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Yeung GYC, Smalbrugge M, van Buul LW, Rutten JJS, van Houten P, Gerridzen IJ, de Bruijne MC, Joling KJ, Hertogh CMPM. Urinary Tract Infection Guideline Adherence in a Dutch Sentinel Nursing Home Surveillance Network. J Am Med Dir Assoc 2024; 25:105037. [PMID: 38796171 DOI: 10.1016/j.jamda.2024.105037] [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: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To investigate guideline adherence 3 years after the introduction of a national guideline on urinary tract infections (UTIs) in frail older adults. Appropriate use of urine dipstick tests, treatment decisions, and antibiotic drug choices in residents with (suspected) UTIs without a catheter were examined. DESIGN Observational prospective study. SETTING AND PARTICIPANTS Nineteen nursing homes participating in a Dutch Sentinel Nursing Home Surveillance Network. METHODS As of September 2021, for a 3-month period, medical practitioners recorded additional clinical information in the electronic health record in case of a (suspected) UTI. Based on this information, adherence to guideline recommendations was assessed. Nonadherence was classified into 2 categories: (1) "intentional nonadherence" as reported by practitioners and (2) "nonadherence otherwise" applied to all other cases where the recorded information was discordant with the guideline recommendations. RESULTS A total of 532 cases of (suspected) UTIs from 469 residents were analyzed. In 455 cases (86%), dipsticks were used. For the 231 cases where clinical signs and symptoms already indicated no UTI treatment according to the guideline, a dipstick was still inappropriately ordered in 196 cases (85%). The decision to prescribe or withhold antibiotics was in 69% of the cases adherent, in 6% intentionally nonadherent, and in 25% nonadherent otherwise. The type of prescribed antibiotic was adherent to the recommended antibiotics for cystitis in 88% and for UTIs with signs of tissue invasion in 48%. Overall, for 40% of suspected UTIs, adherence to all relevant recommendations could be established, and in 9% practitioners reported intentional nonadherence to the guideline. CONCLUSIONS AND IMPLICATIONS There is considerable room for improvement in all clinical stages of managing a suspected UTI in Dutch nursing homes, particularly with regard to the importance of patient's clinical signs and symptoms for appropriate dipstick use and antibiotic UTI treatments.
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Affiliation(s)
- Gary Y C Yeung
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Laura W van Buul
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jeanine J S Rutten
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Paul van Houten
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; ABR Zorgnetwerken Noord-Holland en Flevoland, Amsterdam, the Netherlands
| | - Ineke J Gerridzen
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Atlant, Korsakoff Centre of Expertise, Beekbergen, the Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Verhees LHF, Banning LCP, Stalman H, Koopmans RTCM, Gerritsen DL. Transferring people with dementia to severe challenging behavior specialized units, an in-depth exploration. Aging Ment Health 2024; 28:838-848. [PMID: 37993411 DOI: 10.1080/13607863.2023.2280673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES One of the main reasons for people with dementia to move to a dementia special care unit of a nursing home is challenging behavior. This behavior is often difficult to manage, and in the Netherlands, residents are sometimes relocated to a severe challenging behavior specialized unit. However, relocation often comes with trauma and should be prevented if possible. This study aimed to investigate the patient- and context-related reasons for these relocations. METHODS Qualitative multiple case study using individual (n = 15) and focus group interviews (n = 4 with n = 20 participants) were held with elderly care physicians, physician assistants, psychologists, nursing staff members, and relatives involved with people with dementia and severe challenging behavior who had been transferred to a severe challenging behavior specialized unit. Audio recordings were transcribed and analyzed with thematic analysis, including directed content analysis. RESULTS After five cases, data-saturation occurred. The thematic analysis identified three main processes: increasing severity of challenging behavior, increasing realization that the clients' needs cannot be met, and an increasing burden of nursing staff. The interaction between these processes, triggered mainly by a life-threatening situation, led to nursing staff reaching their limits, resulting in relocation of the client. CONCLUSION Our study resulted in a conceptual framework providing insight into reasons for relocation in cases of severe challenging behavior. To prevent relocation, the increasing severity of challenging behavior, increasing burden on nursing staff, and increasing realization that the clients' needs cannot be met need attention.
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Affiliation(s)
- Leon H F Verhees
- De Zorggroep, Center for Specialized Geriatric Care, Venlo, Netherlands
- Center for Specialized Psychiatric Care, Vincent van Gogh Institute, Venray, Netherlands
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Leonie C P Banning
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Hester Stalman
- De Zorggroep, Center for Specialized Geriatric Care, Venlo, Netherlands
| | - Raymond T C M Koopmans
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
- Center for Specialized Geriatric Care, Joachim en Anna, Nijmegen, Netherlands
| | - Debby L Gerritsen
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
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Suntjens AF, Leontjevas R, van den Brink AMA, Voshaar RCO, Koopmans RTCM, Gerritsen DL. Personality assessment in nursing home residents with mental and physical multimorbidity: two informant perspectives. Int Psychogeriatr 2024:1-13. [PMID: 38659294 DOI: 10.1017/s1041610224000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES In older patients with mental and physical multimorbidity (MPM), personality assessment is highly complex. Our aim was to examine personality traits in this population using the Hetero-Anamnestic Personality questionnaire (HAP), and to compare the premorbid perspective of patients' relatives (HAP) with the present-time perspective of nursing staff (HAP-t). DESIGN Cross-sectional. SETTING Dutch gerontopsychiatric nursing home (GP-NH) units. PARTICIPANTS Totally, 142 GP-NH residents with MPM (excluding dementia). MEASUREMENTS NH norm data of the HAP were used to identify clinically relevant premorbid traits. Linear mixed models estimated the differences between HAP and HAP-t trait scores (0-10). Agreement was quantified by intraclass correlation coefficients (ICCs). All HAP-HAP-t analyses were corrected for response tendency (RT) scores (-10-10). RESULTS 78.4% of the patients had at least one premorbid maladaptive trait, and 62.2% had two or more. Most prevalent were: "disorderly" (30.3%), "unpredictable/impulsive" (29.1%) and "vulnerable" (27.3%) behavior. The RT of relatives appeared significantly more positive than that of nursing staff (+1.8, 95% CI 0.6-2.9, p = 0.002). After RT correction, the traits "vulnerable", "perfectionist" and "unpredictable/impulsive" behavior scored higher on the HAP than HAP-t (respectively +1.2, 95% CI 0.6-1.7, p < 0.001; +2.1, 95% CI 1.3-2.8, p < 0.001; +0.6, 95% CI 0.1-1.1, p = 0.013), while "rigid" behavior scored lower (-0.7, 95% CI -1.3 to -0.03, p = 0.042). Adjusted ICCs ranged from 0.15 to 0.58. CONCLUSIONS Our study shows high percentages of premorbid maladaptive personality traits, which calls for attention on personality assessment in MPM NH residents. Results also indicate that the HAP and HAP-t questionnaires should not be used interchangeably for this patient group in clinical practice.
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Affiliation(s)
- Ankie F Suntjens
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Primary and Community Care, University Knowledge Network for Older Adult Care Nijmegen (UKON), Nijmegen, The Netherlands
| | - Ruslan Leontjevas
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Primary and Community Care, University Knowledge Network for Older Adult Care Nijmegen (UKON), Nijmegen, The Netherlands
- Open University, School of Psychology, Heerlen, The Netherlands
| | - Anne M A van den Brink
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Primary and Community Care, University Knowledge Network for Older Adult Care Nijmegen (UKON), Nijmegen, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
| | - Raymond T C M Koopmans
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Primary and Community Care, University Knowledge Network for Older Adult Care Nijmegen (UKON), Nijmegen, The Netherlands
- De Waalboog, Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Primary and Community Care, University Knowledge Network for Older Adult Care Nijmegen (UKON), Nijmegen, The Netherlands
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van Voorden G, Koopmans RTCM, Smalbrugge M, Zuidema SU, van den Brink AMA, Persoon A, Oude Voshaar RC, Gerritsen DL. Well-being, multidisciplinary work and a skillful team: essential elements of successful treatment in severe challenging behavior in dementia. Aging Ment Health 2023; 27:2482-2489. [PMID: 36688302 DOI: 10.1080/13607863.2023.2169248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Conceptualize successful treatment of persons with dementia and severe challenging behavior as perceived by professionals. METHODS In this concept mapping study 82 experts in dementia care participated. The study followed two phases of data collection: (1) an online brainstorm where participants completed the focus prompt: 'I consider the treatment of people with severe challenging behavior in dementia successful if.'; (2) individual sorting and rating of the collected statements followed by data analysis using multidimensional scaling and hierarchical cluster analysis, resulting in a concept map. RESULTS Three clusters were identified, the first addressing treatment outcomes and the latter two addressing treatment processes, each divided into sub-clusters: (1) well-being, comprising well-being of the person with dementia and all people directly involved; (2) multidisciplinary analysis and treatment, comprising multidisciplinary analysis, process conditions, reduction in psychotropic drugs, and person-centered treatment; and (3) attitudes and skills of those involved, comprising consistent approach by the team, understanding behavior, knowing how to respond to behavior, and open attitudes. CONCLUSIONS Successful treatment in people with dementia and severe challenging behavior focuses on well-being of all people involved wherein attention to treatment processes including process conditions is essential to achieve this.
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Affiliation(s)
- Gerrie van Voorden
- Department of primary and community care, Radboud university medical center, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of primary and community care, Radboud university medical center, Nijmegen, The Netherlands
- Joachim en Anna, Center for Specialized Geriatric Care, De Waalboog, Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of medicine for older people, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne M A van den Brink
- Department of primary and community care, Radboud university medical center, Nijmegen, The Netherlands
| | - Anke Persoon
- Department of primary and community care, Radboud university medical center, Nijmegen, The Netherlands
| | - Richard C Oude Voshaar
- University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Debby L Gerritsen
- Department of primary and community care, Radboud university medical center, Nijmegen, The Netherlands
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Zimmerman S, Cesari M, Gaugler JE, Gleckman H, Grabowski DC, Katz PR, Konetzka RT, McGilton KS, Mor V, Saliba D, Shippee TP, Sloane PD, Stone RI, Werner RM. The Inevitability of Reimagining Long-Term Care. J Am Med Dir Assoc 2022; 23:187-189. [DOI: 10.1016/j.jamda.2021.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
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