[Improving psychosocial health of nursing home residents: a systematic review of interventions for prevention and health promotion]

[Validation for people with dementia: innovation without evidence? : Systematic review]

BACKGROUND

Validation was an innovative approach to dealing with people with dementia that was supposed to reduce the incidence of challenging behavior. This effect, however, remains unclear to this day.

OBJECTIVE

Does validation reduce challenging behaviour in people with dementia?

MATERIAL AND METHOD

Systematic review according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Literature search in PubMed, CINAHL, PsycInfo and Web of Science. Description and critical appraisal of identified studies by two reviewers using the revised Cochrane risk of bias tool for randomized controlled trials.

RESULTS

A total of five studies were identified. Only one showed a significant reduction in challenging behavior compared to the control group. All studies had a moderate to high risk of bias.

CONCLUSION

Despite the negative results, a positive effect of validation cannot be ruled out as the trials tested validation as an isolated treatment and not as an integrated part of daily care. In addition, blinding, which is common in clinical trials, is not an appropriate criterion for evaluating trials investigating interventions where the effects result exclusively from interpersonal interaction.

Application effect of diversified health-promoting models on rehabilitation exercises for cervical spondylotic myelopathy

BACKGROUND

With improving living standards, the incidence of cervical spondylotic myelopathy (CSM) has become increasingly high.

OBJECTIVE

The study aims to explore the effect of diversified health-promoting models on rehabilitation exercises in patients with CSM after an operation.

METHOD

This was a randomized controlled trial, wherein 107 patients with CSM treated by neurosurgery were selected as the subjects. Of those, 52 patients in the control group adopted the conventional health-promoting model, while the remaining 55 patients in the intervention group adopted diversified health-promoting models. The effect of rehabilitation exercises in the two groups was evaluated according to the self-efficacy rehabilitation outcome scale, grip strength measurement of the affected limb, and Barthel index.

RESULTS

At Day 3 post-operation and before discharge, the self-efficacy management of rehabilitation exercises in the intervention group was better than that of the control group (P< 0.05). The grip strength measurement of the affected limb, Japanese Orthopedic Association score of the cervical vertebra, and Barthel index of the two groups at Day 3 post-operation were lower than before the intervention and were not statistically significant (P> 0.05). However, these three items before discharge were improved when compared with those of before intervention and were statistically significant (P< 0.05).

CONCLUSION

Postoperative rehabilitation exercises guided by the diversified health-promoting models for patients with CSM can improve the patients' self-efficacy management ability in rehabilitation exercises, help improve grip strength, and promote the recovery of cervical vertebra function, thereby improving the patients' quality of life.

[Health promotion and prevention in nursing homes in the context of the German Prevention Act]

The German Prevention Act obliges the nursing care insurance funds to provide health-promoting interventions and preventive offers in nursing homes. These interventions should clearly differ from activating nursing care and be of proven effectiveness and cost-effectiveness.The present opinion article critically appraises the evidence base of the interventions belonging to the pre-defined preventive areas "nutrition," "physical activity," "cognitive resources," "psychosocial health," and "prevention of elder abuse." The interventions' underlying evidence is weak or even missing. It is unclear whether the interventions contribute to the intended strengthening of the health-promoting potential of care facilities and meet the goal of improving the health situation and resources of the care-dependent people. On the other hand, there are areas of prevention, which are not covered, but have great potential for improving the life situation of those in need of care, for example, in the context of person-centered care and a caring nursing culture.

Activities outside of the care setting for people with dementia: a systematic review

OBJECTIVES

To summarise the evidence from interventions investigating the effects of out of care setting activities on people with dementia living in residential aged care.

DESIGN

A systematic review.

METHODS

A systematic search of electronic databases (PubMed, PsycINFO, Scopus, Web of Science and the Cochrane Library) was performed to identify intervention trials published from journal inception to January 2020. Controlled trials, or quasi-experimental trials, which measured pre-intervention, post-intervention or during-intervention outcomes, where the participants were required to leave the care setting to participate in an intervention, were eligible for inclusion. Quality appraisal of the studies was performed following the Cochrane Collaboration's Risk of Bias or Newcastle-Ottawa Scale tools.

RESULTS

Of the 4155 articles screened, 11 articles met the inclusion criteria from 9 different studies. The number of participants in the studies ranged from 6 to 70 people living with dementia and lasted for 3 weeks up to 5 months. The interventions were aquatic exercise, wheelchair cycling, art gallery discussion groups, an intergenerational mentorship programme, horse riding, walking and outdoor gardening. Overall, the studies indicated preliminary evidence of psychological (n=7), physical (n=4) and physiological (n=1) benefits, and all interventions were feasible to conduct away from the aged care facilities. However, the low number of participants in the included studies (n=177), the absence of a control group in all but three studies, and potential for selection bias, limits the generalisability of the findings.

CONCLUSIONS

Activities outside of the residential aged care setting have the potential to be effective at providing a range of benefits for people living with dementia. Higher quality studies are required to encourage care providers to implement these type of activities in dementia care settings.

PROSPERO REGISTRATION NUMBER

CRD42020166518.

A nurse practitioner led protocol to address polypharmacy in long-term care

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Polypharmacy is common in long term care facilities and frequently associated with poor outcomes.

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A focus on decreasing polypharmacy as part of 60-day periodic review process in long term care facilities has the potential to improve resident outcomes and assist health care providers in improved medication management.

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To achieve success in decreasing polypharmacy, an interdisciplinary team with shared goals and communication is needed.

Polypharmacy is common in long term care facilities and frequently associated with poor outcomes. This study sought to determine if a medication management protocol completed at four month intervals by nurse practitioners (NP) could impact polypharmacy and administration times for long term care residents. The data was collected as part of a Centers for Medicare and Medicaid Services (CMS) “Initiative to Reduce Avoidable Hospitalization among Nursing Facility Residents” grant. Residents were recruited from participating long-term care facilities. NP completed a medication management protocol on admission to the program and at subsequent 4-month intervals or with an acute change in condition. A total of 2442 non-duplicated individuals were seen for at least 1 visit. Although the protocol did not result in a reduction of regularly scheduled medications, the number of scheduled medication administration times did significantly decrease. NP polypharmacy assessments and recommendations are important but were insufficient to decrease the medication burden.