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Tsai MR, Shieh WY, Tsai HH, Lotus Shyu YI, Chang KH, Wen FH, Liu CY. Appropriate volumes of water for non-invasive swallowing assessments of nursing home residents: A descriptive correlational study. Heliyon 2024; 10:e37340. [PMID: 39296193 PMCID: PMC11408772 DOI: 10.1016/j.heliyon.2024.e37340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 08/27/2024] [Accepted: 09/02/2024] [Indexed: 09/21/2024] Open
Abstract
Background The volume of water that can be swallowed without risk of choking or aspiration is a common way to assess swallowing function in patients with dysphagia in institutional settings. However, no evidence-based study has established what volumes of water are safest and most effective for testing. Objective A validated portable non-invasive device for swallowing and respiration (NIDSAR) was employed to determine safe swallowing volumes for nursing home residents with different levels of dysphagia. Methods Participants (N = 94) were grouped by the absence or presence of a nasogastric (NG)-tube: those without an NG-tube (n = 60) and those with an NG-tube (n = 34).Swallowing 1 ml, 3 ml, and 5 ml of water was assessed with the Functional Oral Intake Scale (FOIS) and compared with measures with objective scores from the portable NIDSAR. In addition, swallowing measures were compared between groups, as well as relationships with participant-reported choking frequency. Results Participants without an NG-tube had significant different scores for swallowing during the respiration phase and pharyngeal stage for both 3 ml (t = 3.894 to 4.277, p < .001) and 5 ml (t = 1.999 to 2.944, p < .05 to p < .01) compared with participants with an NG-tube. Discussion Our research revealed that participants with frequent episodes of choking required more time to swallow 1 ml compared with 3 ml or 5 ml which might be a function of piecemeal swallowing. Conclusions NIDSAR measures with 3 ml and 5 ml boluses of water are effective volumes for safely assessing swallowing ability of nursing home residents with dysphagia without risk of choking or aspiration.
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Affiliation(s)
- Meng Rung Tsai
- Department of Nursing, Meiho University, Neipu, Pingtung, Taiwan
| | - Wann Yun Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Yea Ing Lotus Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Fur Hsing Wen
- Department of International Business, Soochow University, Taipei City, Taiwan
| | - Chia Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Shin JH, Jung SO, Min EJ. Factors Influencing Hospitalization of Nursing Home Residents in Korea Using Regularized Negative Binomial Regression. Policy Polit Nurs Pract 2024; 25:141-151. [PMID: 38874520 DOI: 10.1177/15271544241259427] [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] [Indexed: 06/15/2024]
Abstract
The appropriateness of hospitalization for nursing home (NH) residents is still up for debate, with determining factors including timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues. Although the factors leading to hospitalization have been studied expansively, research on staffing is limited. Thus, this study aimed to investigate organizational predictors, nurse staffing, and government incentives and find important factors to hospitalization due to infection or disease among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022. A total of 32 explanatory variables were included. The response variable was the count of hospitalized residents due to infection or disease. We analyzed data using least absolute shrinkage and negative binomial regression. We found that registered nurses' increased hours per resident day were related to decreased hospitalizations due to infection or disease. Appropriate retention and recruitment of nurse staffing with professional leadership should be performed to increase the quality of care for NH residents.
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Affiliation(s)
- Juh H Shin
- School of Nursing, George Washington University, USA
| | - Sun O Jung
- College of Nursing, Ewha Womans University, Korea
| | - Eun J Min
- College of Medicine, The Catholic University of Korea, Korea
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Wang JY, Yang YW, Liu CH, Chang KC, Lin YT, Liu CC. Emergency department visits and associated factors among people with dementia residing in nursing homes in Taiwan: a one-year cohort study. BMC Geriatr 2023; 23:503. [PMID: 37605133 PMCID: PMC10441757 DOI: 10.1186/s12877-023-04221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Residing in a nursing home (NH) may increase emergency department (ED) utilization in patients with dementia; however, evidence regarding the status of and predictors for ED utilization of NH residents with dementia remains unclear, especially in Asia. This study aimed to assess the incidence density of ED visits and associated factors for the risk of ED utilization among NH residents with dementia. METHODS This one-year cohort study followed 6595 NH residents with dementia aged ≧ 40 years from Taiwan's National Health Insurance Research Database between 2012 and 2014. The Andersen-Gill extension of Cox regression analysis with death as a competing risk was applied to investigate the association of the risk of all causes and the most common causes of ED utilization with the predisposing, enabling, and need factors as defined by the Andersen model. RESULTS All participants encountered 9254 emergency visits in the 5371.49 person-years observed, representing incidence densities of ED visits of 1722.80 per 1000 person-years. Among them, respiratory disease was the most common cause of ED visits. The significant predictors for the risk of all-cause and respiratory-cause ED visits included: (1) predisposing factors (i.e., age and gender); (2) enabling factors (i.e., regional variables); and (3) need factors (i.e., prolonged ventilator dependence and comorbidity status). CONCLUSIONS Predisposing, enabling, and need factors could influence ED visits among studies patients. NH providers should consider these factors to develop strategies for reducing ED utilization.
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Affiliation(s)
- Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Wan Yang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Division of Emergency Medical Service, New Taipei City Fire Department, New Taipei, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
| | - Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan.
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Vogelsmeier A, Popejoy L, Fritz E, Canada K, Ge B, Brandt L, Rantz M. Repeat hospital transfers among long stay nursing home residents: a mixed methods analysis of age, race, code status and clinical complexity. BMC Health Serv Res 2022; 22:626. [PMID: 35538575 PMCID: PMC9087933 DOI: 10.1186/s12913-022-08036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Nursing home residents are at increased risk for hospital transfers resulting in emergency department visits, observation stays, and hospital admissions; transfers that can also result in adverse resident outcomes. Many nursing home to hospital transfers are potentially avoidable. Residents who experience repeat transfers are particularly vulnerable to adverse outcomes, yet characteristics of nursing home residents who experience repeat transfers are poorly understood. Understanding these characteristics more fully will help identify appropriate intervention efforts needed to reduce repeat transfers. Methods This is a mixed-methods study using hospital transfer data, collected between 2017 and 2019, from long-stay nursing home residents residing in 16 Midwestern nursing homes who transferred four or more times within a 12-month timeframe. Data were obtained from an acute care transfer tool used in the Missouri Quality Initiative containing closed- and open-ended questions regarding hospital transfers. The Missouri Quality Initiative was a Centers for Medicare and Medicaid demonstration project focused on reducing avoidable hospital transfers for long stay nursing home residents. The purpose of the analysis presented here is to describe characteristics of residents from that project who experienced repeat transfers including resident age, race, and code status. Clinical, resident/family, and organizational factors that influenced transfers were also described. Results Findings indicate that younger residents (less than 65 years of age), those who were full-code status, and those who were Black were statistically more likely to experience repeat transfers. Clinical complexity, resident/family requests to transfer, and lack of nursing home resources to manage complex clinical conditions underlie repeat transfers, many of which were considered potentially avoidable. Conclusions Improved nursing home resources are needed to manage complex conditions in the NH and to help residents and families set realistic goals of care and plan for end of life thus reducing potentially avoidable transfers.
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Affiliation(s)
- Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Elizabeth Fritz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Kelli Canada
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - Bin Ge
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Lea Brandt
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Nursing Home Residents' Functional Trajectories and Mortality After a Transfer to the Emergency Department. J Am Med Dir Assoc 2020; 22:393-398.e3. [PMID: 32660854 DOI: 10.1016/j.jamda.2020.05.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe nursing home residents' (NHRs) functional trajectories and mortality after a transfer to the emergency department (ED). DESIGN Case-control observational multicenter study. SETTING AND PARTICIPANTS In total, 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks in 2016. METHODS Finite mixture models were fitted to longitudinal data on activities of daily living (ADL) scores before transfer (time 1), during hospitalization (time 2), and within 1 week after discharge (time 3) to identify groups of NHRs following similar functional evolution. Factors associated with mortality were investigated by Cox regressions. RESULTS Trajectory modeling identified 4 distinct trajectories of ADL. The first showed a high and stable (across time 1, time 2, and time 3) functional capacity around 5.2/6 ADL points, with breathlessness as the main condition leading to transfer. The second displayed an initial 37.8% decrease in baseline ADL performance (between time 1 and time 2), followed by a 12.5% recovery of baseline ADL performance (time 2‒time 3), with fractures as the main condition. The third displayed a similar initial decrease, followed by a 6.7% recovery. The fourth displayed an initial 70.1% decrease, followed by an 8.5% recover, with more complex geriatric polypathology situations. Functional decline was more likely after being transferred for a cerebrovascular condition or for a fracture, after being discharged from ED to a surgery department, and with a heavier burden of distressing symptoms during transfer. Mortality after ED transfer was more likely in older NHRs, those in a more severe condition, those who were hospitalized more frequently in the past month, and those transferred for cerebrovascular conditions or breathlessness. CONCLUSIONS AND IMPLICATIONS Identified trajectories and factors associated with functional decline and mortality should help clinicians decide whether to transfer NHRs to ED. NHRs with high functional ability seem to benefit from ED transfers whereas on-site alternatives should be sought for those with poor functional ability.
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Peng TC, Chen WL, Wu LW, Chang YW, Kao TW. The Prevalence of Frailty by the FRAIL-NH Scale in Taiwan Nursing Home Residents. J Nutr Health Aging 2020; 24:507-511. [PMID: 32346689 DOI: 10.1007/s12603-020-1350-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The prevalence of frailty defined by FRAIL-NH varies among different studies in nursing homes, ranging from 19.0% to 75.6%. This study investigated the prevalence of frailty in a nursing home in Taiwan using different diagnostic criteria for frailty. METHODS The 7-item FRAIL-NH scale was used for assessing frailty. There are 7 components: fatigue, resistance, mobility, incontinence or disease, weight loss, eating style and assistance with dressing. Each item is worth 0, 1, or 2 points for a total score of 14 points. We sorted and summarized the patients, according to the number of variables, into the not frail, frail, and most frail groups. Descriptive analysis was applied to understand the basic attributes of the elderly with different degrees of frailty, the influencing factors of frailty, and the occurrence of frailty. RESULTS Our final sample included 34 residents. They were aged between 56 and 100 years (mean age 83.91 ± 10.84), and 18 (52.94%) were female. The frail group revealed a higher prevalence of males than of females. The marital status composition of participants was as follows: 2 (5.88%) unmarried, 24 (70.59%) married, and 8 (23.53%) widowed. The mean FRAIL-NH score was 5.79±3.72. CONCLUSIONS A significant prevalence of frailty defined by FRAIL-NH was observed in a nursing home in Taiwan. Our findings indicate that frailty is an important issue in nursing homes. Further prospective cohort studies using FRAIL-NH evaluation are warranted.
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Affiliation(s)
- T-C Peng
- Tung-Wei Kao, M.D. Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Number 325, Section 2, Chang-gong Rd, Nei-Hu District, 114, Taipei, Taiwan, Tel.: +886-2-87923311 ext. 16567, Fax: +886-2-87927057, E-mail:
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Tsai HH, Tsai YF. Development, validation and testing of a nursing home to emergency room transfer checklist. J Clin Nurs 2017; 27:115-122. [PMID: 28401615 DOI: 10.1111/jocn.13853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 12/23/2022]
Abstract
AIMS AND OBJECTIVES To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. BACKGROUND Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. DESIGN Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. METHODS Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. RESULTS Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. CONCLUSIONS The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. RELEVANCE TO CLINICAL PRACTICE Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults between facilities such as nursing homes and hospitals.
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Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
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Tsai HH, Tsai YF, Liu CY. Advance directives and mortality rates among nursing home residents in Taiwan: A retrospective, longitudinal study. Int J Nurs Stud 2016; 68:9-15. [PMID: 28033524 DOI: 10.1016/j.ijnurstu.2016.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 12/10/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND No data-based evidence is available regarding the best time for nursing home nurses to obtain residents' signatures on advance directives, especially for do-not-resuscitate directives, the most common type of advance directive. This information is needed to enhance the low prevalence of advance directives in Asian countries. OBJECTIVES The purposes of this study were to understand (1) the timing between nursing home admission and signing a do-not-resuscitate directive, (2) the factors related to having a do-not-resuscitate directive, and (3) the association between having a do-not-resuscitate directive and nursing home residents' mortality in Taiwan. DESIGN Retrospective, longitudinal design. SETTING Six nursing homes in Taiwan. PARTICIPANTS Nursing home residents (N=563). METHODS Data were collected by retrospective chart review with 1-year follow-up. Factors related to having a do-not-resuscitate directive were analyzed by multiple logistic regression, while associations between signing a do-not-resuscitate directive (resuscitation preference) and mortality were examined by Cox proportional hazard regression models. RESULTS The mean interval between nursing home admission and signing a do-not-resuscitate directive was 840.65days (2.30 years), which was longer than the time from admission to first transfer to hospital (742.4days). Having a do-not-resuscitate directive was related to whether the resident had a nasogastric tube (odds=2.57) and the number of transfers to hospital (odds=1.18). Among the 563 residents, 55 (9.77%) had died at the 1-year follow-up. Having a do-not-resuscitate directive was associated with a greater risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.10-3.98; p=0.02), but this risk did not persist after adjusting for age (hazard ratio, 1.89; 95% confidence interval, 0.99-3.59; p=0.05). CONCLUSION Early research recommendations to sign an advance directive, particularly a do-not-resuscitate order, on nursing home admission may not be the best time for Chinese nursing home residents. Our results suggest that the best time to sign a do-not-resuscitate directive is as early as possible and no later than 2 years (742days) after admission if residents had not already done so. Residents on nasogastric tube feeding should be particularly targeted for discussions about do-not-resuscitate directives.
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Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; Department of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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