisan AE, Neifert SN, Gal JS, Deutsch BC, Caridi JM. Discharge Destination as a Predictor of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion. World Neurosurg 2019; 122:e139-e146. [DOI: 10.1016/j.wneu.2018.09.147] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/17/2023]
|
12
|
Comparison of Potentially Inappropriate Medications for People with Dementia at Admission and Discharge during An Unplanned Admission to Hospital: Results from the SMS Dementia Study. Healthcare (Basel) 2019; 7:healthcare7010008. [PMID: 30634548 PMCID: PMC6473531 DOI: 10.3390/healthcare7010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 11/16/2022] Open
Abstract
People with dementia (PWD) and cognitive impairment are particularly vulnerable to medication problems, and unplanned admission to hospital presents an opportunity to address polypharmacy, potentially inappropriate medications (PIMs) and anticholinergic burden. This study aimed to compare PIMS and other medication data for PWD to determine whether these changed during hospitalization. Medications documented in patient’s records at admission and discharge were evaluated for PWD recruited to phase one of a prospective quasi-experimental pre/post-controlled trial that was conducted at two regional hospitals in NSW, Australia. The study sample included PWD or cognitive impairment having an unplanned admission to hospital. Data were collected using a purpose developed audit tool for medications and PIMs, and a Modified Anticholinergic Burden Scale. Total participants were 277, and results determined that the cognitive status of PWD is not always detected during an unplanned admission. This may make them more vulnerable to medication problems and poor outcomes. Polypharmacy and PIMS for PWD were high at admission and significantly reduced at discharge. However, PWD should be routinely identified as high risk at admission; and there is potential to further reduce polypharmacy and PIMs during admission to hospital, particularly psychotropic medications at discharge. Future studies should focus on evaluating targeted interventions designed to increase medication safety for PWD.
Collapse
|
13
|
Laffon de Mazières C, Romain M, Hermabessière S, Abellan G, Gerard S, Castex A, Krams T, Vellas B, Rolland Y. An Innovative Day Hospital Dedicated to Nursing Home Resident: A Descriptive Study of 1306 Residents Referred by their Physicians. J Nutr Health Aging 2018; 22:1138-1143. [PMID: 30379316 PMCID: PMC6302543 DOI: 10.1007/s12603-018-1106-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The transfer rate of residents from nursing homes (NH) to emergency rooms is high. These transfers are often inappropriate but also potentially avoidable. Recent studies have shown that in terms of methods for training NH teams, proposals for improvement of the healthcare sector must be organized. Given this observation, Gérontopôle de Toulouse (France) opened in October 2015, a responsive day hospital dedicated to NH residents (DH NH). This day hospital is characterized by its vocation, exclusively dedicated to NH residents and its ability to provide patient care within a short period of time. OBJECTIVES The purpose of this day hospital is twofold: (1) decrease the rate of inappropriate transfers for NH residents by offering general practitioners and NH teams quick access to expert advice, blood tests and radiological examinations during hospitalizations and care adapted to the characteristics of NH residents; (2) potentially reduce avoidable transfers to emergency rooms and hospitalizations by taking action to prevent acute decompensation in residents, but also for the education and training of NH healthcare teams. This manuscript aims to describe the arrangements put in place and the characteristics of the residents collected after two years of activity. DESIGN Retrospective descriptive study. SETTING Gérontopôle of Toulouse, France. PARTICIPANTS 1306 residents have been consulted at the DH NH. MEASUREMENTS Referring physicians (treating physicians, coordinating physician or emergency room physicians) send a standardized hospitalization request form to the day hospital by fax or email indicating the reason for the request, specialist opinion(s) desired and additional required examination(s). A gerontological assessment was conducted and anamnesis data was collected for each resident, on the very day of their coming to the DH NH. RESULTS In 2 years, 1306 residents from 120 NHs were sent to the DH NH. The mean age was 86.23 ± 7.05 years and the majority of patients were women (n=941, 72.22%), dependent (median ADL at 2.75, [1.25-4.5]) and malnourished (821, 63.25%). In the 3 months prior to their visit to the day hospital, 668 (57.14%) residents had been hospitalized, and one-quarter (n=336, 25.72%) had been transferred to emergency rooms. The main reasons for hospitalization included assessment of cognitive disorders (n=336, 17.52%), assistance in managing behavioral disorders (n=297, 15.48%) and bedsores and slow wound healing (n=223, 11.63%). CONCLUSION Our experience over a 2-year period suggests that the DH NH could be a practical response to the problem of inappropriate and avoidable transfers of NH residents to emergency rooms. This innovation could easily be utilized in other hospitals.
Collapse
Affiliation(s)
- C Laffon de Mazières
- Clarisse Laffon de Mazières, Department of Geriatric Medicine, Gérontopôle, Toulouse University Hospital, Cité de la santé - 20, rue du Pont Saint-Pierre - TSA 60033 - 31059 Toulouse cedex 9, France. E-mail address : . Tel: +33 (0)5 61 77 70 46
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Health status and drug use 1 year before and 1 year after skilled nursing home admission during the first quarter of 2013 in France: a study based on the French National Health Insurance Information System. Eur J Clin Pharmacol 2017; 74:109-118. [PMID: 28975381 DOI: 10.1007/s00228-017-2343-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/25/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE Changes in prescribing practices following skilled nursing home (SNH) admission have not been clearly described in France. The study aimed to evaluate health status and drug use 1 year before and 1 year after admission to SNH. METHOD People ≥ 65 years old admitted to SNH in the first quarter of 2013, covered by the national health insurance general scheme (69% of the population of this age) and still alive 1 year after admission were identified in a specific database (Resid-ehpad). Linking with the National Health Insurance Information System (SNIIRAM) allowed analysis of their health status, identified by algorithms, and changes in their use of reimbursed drugs. RESULTS In a population of 11,687 residents (mean age: 86 years, women: 76%), the most prevalent diseases were cardiovascular/neurovascular diseases (45%) and dementias (35%). The use of certain chronic treatments (≥ 3 reimbursements/year) increased significantly (p < 0.001) after nursing home admission: antidepressants: 34 to 46%, anxiolytics: 32 to 42%, hypnotics/sedatives: 18 to 24%, antipsychotics: 10 to 21% (14 to 30% in patients with dementia). The use of lipid-modifying agents and agents acting on the renin-angiotensin system decreased significantly (33 to 24% and 44 to 37%, respectively, p < 0.001). The use of antibacterials (≥ 1 reimbursement/year) increased also significantly (p < 0.001): 45 to 61%, including quinolones (13 to 20%) and third-generation cephalosporins (10 to 18%). CONCLUSION These results reveal increased prescribing of psychotropic drugs and antibacterials in SNH, requiring the development or sustainability of actions designed to improve prescribing practices in older people targeted by these treatments.
Collapse
|
15
|
Perrin A, Tavassoli N, Mathieu C, Hermabessière S, Houles M, McCambridge C, Magre E, Fernandez S, Caquelard A, Charpentier S, Lauque D, Azema O, Bismuth S, Chicoulaa B, Oustric S, Costa N, Molinier L, Vellas B, Bérard E, Rolland Y. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol. Contemp Clin Trials Commun 2017; 7:217-223. [PMID: 29696189 PMCID: PMC5898573 DOI: 10.1016/j.conctc.2017.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background Each year, around one out of two nursing home (NH) residents are hospitalized in France, and about half to the emergency department (ED). These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents) is determined by a multidisciplinary team of experts. Results Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization.
Collapse
Affiliation(s)
- Amélie Perrin
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Neda Tavassoli
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- Corresponding author. La Cité de la Santé - Équipe Régionale Vieillissement et Prévention de la Dépendance, 20 rue du Pont Saint Pierre – TSA 60033, 31059, Toulouse Cedex 9, France.
| | - Céline Mathieu
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Observatoire Régional de La Santé de Midi-Pyrénées (ORSMIP), Toulouse, France
| | | | - Mathieu Houles
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Cécile McCambridge
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- Pôle Pharmacie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Elodie Magre
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Pôle Pharmacie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Sophie Fernandez
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne Caquelard
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sandrine Charpentier
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
| | - Dominique Lauque
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- UFR Sciences Médicales, Université de Toulouse III, Toulouse, France
| | - Olivier Azema
- Observatoire Régional des Urgences de Midi-Pyrénées (ORU-MiP), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Serge Bismuth
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Bruno Chicoulaa
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Stéphane Oustric
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Nadège Costa
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département D’Information Médicale (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laurent Molinier
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département D’Information Médicale (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Département D’Epidémiologie, D’Economie de La Santé et de Santé Publique, Université Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
| | - Emilie Bérard
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Service D'Epidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
| |
Collapse
|
16
|
Perehudoff K, Azermai M, Wauters M, Van Acker S, Versluys K, Steeman E, Petrovic M. The psychotropic education and knowledge test for nurses in nursing homes: striving for PEAK performance. Aging Ment Health 2016. [PMID: 26213245 DOI: 10.1080/13607863.2015.1068738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The psychotropic education and knowledge test for nurses in acute geriatric care (PEAK-AC) measures knowledge of psychotropic indications, doses and adverse drug reactions in older inpatients. Given the low internal consistency and poor discrimination of certain items, this study aims to adapt the PEAK-AC, validate it in the nursing home setting and identify factors related to nurses' knowledge of psychotropics. METHOD This study included nurses and nurse assistants employed by nursing homes (n = 13) and nursing students at educational institutions (n = 5) in Belgium. A Delphi technique was used to establish content validity, the known groups technique for construct validity (nrespondents = 550) and the test-retest procedure for reliability (nrespondents = 42). Internal consistency and item analysis were determined. RESULTS The psychotropic education and knowledge test for nurses in nursing homes (PEAK-NH) (nitems = 19) demonstrated reliability (κ = 0.641) and internal consistency (Cronbach's α = 0.773). Significant differences between-group median scores were observed by function (p < 0.001), gender (p = 0.019), educational background (p < 0.001), work experience (p = 0.008) and continuing education (p < 0.001) for depression, delirium and pharmacotherapy topics. Items were acceptably difficult (nitems = 15) and well-functioning discriminators (nitems = 17). Median PEAK-NH score was 9/19 points (interquartile range 6-11 points). Respondents' own estimated knowledge was related to their PEAK-NH performance (p < 0.001). CONCLUSION The PEAK-NH is a valid and reliable instrument to measure nurses' knowledge of psychotropics. These results suggest that nurses have limited knowledge of psychotropic use in nursing homes and are aware of their knowledge deficits. The PEAK-NH enables educational initiatives to be targeted and their impact on nurses' knowledge to be tracked.
Collapse
Affiliation(s)
- Katrina Perehudoff
- a Department of Geriatrics , Ghent University Hospital , Ghent , Belgium
| | - Majda Azermai
- b Department of Pharmacology, Heymans Institute of Pharmacology , Ghent University , Ghent , Belgium
| | - Maarten Wauters
- b Department of Pharmacology, Heymans Institute of Pharmacology , Ghent University , Ghent , Belgium
| | - Sandra Van Acker
- c Department of Public Health , Ghent University , Ghent , Belgium
| | - Karen Versluys
- a Department of Geriatrics , Ghent University Hospital , Ghent , Belgium
| | - Els Steeman
- c Department of Public Health , Ghent University , Ghent , Belgium
| | - Mirko Petrovic
- a Department of Geriatrics , Ghent University Hospital , Ghent , Belgium
| |
Collapse
|
17
|
Improvements in the prescribing of antipsychotics in dementia and psychogeriatric units in New Zealand. Int J Clin Pharm 2016; 38:941-9. [DOI: 10.1007/s11096-016-0318-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
|
18
|
de Souto Barreto P, Morley JE, Chodzko-Zajko W, H Pitkala K, Weening-Djiksterhuis E, Rodriguez-Mañas L, Barbagallo M, Rosendahl E, Sinclair A, Landi F, Izquierdo M, Vellas B, Rolland Y. Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report. J Am Med Dir Assoc 2016; 17:381-92. [PMID: 27012368 DOI: 10.1016/j.jamda.2016.01.021] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 01/01/2023]
Abstract
A taskforce, under the auspices of The International Association of Gerontology and Geriatrics-Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics, met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCFs). Due to the high heterogeneity in terms of functional ability and cognitive function that characterizes older adults living in LTCFs, taskforce members established 2 sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. To promote a successful implementation of recommendations, taskforce experts highlighted the importance of promoting residents' motivation and pleasure, the key factors that can be increased when taking into account residents' desires, preferences, beliefs, and attitudes toward physical activity and exercise. The importance of organizational factors related to LTCFs and health care systems were recognized by the experts. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCF settings.
Collapse
Affiliation(s)
- Philipe de Souto Barreto
- Gerontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France.
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St Louis, MO
| | | | - Kaisu H Pitkala
- Unit of Primary Health Care, Department of General Practice and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Elizabeth Weening-Djiksterhuis
- Lectoraat Healthy Aging, Allied Health Care and Nursing, School of Health Care Studies, Hanze University, Groningen, the Netherlands
| | | | - Mario Barbagallo
- International Association of Gerontology and Geriatrics for the European Region, Chair of the Clinical Section, Palermo, Italy; University of Palermo, Palermo, Italy
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Alan Sinclair
- University of Aston & Diabetes Frail, Birmingham, United kingdom
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarre, Navarra, Pamplona, Spain
| | - Bruno Vellas
- Gerontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Yves Rolland
- Gerontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| |
Collapse
|
19
|
Jacquin-Piques A, Sacco G, Tavassoli N, Rouaud O, Bejot Y, Giroud M, Robert P, Vellas B, Bonin-Guillaume S. Psychotropic Drug Prescription in Patients with Dementia: Nursing Home Residents Versus Patients Living at Home. J Alzheimers Dis 2015; 49:671-80. [DOI: 10.3233/jad-150280] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Agnès Jacquin-Piques
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Guillaume Sacco
- Centre Mémoire de Ressource et de Recherche, EA CoBTeK, Université de Nice Sophia-Antipolis, Nice, France
| | - Neda Tavassoli
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Olivier Rouaud
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Yannick Bejot
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Maurice Giroud
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Philippe Robert
- Centre Mémoire de Ressource et de Recherche, EA CoBTeK, Université de Nice Sophia-Antipolis, Nice, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sylvie Bonin-Guillaume
- University Hospital AP-HM, Department of Internal Medicine and Geriatrics, Aix Marseille University, Marseille, France
| |
Collapse
|
20
|
Azermai M. Dealing with behavioral and psychological symptoms of dementia: a general overview. Psychol Res Behav Manag 2015; 8:181-5. [PMID: 26170729 PMCID: PMC4498729 DOI: 10.2147/prbm.s44775] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dealing with the behavioral and psychological symptoms of dementia (BPSD) is often complex. Given the controversy with regard to antipsychotics for behavioral problems in people with dementia, there has been a renewed emphasis on nonpharmacological interventions, with progress in the design of the relevant studies. Potential nonpharmacological interventions for BPSD are: cognitive training/stimulation, rehabilitative care, activities of daily living, music therapy, massage/touch, physical activity, education/training of professionals, and education and psychosocial support of informal caregivers. Use of antipsychotics in the management of BPSD is controversial due to limited efficacy and the risk of serious adverse effects, but credible alternatives remain scarce. The problem of chronic use of antipsychotics in nursing homes should be tackled. Discontinuation of antipsychotic medication in older individuals with BPSD appears to be feasible. Discontinuation efforts are needed to differentiate between patients for whom antipsychotics have no added value and patients for whom the benefits outweigh the risks.
Collapse
Affiliation(s)
- Majda Azermai
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| |
Collapse
|
21
|
Touchon J, Lachaine J, Beauchemin C, Granghaud A, Rive B, Bineau S. The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer's disease to nursing homes: cost-effectiveness analysis in France. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:791-800. [PMID: 23928827 PMCID: PMC4201748 DOI: 10.1007/s10198-013-0523-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/10/2013] [Indexed: 05/22/2023]
Abstract
The costs associated with the care of Alzheimer's disease patients are very high, particularly those associated with nursing home placement. The combination of a cholinesterase inhibitor (ChEI) and memantine has been shown to significantly delay admission to nursing homes as compared to treatment with a ChEI alone. The objective of this cost-effectiveness analysis was to evaluate the economic impact of the concomitant use of memantine and ChEI compared to ChEI alone. Markov modelling was used in order to simulate transitions over time among three discrete health states (non-institutionalised, institutionalised and deceased). Transition probabilities were obtained from observational studies and French national statistics, utilities from a previous US survey and costs from French national statistics. The analysis was conducted from societal and healthcare system perspectives. Mean time to nursing home admission was 4.57 years for ChEIs alone and 5.54 years for combination therapy, corresponding to 0.98 additional years, corresponding to a gain in quality adjusted life years (QALYs) of 0.25. From a healthcare system perspective, overall costs were €98,609 for ChEIs alone and €90,268 for combination therapy, representing cost savings of €8,341. From a societal perspective, overall costs were €122,039 and €118,721, respectively, representing cost savings of €3,318. Deterministic and probabilistic (Monte Carlo simulations) sensitivity analyses indicated that combination therapy would be the dominant strategy in most scenarios. In conclusion, combination therapy with memantine and a ChEI is a cost-saving alternative compared to ChEI alone as it is associated with lower cost and increased QALYs from both a societal and a healthcare perspective.
Collapse
Affiliation(s)
- Jacques Touchon
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Jean Lachaine
- Faculty of Pharmacy, University of Montreal, Montreal, QC Canada
| | | | - Anna Granghaud
- Market Access Department, Lundbeck SAS, Issy-Les-Moulineaux, France
| | - Benoit Rive
- Global Outcomes Research Division, Lundbeck SAS, 43-45, Quai du Président Roosevelt, 92445 Issy-Les-Moulineaux, France
| | - Sébastien Bineau
- Global Outcomes Research Division, Lundbeck SAS, 43-45, Quai du Président Roosevelt, 92445 Issy-Les-Moulineaux, France
| |
Collapse
|
22
|
de Mauleon A, Sourdet S, Renom-Guiteras A, Gillette-Guyonnet S, Leino-Kilpi H, Karlsson S, Bleijlevens M, Zabategui A, Saks K, Vellas B, Jolley D, Soto M. Associated factors with antipsychotic use in long-term institutional care in eight European countries: Results from the RightTimePlaceCare study. J Am Med Dir Assoc 2014; 15:812-8. [PMID: 25129474 DOI: 10.1016/j.jamda.2014.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/15/2014] [Accepted: 06/19/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine factors associated with the antipsychotic (AP) prescription for people with dementia (PwD) recently admitted to institutional long-term care facilities (LTCFs) and to ascertain differences in the use of this medication in 8 European countries. DESIGN An exploratory cross-sectional study. SETTING LTCFs from 8 European countries (Estonia, Finland, France, Germany, The Netherlands, Spain, Sweden, and England). PARTICIPANTS A total of 791 PwD recently admitted to an LTCF and their caregivers. MEASUREMENTS Baseline data from RightTimePlaceCare survey was used. Patients' medical conditions, neuropsychiatric symptoms, physical and cognitive status, and medications were recorded. Multiple logistic regression models were used to assess associations with the AP use. RESULTS A group of 296 patients (37.4%) of 791 patients recently admitted received AP medication. The prevalence of the use of 1 or more APs varied between study countries, ranging from 12% in Sweden to 54% in Spain. Factors independently associated with the AP use were living in Sweden [odds ratio (OR) 0.12, 95% confidence interval (CI) 0.05-0.30], Finland (OR 0.26, 95% CI 0.14-0.48), Germany (OR 2.75, 95% CI 1.55-4.86) and Estonia (OR 6.79, 95% CI 3.84-12.0). The odds of AP use decreased with the presence of a dementia specific unit in the LTCF (OR 0.60, 95% CI 0.39-0.92), but was higher among residents with a hyperactivity behavior (OR 2.12, 95% CI 1.41-3.18). CONCLUSION The current study shows that more than one-third of the residents recently admitted received APs and that prescription frequency across countries varied significantly. This study raises the possibility that the presence of a dementia-specific unit might play a role in the AP use. Further studies should investigate this association and seek better understanding of what will achieve optimal quality of AP use among newly admitted residents in LTCF.
Collapse
Affiliation(s)
- Adelaide de Mauleon
- Department of Geriatric Medicine, Gerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - Sandrine Sourdet
- Department of Geriatric Medicine, Gerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - Anna Renom-Guiteras
- Institut fuer Allgemeinmedizin und Familienmedizin, Universitaet Witten/Herdecke, Witten, Germany
| | - Sophie Gillette-Guyonnet
- Department of Geriatric Medicine, Gerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | | | | | - Michel Bleijlevens
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | | | - Kai Saks
- Department of Internal Medicine, University of Tartu, Tartu, Estonia
| | - Bruno Vellas
- Department of Geriatric Medicine, Gerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - David Jolley
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Maria Soto
- Department of Geriatric Medicine, Gerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France.
| | | |
Collapse
|
23
|
de Souto Barreto P, Lapeyre-Mestre M, Mathieu C, Piau C, Bouget C, Cayla F, Vellas B, Rolland Y. The Nursing Home Effect: A Case Study of Residents With Potential Dementia and Emergency Department Visits. J Am Med Dir Assoc 2013; 14:901-5. [DOI: 10.1016/j.jamda.2013.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 02/02/2023]
|
24
|
Kripalani S, Theobald CN, Anctil B, Vasilevskis EE. Reducing hospital readmission rates: current strategies and future directions. Annu Rev Med 2013; 65:471-85. [PMID: 24160939 PMCID: PMC4104507 DOI: 10.1146/annurev-med-022613-090415] [Citation(s) in RCA: 362] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.
Collapse
Affiliation(s)
- Sunil Kripalani
- Department of Medicine, Vanderbilt University, Nashville, TN
| | - Cecelia N Theobald
- Department of Medicine, Vanderbilt University, Nashville, TN
- Department of Veterans Affairs, VA National Quality Scholars Program
| | - Beth Anctil
- Office of Transition Management, Vanderbilt University Medical Center, Nashville, TN
| | - Eduard E Vasilevskis
- Department of Medicine, Vanderbilt University, Nashville, TN
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
| |
Collapse
|
25
|
Galik E, Resnick B, Hammersla M, Brightwater J. Optimizing function and physical activity among nursing home residents with dementia: testing the impact of function-focused care. THE GERONTOLOGIST 2013; 54:930-43. [PMID: 24092822 DOI: 10.1093/geront/gnt108] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY The purpose of this study was to test the impact of Function-Focused Care for the Cognitively Impaired Intervention on nursing home residents with dementia and the nursing assistants who care for them. DESIGN AND METHODS This was a cluster-randomized controlled trial using repeated measures. A total of 103 cognitively impaired residents and 77 nursing assistants were recruited from four nursing homes. For residents, outcome measures included function, physical activity (survey and actigraphy), mood, behavior, and adverse events (falls and hospitalization). Main outcome measures for nursing assistants included knowledge, beliefs, and performance of function focused care. RESULTS There were significant improvements in the amount and intensity of physical activity (by survey and actigraphy) and physical function in the treatment group. In addition, there was a significant decrease in the number of residents who fell during the treatment period with those in the treatment sites having fewer falls (28% vs. 50% in the control group). Nursing assistants were also observed to be providing a greater percentage of function focused care during resident care interactions in the treatment group at 6 months following the completion of baseline measures. IMPLICATIONS This study provides some evidence that nursing home residents with severe cognitive impairment can safely and successfully be engaged in physical and functional activities.
Collapse
|
26
|
Demougeot L, Rolland Y, Gérard S, Pennetier D, Duboué M, Vellas B, Cesari M. Incidence and economical effects of pneumonia in the older population living in French nursing homes: design and methods of the INCUR study. BMC Public Health 2013; 13:861. [PMID: 24044421 PMCID: PMC3851141 DOI: 10.1186/1471-2458-13-861] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 09/11/2013] [Indexed: 02/03/2023] Open
Abstract
Background Among the most burdensome clinical conditions occurring in older persons, respiratory infections are particularly relevant. In fact, the onset of pneumonias is associated with a significant worsening of the individual’s global health status and significant increase of healthcare costs. The clinical and economical negative consequences of pneumonia may be particularly evident among the frailest groups of elders, in particular those living in nursing home. Nevertheless, specific research on incidence and economical effects of pneumonia in nursing homes residents is still scarce. In the present article, we present the rationale, the design and the methods of the “Incidence of pNeumonia and related ConseqUences in nursing home Resident (INCUR) study, specifically aimed at filling some of the gaps currently present in the field. Methods/design INCUR is an observational longitudinal study recruiting 800 residents across 13 randomly selected nursing homes in France. Multidimensional evaluations of participants are conducted at the baseline, mid-term (at 6 months), and end of the study (at 12 months) visits in order to measure and follow-up their physical function, nutrition, cognition, depression, quality of life, and healthcare costs. Incident pneumonia as well as the onset/recurrence of other major health-related events are monitored during the study follow-up. Discussion The INCUR study will provide valuable information about older persons living in nursing homes. Results from INCUR study may constitute the basis for the development of future preventive campaigns against pneumonia and its consequences.
Collapse
Affiliation(s)
- Laurent Demougeot
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | | | | | | | | | | | | |
Collapse
|
27
|
Tolson D, Rolland Y, Katz PR, Woo J, Morley JE, Vellas B. An international survey of nursing homes. J Am Med Dir Assoc 2013; 14:459-62. [PMID: 23702606 DOI: 10.1016/j.jamda.2013.04.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/15/2013] [Indexed: 11/18/2022]
Abstract
This article reports the results of an exploratory survey of nursing home care in 30 countries. Most countries used either a social or nursing home model, with a physician model being less common. Resident Assessment Instruments were used in only 35% of countries. Physician visits to the nursing home occurred in 37%. All but 2 countries used advanced practice nurses. Medication use was high, with 82% of countries reporting residents taking 6 or more medicines a day.
Collapse
Affiliation(s)
- Debbie Tolson
- Alzheimer's Scotland Centre for Policy and Practice, The University of Western Scotland, Hamilton, Scotland, UK
| | | | | | | | | | | |
Collapse
|
28
|
Ridder HMO, Stige B, Qvale LG, Gold C. Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging Ment Health 2013; 17:667-78. [PMID: 23621805 PMCID: PMC4685573 DOI: 10.1080/13607863.2013.790926] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life. METHOD In a crossover trial, 42 participants with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication. RESULTS Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at -6.77 (95% CI (confidence interval): -12.71, -0.83) was significant (p = 0.027), with a medium effect size (0.50). The prescription of psychotropic medication increased significantly more often during standard care than during music therapy (p = 0.02). CONCLUSION This study shows that six weeks of music therapy reduces agitation disruptiveness and prevents medication increases in people with dementia. The positive trends in relation to agitation frequency and quality of life call for further research with a larger sample.
Collapse
Affiliation(s)
- Hanne Mette O Ridder
- Doctoral Programme in Music Therapy, Department of Communication & Psychology, Aalborg University, Aalborg Øst, Denmark.
| | | | | | | |
Collapse
|
29
|
Rolland Y, de Souto Barreto P. Research Can Improve Care in the Nursing Home. J Am Med Dir Assoc 2013; 14:233-5. [DOI: 10.1016/j.jamda.2013.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 11/30/2022]
|
30
|
Rolland Y, de Souto Barreto P, Abellan Van Kan G, Annweiler C, Beauchet O, Bischoff-Ferrari H, Berrut G, Blain H, Bonnefoy M, Cesari M, Duque G, Ferry M, Guerin O, Hanon O, Lesourd B, Morley J, Raynaud-Simon A, Ruault G, Souberbielle JC, Vellas B. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging 2013; 17:402-12. [PMID: 23538667 DOI: 10.1007/s12603-013-0007-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of vitamin D insufficiency is very high in the nursing home (NH) population. Paradoxically, vitamin D insufficiency is rarely treated despite of strong clinical evidence and recommendations for supplementation. This review aims at reporting the current knowledge of vitamin D supplementation in NH and proposing recommendations adapted to the specificities of this institutional setting. DESIGN Current literature on vitamin D supplementation for NH residents was narratively presented and discussed by the French Group of Geriatrics and Nutrition. RESULT Vitamin D supplementation is a safe and well-tolerated treatment. Most residents in NH have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. Current specific and personalized protocols for vitamin D supplementation may not be practical for use in NH settings (e.g., assessment of serum vitamin D concentrations before and after supplementation). Therefore, our group proposes a model of intervention based on the systematic supplementation of vitamin D (1,000 IU/day) since the patient's admission to the NH and throughout his/her stay without the need of a preliminary evaluation of the baseline levels. Calcium should be prescribed only in case of poor dietary calcium intake. CONCLUSION A population-based rather than individual-based approach may probably improve the management of vitamin D insufficiency in the older population living in NH, without increasing the risks of adverse health problems. The clinical relevance and cost effectiveness of this proposal should be assessed under NH real-world conditions to establish its feasibility.
Collapse
Affiliation(s)
- Y Rolland
- Department of Geriatric Medicine, CHU Toulouse, Institute of aging, F-31059 Toulouse, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
de Souto Barreto P, Lapeyre-Mestre M, Mathieu C, Piau C, Bouget C, Cayla F, Vellas B, Rolland Y. A multicentric individually-tailored controlled trial of education and professional support to nursing home staff: research protocol and baseline data of the IQUARE study. J Nutr Health Aging 2013; 17:173-8. [PMID: 23364498 DOI: 10.1007/s12603-013-0008-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Whilst the number of people living in nursing homes (NH) is expected to rise, research on NH quality is scarce. The purpose of this article is to describe the research protocol of the IQUARE study and to present its baseline data. METHODS AND DESIGN IQUARE is a 18-month multicentric individually-tailored controlled trial of education and professional support to NH staff. The main purposes of IQUARE are to improve the quality of the health care provided in NHs and to reduce the risk of functional decline among residents. Data on internal organisation and residents' health for the 175 participating NHs were recorded by NH staff at baseline. NHs were allocated to either a light intervention group (LIG, n = 90 NHs, totalising 3 258 participants) or a strong intervention group (SIG, n = 85 NHs, totalising 3 017 participants). Intervention for LIG consisted at delivering to NH staff descriptive statistics on indicators of quality regarding their NH and the NHs from their sub-region of health and region; whereas for SIG, NH staff received the same information that LIG, but quality indicators were discussed by a cooperative work (two half-day meetings) between a hospital geriatrician and NH staff. Strategies for overcoming NH's weaknesses were then traced; the efficacy of strategies is evaluated at a 6-month period. RESULTS Baseline data showed high levels of dependence, comorbidities, psychological disturbances and medication's consumption among NH residents. Large discrepancies among NHs were observed. CONCLUSIONS IQUARE is one of the largest controlled trials in NHs developed in France. Results from IQUARE may constitute the basis for the development of new work modalities within the French health system, and serve as a model of a feasible research approach in NHs.
Collapse
Affiliation(s)
- P de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Rolland Y, Cesari M, de Souto Barreto P. Perspective: Interventions are Relevant in Frail Older Adults. J Am Med Dir Assoc 2013; 14:63-5. [DOI: 10.1016/j.jamda.2012.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
|
33
|
de Souto Barreto P, Lapeyre-Mestre M, Mathieu C, Piau C, Bouget C, Cayla F, Vellas B, Rolland Y. Indicators of Benzodiazepine Use in Nursing Home Residents in France: A Cross-Sectional Study. J Am Med Dir Assoc 2013; 14:29-33. [DOI: 10.1016/j.jamda.2012.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 08/31/2012] [Accepted: 09/04/2012] [Indexed: 11/29/2022]
|
34
|
Cestac P, Tavassoli N, Vellas B, Rolland Y. Improving Medication Use in the Nursing Homes: A European Perspective. J Am Med Dir Assoc 2013; 14:6-9. [DOI: 10.1016/j.jamda.2012.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 11/26/2022]
|
35
|
Morley JE. Antipsychotics and dementia: a time for restraint? J Am Med Dir Assoc 2012; 13:761-3. [PMID: 23062622 DOI: 10.1016/j.jamda.2012.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 09/04/2012] [Indexed: 12/14/2022]
|