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Kummer I, Reissigová J, Lukačišinová A, Ortner Hadžiabdić M, Stuhec M, Liperoti R, Finne-Soveri H, Onder G, van Hout H, Fialová D. Polypharmacy and potentially inappropriate prescribing of benzodiazepines in older nursing home residents. Ann Med 2024; 56:2357232. [PMID: 38833339 DOI: 10.1080/07853890.2024.2357232] [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: 09/01/2023] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.
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Affiliation(s)
- Ingrid Kummer
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
| | - Jindra Reissigová
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, The Czech Republic
| | - Anna Lukačišinová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
| | - Maja Ortner Hadžiabdić
- Center for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hein van Hout
- Departments of General Practice and Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, The Czech Republic
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Gruneir A, Chamberlain SA, Jensen C, Cummings G, Hoben M, Boamah S, Bosco C, Ekhlas S, Bolt SR, Rappon T, Berta WB, Squires J, Estabrooks CA. Burnout Among Nursing Home Care Aides and the Effects on Resident Outcomes. Med Care Res Rev 2024; 81:233-244. [PMID: 38158788 PMCID: PMC11092296 DOI: 10.1177/10775587231220072] [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: 04/25/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014-2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work-life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.
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Affiliation(s)
| | | | | | | | - Matthias Hoben
- University of Alberta, Edmonton, Canada
- York University, Toronto, Ontario, Canada
| | | | | | | | | | - Tim Rappon
- McMaster University, Hamilton, Ontario, Canada
| | | | - Janet Squires
- Ottawa Health Research Institute, Ontario, Canada
- University of Ottawa, Ontario, Canada
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Morrison-Koechl J, Heckman G, Banerjee A, Keller H. Factors associated with dietitian referrals to support long-term care residents advancing towards the end of life. J Hum Nutr Diet 2024; 37:673-684. [PMID: 38446530 DOI: 10.1111/jhn.13294] [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: 08/22/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Dietitians are central members of the multidisciplinary long-term care (LTC) healthcare team. The overall aim of this current investigation is to gain a better understanding of dietitian involvement in LTC resident's end-of-life care via referrals. METHODS Retrospective chart reviews for 164 deceased residents (mean age = 88.3 ± 7.3; 61% female) in 18 LTC homes in Ontario, Canada, identified dietitian referrals and documented eating challenges recorded over 2-week periods at four time points (i.e., 6 months, 3 months, 1 month and 2 weeks) prior to death. Nutrition care plans at the beginning of these time points were also noted. Logistic mixed effects regression models identified time-varying predictors of dietitian referrals. Bivariate tests identified associations between nutrition orders and dietitian referrals that occurred in the last month of life. RESULTS Nearly three-quarters (73%) of participants had at least one dietitian referral across the four observations. Referrals increased significantly with proximity to death; 45% of residents had a referral documented in the last 2 weeks of life. Dietitian referrals were associated with the number of eating challenges (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.27, 1.58). Comfort-focused nutrition care orders were significantly more common when a dietitian was referred (25%) compared with when a dietitian was not referred (12%) in the final month of life (p = 0.04). CONCLUSIONS Our findings suggest that dietitians are involved in end-of-life and comfort-focused nutrition care initiatives, yet they are not engaged consistently for this purpose. This presents a significant opportunity for dietitians to upskill and champion palliative approaches to nutrition care within the multidisciplinary LTC team.
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Affiliation(s)
- Jill Morrison-Koechl
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - George Heckman
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada
| | - Albert Banerjee
- Department of Gerontology, St. Thomas University, Fredericton, New Brunswick, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Vallet F, Ludwig C, Ashikali EM, Busnel C. First Evidence on the Validity of the Complexity Index Derived from the Resident Assessment Instrument for Home Care in Home Care Patients. J Am Med Dir Assoc 2024:105046. [PMID: 38825323 DOI: 10.1016/j.jamda.2024.105046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES Recently, a Complexity Index (CI), based on the multidimensional complexity model and derived from the Resident Assessment Instrument for Home Care (interRAI HC) was proposed as a decision-support tool to help frontline health care professionals in their clinical evaluation to identify and analyze complex situations. This study aims to test the CI: (1) concurrent validity with another measure of complexity (ie, the COMID), (2) convergent validity with related constructs assessed by interRAI HC scales (eg, depression), (3) divergent validity (comparison between CI-COMID and scales-COMID correlations), and (4) predictive validity on coordination meetings. DESIGN A cross-sectional observational design was used for a secondary analysis of interRAI HC and COMID data collected in routine home care nursing practice (July-December 2021). SETTING AND PARTICIPANTS Participants were community-dwelling adults receiving home care, with full interRAI HC and COMID assessments (N = 3533). METHODS Correlational analyses were conducted to test the concurrent validity of the CI (with the COMID) and the convergent and divergent validity of the CI (with interRAI HCSwitzerland scales, eg, Depression Rating Scale, Method for Assigning Priority Levels, and a Frailty Index). A receiver operating characteristic (ROC) analysis was conducted to test the discriminative ability of CI on specific professional team coordination meetings. RESULTS Results showed that the CI correlated positively and strongly with the COMID (ρ = 0.691, P < .001, concurrent validity), positively with all the tested scales (P < .001, convergent validity), whereas the CI-COMID correlation was higher than the interRAI HC scales-COMID correlations (divergent validity). The ROC analysis showed the CI had a high area under the curve (AUC = 0.719, predictive validity). CONCLUSIONS AND IMPLICATIONS The CI demonstrates good validity properties with a strong correlation with the COMID and a high predictive value for coordination meeting. It is distinct from the other interRAI HC scales and has its place among them to support the clinical analysis of complex situations.
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Affiliation(s)
- Fanny Vallet
- Research and Development Unit, Geneva Institution for Homecare and Assistance (IMAD), Grand-Lancy, Switzerland.
| | - Catherine Ludwig
- Geneva School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Eleni-Marina Ashikali
- Research and Development Unit, Geneva Institution for Homecare and Assistance (IMAD), Grand-Lancy, Switzerland
| | - Catherine Busnel
- Research and Development Unit, Geneva Institution for Homecare and Assistance (IMAD), Grand-Lancy, Switzerland
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Saari ME, Giosa JL, Holyoke P, Heckman GA, Hirdes JP. Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home. PLoS One 2024; 19:e0300521. [PMID: 38558082 PMCID: PMC10984553 DOI: 10.1371/journal.pone.0300521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.
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Affiliation(s)
- Margaret E. Saari
- SE Research Centre, SE Health, Markham, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Justine L. Giosa
- SE Research Centre, SE Health, Markham, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - George A. Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John P. Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Bužančić I, Držaić M, Kummer I, Ortner Hadžiabdić M, Brkić J, Fialová D. Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist's geriatric assessment. Sci Rep 2024; 14:6235. [PMID: 38485992 PMCID: PMC10940601 DOI: 10.1038/s41598-024-56780-1] [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: 11/18/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Pharmacist's geriatric assessment can provide valuable insights into potential deprescribing targets, while including important information on various health-related domains. Data collected from a geriatric assessment questionnaire, for 388 patients, from the Croatian cohort of the EuroAgeism H2020 ESR 7 international project, along with guideline-based deprescribing criteria, were used to analyse potentially inappropriate prescribing of four medication groups (benzodiazepines (BZN), proton pump inhibitors (PPI), opioids, and non-steroidal anti-inflammatory drugs (NSAID)), and to assess the deprescribing potential. Binary logistic regression was used to explore the effects of age, gender, number of medicines and diagnoses, self-reported health, frailty score, and healthcare utilization on the likelihood of needing deprescribing. More than half of participants (n = 216, 55.2%) are candidates for deprescribing, with 31.1% of PPI, 74.8% of NSAID, 75% of opioid, and 96.1% of BZN users meeting at least one criterion. Most common criteria for deprescribing were inappropriately long use and safety concerns. Women (aOR = 2.58; p < 0.001), those reporting poor self-reported health (aOR = 5.14; p < 0.001), and those exposed to polypharmacy (aOR = 1.29; p < 0.001) had higher odds of needing to have medicines deprescribed. The high rate of deprescribing potential warrants prompt action to increase patient safety and decrease polypharmacy. Pharmacist's geriatric assessment and deprescribing-focused medication review could be used to lead a personalised approach.
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Affiliation(s)
- Iva Bužančić
- City Pharmacies Zagreb, Kralja Držislava 6, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, Center for Applied Pharmacy, University of Zagreb, Ante Kovačića 1, 10 000, Zagreb, Croatia
| | - Margita Držaić
- City Pharmacies Zagreb, Kralja Držislava 6, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, Center for Applied Pharmacy, University of Zagreb, Ante Kovačića 1, 10 000, Zagreb, Croatia
| | - Ingrid Kummer
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203/8, Hradec Králové, Prague, Czech Republic
| | - Maja Ortner Hadžiabdić
- Faculty of Pharmacy and Biochemistry, Center for Applied Pharmacy, University of Zagreb, Ante Kovačića 1, 10 000, Zagreb, Croatia.
| | - Jovana Brkić
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203/8, Hradec Králové, Prague, Czech Republic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 450 Vojvode Stepe Street, Belgrade, Serbia
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203/8, Hradec Králové, Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Kateřinská 32, Prague, Czech Republic
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Lukačišinová A, Reissigová J, Ortner-Hadžiabdić M, Brkic J, Okuyan B, Volmer D, Tadić I, Modamio P, Mariño EL, Tachkov K, Liperotti R, Onder G, Finne-Soveri H, van Hout H, Howard EP, Fialová D. Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries. BMC Geriatr 2024; 24:240. [PMID: 38454372 PMCID: PMC10921596 DOI: 10.1186/s12877-024-04742-7] [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: 04/02/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults' clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries. METHODS International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use. RESULTS Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19-2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22-3.16), anxiety (OR 4.26, 95%CI 2.86-6.38), sleeping problems (OR 4.47, 95%CI 3.38-5.92), depression (OR 1.95, 95%CI 1.29-2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29-2.42), problems with syncope (OR 1.78, 95%CI 1.03-3.06), and loss of appetite (OR 0.60, 95%CI 0.38-0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32-0.75) in Spain to 0.01 (95%CI 0.00-0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79-1.56). CONCLUSIONS Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.
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Affiliation(s)
- Anna Lukačišinová
- Department of Social and Clinical Pharmacy - Research Group "Ageing, Polypharmacy and Changes in the Therapeutic Value of Drugs in the Aged", Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, Hradec Králové, 500 05, Czech Republic.
| | - Jindra Reissigová
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
| | - Maja Ortner-Hadžiabdić
- Center for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Jovana Brkic
- Department of Social and Clinical Pharmacy - Research Group "Ageing, Polypharmacy and Changes in the Therapeutic Value of Drugs in the Aged", Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, Hradec Králové, 500 05, Czech Republic
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Betul Okuyan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Daisy Volmer
- Faculty of Medicine, Institute of Pharmacy, University of Tartu, Tartu, Estonia
| | - Ivana Tadić
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Pilar Modamio
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Eduardo L Mariño
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | | | - Rosa Liperotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Hein van Hout
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Elizabeth P Howard
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
- The Hinda and Arthur Marcus Institute for Aging Research (The Marcus Institute), Hebrew Senior Life, Boston, MA, USA
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy - Research Group "Ageing, Polypharmacy and Changes in the Therapeutic Value of Drugs in the Aged", Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203, Hradec Králové, 500 05, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic
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Pesonen T, Corneliusson L, Väisänen V, Siira H, Edgren J, Elo S, Sinervo T. The relationship between sensory impairment and home care client's received care time-A cross-sectional study. J Adv Nurs 2024; 80:1166-1176. [PMID: 37710399 DOI: 10.1111/jan.15863] [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: 06/01/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
AIM The aim of this study was to explore the relationship between sensory impairment and home care client's received care time. DESIGN A cross-sectional multi-source study. METHODS Data from a self-reported staff survey on care time allocation were merged with registry data from the Resident Assessment Instrument registry (n = 1477). The data were collected during 1 week from 17 home care units in Finland in October 2021. The relationship between sensory impairment and clients received care time was examined using linear regression analyses. RESULTS The linear regression analyses showed that having vision impairment alone increased care time, while dual sensory impairment resulted in decreased received care time. Hearing impairment alone was not statistically significantly associated with care time. CONCLUSION The holistic care need of home care clients with dual sensory impairment may not be adequate. To ensure equality and the individually tailored care of clients, further attention must be paid to clients with sensory impairments, especially those with dual sensory impairment. Furthermore, the competence of home care workers to encounter and communicate with clients with sensory impairment must be developed to support the holistic care. IMPLICATIONS FOR THE PATIENT CARE The sensory impairments of home care clients must be identified in time and considered in care planning and encountering clients. IMPACT As there is a risk that clients with dual sensory impairment are not able to fully express themselves, it is imperative that further attention is paid to clients with sensory impairments, to better understand and support this vulnerable group. Increased awareness and continuous education are needed to better identify and support home care clients with sensory impairment. REPORTING METHOD The study adheres to the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Tiina Pesonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Laura Corneliusson
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Visa Väisänen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heidi Siira
- Research Unit of Health Sciences and Technology/GeroNursing Centre, University of Oulu, Oulu, Finland
| | - Johanna Edgren
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Satu Elo
- Oulu University of Applied Sciences, Oulu, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Kooijmans ECM, Hoogendijk EO, Pokladníková J, Smalbil L, Szczerbińska K, Barańska I, Ziuziakowska A, Fialová D, Onder G, Declercq A, Finne-Soveri H, Hoogendoorn M, van Hout HPJ, Joling KJ. The prevalence of non-pharmacological interventions in older homecare recipients: an overview from six European countries. Eur Geriatr Med 2024; 15:243-252. [PMID: 37792242 PMCID: PMC10876758 DOI: 10.1007/s41999-023-00868-w] [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: 06/12/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Non-pharmacological interventions (NPIs) play an important role in the management of older people receiving homecare. However, little is known about how often specific NPIs are being used and to what extent usage varies between countries. The aim of the current study was to investigate the prevalence of NPIs in older homecare recipients in six European countries. METHODS This is a cross-sectional study of older homecare recipients (65+) using baseline data from the longitudinal cohort study 'Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care' (IBenC). The analyzed NPIs are based on the interRAI Home Care instrument, a comprehensive geriatric assessment instrument. The prevalence of 24 NPIs was analyzed in Belgium, Germany, Finland, Iceland, Italy and the Netherlands. NPIs from seven groups were considered: psychosocial interventions, physical activity, regular care interventions, special therapies, preventive measures, special aids and environmental interventions. RESULTS A total of 2884 homecare recipients were included. The mean age at baseline was 82.9 years and of all participants, 66.9% were female. The intervention with the highest prevalence in the study sample was 'emergency assistance available' (74%). Two other highly prevalent interventions were 'physical activity' (69%) and 'home nurse' (62%). Large differences between countries in the use of NPIs were observed and included, for example, 'going outside' (range 7-82%), 'home health aids' (range 12-93%), and 'physician visit' (range 24-94%). CONCLUSIONS The use of NPIs varied considerably between homecare users in different European countries. It is important to better understand the barriers and facilitators of use of these potentially beneficial interventions in order to design successful uptake strategies.
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Affiliation(s)
- Eline C M Kooijmans
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health, Ageing and Later Life, Amsterdam, The Netherlands.
| | - Emiel O Hoogendijk
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing and Later Life, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jitka Pokladníková
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - Louk Smalbil
- Department of Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, 1081 HV, Amsterdam, The Netherlands
| | - Katarzyna Szczerbińska
- Chair of Epidemiology and Preventive Medicine, Laboratory for Research on Aging Society, Medical Faculty, Jagiellonian University Medical College, ul. Skawińska 8, Kraków, Poland
| | - Ilona Barańska
- Chair of Epidemiology and Preventive Medicine, Laboratory for Research on Aging Society, Medical Faculty, Jagiellonian University Medical College, ul. Skawińska 8, Kraków, Poland
| | - Adrianna Ziuziakowska
- Chair of Epidemiology and Preventive Medicine, Laboratory for Research on Aging Society, Medical Faculty, Jagiellonian University Medical College, ul. Skawińska 8, Kraków, Poland
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anja Declercq
- LUCAS-Center for Care Research and Consultancy and Ceso-Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | - Mark Hoogendoorn
- Department of Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, 1081 HV, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing and Later Life, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Amsterdam Public Health, Ageing and Later Life, Amsterdam, The Netherlands
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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10
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Ameen A, Williams N, Guthrie DM. Language and pain predict persistent depression among seriously ill home care clients. Palliat Support Care 2024; 22:137-145. [PMID: 36727276 DOI: 10.1017/s1478951522001821] [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: 02/03/2023]
Abstract
OBJECTIVES This study examined potential predictors of persistent depressive symptoms in a cohort of seriously ill older adults (aged 65+ years) receiving home care services. METHODS This was a retrospective cohort study using secondary data collected from the Resident Assessment Instrument for Home Care for all assessments completed between 2001 and 2020. The cohort included seriously ill individuals with depressive symptoms at baseline and who continued to have depressive symptoms on reassessment within 12 months (n = 8,304). Serious illness was defined as having severe health instability, a prognosis of less than 6 months, or a goal of care related to palliative care (PC) on admission to the home care program. RESULTS The mean age of the sample was 80.8 years (standard deviation [SD] = 7.7), 61.1% were female, and 82.1% spoke English as their primary language. The average length of time between assessments was 4.9 months (SD = 3.3). During that time, 64% of clients had persistent symptoms of depression. A multivariate logistic regression model found that language, pain, caregiver burden, and cognitive impairment were the most significant predictors of experiencing persistent depressive symptoms. SIGNIFICANCE OF RESULTS Persistent depressive symptoms are highly prevalent in this population and, left untreated, could contribute to the person experiencing a "bad death." Some of the risk factors for this outcome are amenable to change, making it important to continually assess and flag these factors so interventions can be implemented to optimize the person's quality of life for as long as possible.
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Affiliation(s)
- Aaisha Ameen
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Nicole Williams
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Dawn M Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
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Maxwell CJ, Dampf H, Alkabbani W, Cotton CA, Gamble JM, Hogan DB, Gruneir A, McArthur E, Youngson E, Hsu Z, Hoben M. Psychotropic, Anticonvulsant, and Opioid Use in Assisted Living Residents Before and During the COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:121-129. [PMID: 37863111 DOI: 10.1016/j.jamda.2023.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/04/2023] [Accepted: 09/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES To examine the associations between COVID-19 pandemic waves (1-4) and prevalent antipsychotic, antidepressant, benzodiazepine, anticonvulsant, and opioid use among assisted living (AL) residents, by setting (dementia care vs other). DESIGN Population-based, repeated cross-sectional study. SETTING AND PARTICIPANTS Linked clinical and health administrative databases for residents of all publicly subsidized AL homes (N = 256) in Alberta, Canada, examined from January 2018 to December 2021. Setting-specific quarterly cohorts of residents were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. METHODS The quarterly proportion of residents dispensed an antipsychotic, antidepressant, benzodiazepine, anticonvulsant, or opioid was examined for each setting and period. Log-binomial generalized estimating equations models estimated prevalence ratios (PR) for period (pandemic vs historical quarterly periods), setting (dementia care vs other AL), and period-setting interactions. RESULTS On March 1, 2020, there were 2874 dementia care and 6611 other AL residents (mean age 82.4 vs 79.9 years, 68.2% vs 66.1% female, 93.5% vs 42.6% with dementia, respectively). Antipsychotic use increased during waves 2 to 4 for residents of both settings, but this increase was significantly greater for dementia care than other AL residents during waves 3 and 4 (eg, wave 3, PR 1.21, 95% CI 1.14-1.27 vs PR 1.12, 95% CI 1.07-1.17, interaction term P = .029). In both settings, there was a significant but modest increase in antidepressant use and a significant decrease in benzodiazepine use during several pandemic waves. For other AL residents only, there was a small statistically significant increase in anticonvulsant use during waves 2 to 4. No significant pandemic effect was observed for prevalent opioid use in either setting. CONCLUSIONS AND IMPLICATIONS The persistence of the pandemic-associated increase in antipsychotic, antidepressant, and anticonvulsant use in AL residents, and greater increase in antipsychotic use for dementia care settings, raises concerns about the attendant risks for residents, especially those with dementia.
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Affiliation(s)
- Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Hana Dampf
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Cecilia A Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | | | - David B Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada; Department of Family Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Eric McArthur
- London Health Sciences Centre, London, Ontario, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Alberta, Edmonton, Canada; Data and Research Services, Alberta SPOR SUPPORT Unit, Alberta, Edmonton, Canada
| | - Zoe Hsu
- Provincial Research Data Services, Alberta Health Services, Alberta, Edmonton, Canada; Data and Research Services, Alberta SPOR SUPPORT Unit, Alberta, Edmonton, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
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12
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Cheung G, Beyene K, Yan Chan AH, Drayton BA, Jamieson H, Lyndon M, Hikaka J, Ma'u E, Meehan B, Walker X, Rivera-Rodriguez C. Falls Risk in Long-Term Care Residents With Cognitive Impairment: Effects of COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:177-182. [PMID: 38104633 DOI: 10.1016/j.jamda.2023.11.006] [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: 09/30/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of the COVID-19 pandemic on falls rates in long-term care residents with cognitive impairment. DESIGN An observational study using routinely collected national interRAI data. SETTING AND PARTICIPANTS Participants were from long-term care residents (age ≥60 years) who received an interRAI Long Term Care Facility assessment anywhere in New Zealand between August 17, 2018, and August 16, 2022. METHODS The primary outcome was "At least 1 fall in the last 30 days." Based on the Cognitive Performance Scale (CPS), cognitive impairment was categorized into 3 levels: intact or borderline intact (0-1), mild to moderate impairment (2-3), and moderately to very severe impairment (4-6). The COVID-19 pandemic was divided into 3 periods (First wave: March 21, 2020, to June 8, 2020; Varying level of community outbreaks: June 9, 2020 to August 16, 2021; and Delta-Omicron wave: August 17, 2021, to August 16, 2021) and compared to a pre-COVID-19 period (August 17, 2018, to March 20, 2020). Cox regression modeling was used to study falls and interactions between CPS and COVID-19 pandemic periods, along with other established falls risk factors in the literature. RESULTS A total of 282,518 interRAI-LTCF assessments from 75,132 unique residents were included. Interactions between CPS and COVID-19 pandemic periods found that cognitive impairment was associated with a higher hazard ratio (ranged from 1.22 to 1.37) in each of the 3 COVID-19 pandemic periods. We also found unstable health, unsteady gait, wandering, and moderate to severe ADL dependency were the strongest risk factors for falls. CONCLUSIONS AND IMPLICATIONS Cognitively impaired long-term care residents had an increased risk for falls during the COVID-19 pandemic. This risk was influenced by several factors. In future pandemic or infection control related isolation, residents who are most at risk can be identified for targeted falls prevention programs.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.
| | - Kebede Beyene
- Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy, St Louis, MO, USA
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Bradley Alan Drayton
- Department of Statistics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Hamish Jamieson
- Department of Medicine, Christchurch Medical School, University of Otago, Christchurch, New Zealand
| | - Mataroria Lyndon
- The Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Etuini Ma'u
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Brigette Meehan
- interRAI New Zealand, Te Whatu Ora/Health New Zealand, Wellington, New Zealand
| | - Xaviour Walker
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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13
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Kim MH, Dunkle R, Clarke P. Neighborhood resources and risk of cognitive decline among a community-dwelling long-term care population in the U.S. PUBLIC HEALTH IN PRACTICE 2023; 6:100433. [PMID: 37823022 PMCID: PMC10562742 DOI: 10.1016/j.puhip.2023.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Objective To examine the associations between neighborhood resources (i.e., number of restaurants, recreation centers, or social services for seniors and persons with disability per land area) and cognitive decline among a community-dwelling long-term care population and whether they differ by baseline cognition status. Study design Prospective longitudinal cohort study. Methods We used a longitudinal dataset that assessed over a two-year period older adults receiving state-funded home- and community-based services in Michigan Metropolitan areas (N = 9,802) and applied nonlinear mixed models with a random intercept with Poisson distribution. Results Cognitively intact older adults were less likely to experience cognitive decline when they resided in resource-rich neighborhoods, compared to those cognitively intact but living in neighborhoods that lacked resources. But their cognitively impaired or dementia-diagnosed counterparts did not similarly benefit from living in neighborhoods with rich resources. Conclusions Neighborhood resources may be an important aspect of intervention to mitigate cognitive decline before older adults become cognitively impaired.
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Affiliation(s)
- Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Ruth Dunkle
- School Social Work, University of Michigan, 1080 S. University Ave., Ann Arbor, MI, 48109, USA
| | - Philippa Clarke
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104-1248, USA
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14
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Hoben M, Hogan DB, Poss JW, Gruneir A, McGrail K, Griffith LE, Chamberlain SA, Estabrooks CA, Maxwell CJ. Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID-19 pandemic. J Am Geriatr Soc 2023; 71:3467-3479. [PMID: 37428008 DOI: 10.1111/jgs.18499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/22/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. METHODS This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic. RESULTS Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222). CONCLUSIONS QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- ICES, Toronto, Ontario, Canada
| | - Kim McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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15
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Lim E, Nielsen N, Lapane L, Barooah A, Xu S, Qu S, McPhillips E, Dube CE, Lapane K. Health effects of social connectedness in older adults living in congregate long-term care settings: A systematic review of quantitative and qualitative evidence. Int J Older People Nurs 2023; 18:e12577. [PMID: 37803996 PMCID: PMC10843483 DOI: 10.1111/opn.12577] [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: 01/20/2023] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The overall impact of social connectedness on health outcomes in older adults living in nursing homes and assisted living settings is unknown. Given the unclear health impact of social connectedness for older adults in congregate long-term care settings worldwide, a comprehensive systematic review is required to evaluate the overall relationship between social connectedness and health outcomes for them. OBJECTIVES The purpose of this article was to synthesize the literature regarding the health impact of social connectedness among older adults living in nursing homes or assisted living settings. METHODS Using PRISMA guidelines, we identified eligible studies from Scopus, MEDLINE, PsycINFO, CINAHL and Cochrane databases (1990-2021). Bias and quality reporting assessment was performed using standardized criteria for cohort, cross sectional and qualitative studies. At each stage, ≥ 2 researchers conducted independent evaluations. RESULTS Of the 7350 articles identified, 25 cohort (follow-up range: 1 month-11 years; with two also contributing to cross sectional), 86 cross sectional, eight qualitative and two mixed methods were eligible. Despite different instruments used, many residents living in nursing homes and assisted living settings had reduced social engagement. Quantitative evidence supports a link between higher social engagement and health outcomes most studied (e.g. depression, quality of life). Few studies evaluated important health outcomes (e.g. cognitive and functional decline). Most cohort studies showed that lack of social connectedness accelerated time to death. CONCLUSIONS Social connectedness may be an important modifiable risk factor for adverse health outcomes for older adults living in nursing homes and assisted living facilities. Most studies were cross sectional and focused on quality of life and mental health outcomes. Longitudinal studies suggest that higher social engagement delays time to death. Evidence regarding other health outcomes important to older adults was scant and requires further longitudinal studies.
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Affiliation(s)
- Emily Lim
- Department of Gerontology, University of Massachusetts Boston, Wheatley Hall, 100 William T. Morrissey Boulevard, Boston, MA, 02125, USA
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Natalia Nielsen
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Lucienne Lapane
- Boston University, School of Social Work, 264 Bay State Road, Boston, MA, 02215, USA
| | - Adrita Barooah
- Department of Gerontology, University of Massachusetts Boston, Wheatley Hall, 100 William T. Morrissey Boulevard, Boston, MA, 02125, USA
| | - Shu Xu
- Department of Gerontology, University of Massachusetts Boston, Wheatley Hall, 100 William T. Morrissey Boulevard, Boston, MA, 02125, USA
| | - Shan Qu
- Department of Gerontology, University of Massachusetts Boston, Wheatley Hall, 100 William T. Morrissey Boulevard, Boston, MA, 02125, USA
| | - Emily McPhillips
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Catherine E. Dube
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Kate Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
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16
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Rönneikkö J, Huhtala H, Finne-Soveri H, Valvanne J, Jämsen E. The role of geriatric syndromes in predicting unplanned hospitalizations: a population-based study using Minimum Data Set for Home Care. BMC Geriatr 2023; 23:696. [PMID: 37884888 PMCID: PMC10605458 DOI: 10.1186/s12877-023-04408-w] [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: 12/12/2022] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The predictive accuracies of screening instruments for identifying home-dwelling old people at risk of hospitalization have ranged from poor to moderate, particularly among the oldest persons. This study aimed to identify variables that could improve the accuracy of a Minimum Data Set for Home Care (MDS-HC) based algorithm, the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale, in classifying home care clients' risk for unplanned hospitalization. METHODS In this register-based retrospective study, factors associated with hospitalization among home care clients aged ≥ 80 years in the City of Tampere, Finland, were analyzed by linking MDS-HC assessments with hospital discharge records. MDS-HC determinants associated with hospitalization within 180 days after the assessment were analyzed for clients at low (DIVERT 1), moderate (DIVERT 2-3) and high (DIVERT 4-6) risk of hospitalization. Then, two new variables were selected to supplement the DIVERT algorithm. Finally, area under curve (AUC) values of the original and modified DIVERT scales were determined using the data of MDS-HC assessments of all home care clients in the City of Tampere to examine if addition of the variables related to the oldest age groups improved the accuracy of DIVERT. RESULTS Of home care clients aged ≥ 80 years, 1,291 (65.4%) were hospitalized at least once during the two-year study period. Unplanned hospitalization occurred following 15.9%, 22.8%, and 33.9% MDS-HC assessments with DIVERT group 1, 2-3 and 4-6, respectively. Infectious diseases were the most common diagnosis within each DIVERT groups. Many MDS-HC variables not included in the DIVERT algorithm were associated with hospitalization, including e.g. poor self-rated health and old fracture (other than hip fracture) (p 0.001) in DIVERT 1; impaired cognition and decision-making, urinary incontinence, unstable walking and fear of falling (p < 0.001) in DIVERT 2-3; and urinary incontinence, poor self-rated health (p < 0.001), and decreased social interaction (p 0.001) in DIVERT 4-6. Adding impaired cognition and urinary incontinence to the DIVERT algorithm improved sensitivity but not accuracy (AUC 0.64 (95% CI 0.62-0.65) vs. 0.62 (0.60-0.64) of the original DIVERT). More admissions occurred among the clients with higher scores in the modified than in the original DIVERT scale. CONCLUSIONS Certain geriatric syndromes and diagnosis groups were associated with unplanned hospitalization among home care clients at low or moderate risk level of hospitalization. However, the predictive accuracy of the DIVERT could not be improved. In a complex clinical context of home care clients, more important than existence of a set of risk factors related to an algorithm may be the various individual combinations of risk factors.
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Affiliation(s)
- Jukka Rönneikkö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Jaakko Valvanne
- Faculty of Medicine and Health Technology and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
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17
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O’Rourke HM. Connecting Today: Feasibility and acceptability of a remote visiting program for people living with dementia in long-term care homes. DEMENTIA 2023; 22:1321-1347. [PMID: 37341515 PMCID: PMC10521164 DOI: 10.1177/14713012231176858] [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] [Indexed: 06/22/2023]
Abstract
OBJECTIVES Social isolation and loneliness affect the quality of life of people living with dementia, yet few interventions have been developed for this population. The purpose of this study was to assess the feasibility and acceptability of 'Connecting Today', a remote visiting program designed for use with care home residents living with dementia. METHODS This was a feasibility study to assess whether Connecting Today can be delivered in care homes, and was acceptable to family and friends and people living with dementia. We used a single-group before/after design and included residents ≥ 65 years old with a dementia diagnosis from two care homes in Alberta, Canada. Connecting Today involved up to 60 min per week of facilitated remote visits for 6 weeks. To understand feasibility, we assessed rates and reasons for non-enrollment, withdrawal and missing data. We assessed acceptability with the Observed Emotion Rating Scale (residents) and a Treatment Perception and Preferences Questionnaire (family and friends). Data were analyzed with descriptive statistics. RESULTS Of 122 eligible residents, 19.7% (n = 24) enrolled (mean age = 87.9 years, 70.8% females). Three residents withdrew from the study before the first week of calls. Among 21 remaining residents, 62%-90% completed at least 1 call each week. All the calls were completed by videoconference, rather than by phone. Alertness and pleasure were observed for ≥92% of residents during calls. The 24 contacts rated Connecting Today as logical, effective and low risk. CONCLUSIONS Facilitated, remote visits are feasible and highly acceptable to residents and their family and friend contacts. Connecting Today shows promise to address social isolation and loneliness for people living with moderate to severe dementia because it can promote positive engagement in meaningful interactions with their family and friends while they are living in a care home. Future studies will test effectiveness of Connecting Today in a large sample.
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Affiliation(s)
- Hannah M O’Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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18
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Morrison-Koechl J, Liu SH, Banerjee A, Heckman G, Keller H. Nutrition and Non-Nutrition-Related Challenges Predict Time to Death in Long-Term Care Residents: A Retrospective Chart Review. J Multidiscip Healthc 2023; 16:2823-2837. [PMID: 37750163 PMCID: PMC10518155 DOI: 10.2147/jmdh.s417344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023] Open
Abstract
Purpose Signals of end-of-life decline observed in daily habits, such as mealtime participation, are important for moving towards comfort-focused goals of care in the final months of life of long-term care (LTC) residents. It is unclear how eating issues observed in real-time in LTC homes are used as indicators of suspected end of life. The study quantifies nutrition and key non-nutrition related signals (eg, general decline, unstable vitals) documented to describe end-of-life decline and the subsequent time to death. Patients and Methods A retrospective chart review identified the first documented conversation where end-of-life decline was considered by members of the care team (eg, nurses, physicians, dietitian, family member) for 76 randomly selected decedents from 9 LTC homes in southwestern Ontario, Canada. Time (days) to death was calculated. A directed content analysis of the free-text description of the suspected end-of-life decline was used to categorize signals. Cox proportional hazards regression analysis tested the risk of mortality associated with each categorized signal. Results Time to death of residents (mean age = 88 ± 7 years; 60% female) from the first documentation of potential end-of-life decline ranged from 0 days to over 2 years prior to death (median = 27.5 days). Seven nutrition-related and 18 non-nutrition related signals were identified. Swallowing difficulty (HR = 2.99; 95% CI = 1.41, 6.33), cognitive decline (HR = 0.40; 95% CI = 0.20, 0.77), delirium (HR = 13.23; 95% CI = 1.57, 111.69), and cancer (HR = 0.18; 95% CI = 0.07, 0.48) were associated with time to death. Conclusion This study provides insight into the signals used by care providers in LTC to suspect that residents are declining towards the end of life and identifies four signals that were associated with time to death. When identified by care providers as indicators of end-of-life decline, swallowing difficulty and delirium predicted a shorter time to death, while cancer and cognitive decline predicted a longer time to death. Recognition of nutrition and non-nutrition related signals may be leveraged to systematically introduce timely comfort care conversations.
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Affiliation(s)
- Jill Morrison-Koechl
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Sheng Han Liu
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Albert Banerjee
- Department of Gerontology, St. Thomas University, Fredericton, New Brunswick, Canada
| | - George Heckman
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Heather Keller
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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19
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Rochon A, Almost J, Li W, Seitz D, Tranmer J. Opioid deprescribing in long-term care in Ontario: A comparison of resident and facility characteristics. Geriatr Nurs 2023; 53:25-32. [PMID: 37421922 DOI: 10.1016/j.gerinurse.2023.06.024] [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: 04/06/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
Residents of long-term care (LTC) homes have potentially painful conditions and are prescribed opioids to manage their pain, despite the risks associated with the use of these high-risk medications. Therefore, the overall aim of this study was to describe the associations between resident and facility characteristics of residents prescribed long-term opioid therapy and those who remained on opioids or had opioids deprescribed. We conducted a retrospective cohort study utilizing health administrative databases housed within ICES. Our cohort included 26,592 of 121,564 LTC residents (21.9%) of Ontario LTC homes who were prescribed long-term opioid therapy at cohort inception. Of these residents, 4,299 (16.2%) residents had opioids deprescribed during the follow-up period. Opioid deprescribing was associated with younger age, high comorbidity, and co-prescription with benzodiazepines and gabapentinoids. Our findings suggest that there is variation in the characteristics of residents who continued long-term opioid therapy and those who subsequently had opioids deprescribed, and these characteristics need to be considered as part of individualized pain management plans of care.
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Affiliation(s)
- Andrea Rochon
- Queen's University, School of Nursing, 92 Barrie St., Kingston, Ontario, Canada K7L 3N6.
| | - Joan Almost
- Queen's University, School of Nursing, 92 Barrie St., Kingston, Ontario, Canada K7L 3N6
| | - Wenbin Li
- ICES Queen's, Queen's University, 21 Arch St., Kingston, Ontario, Canada, K7L 3L3
| | - Dallas Seitz
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada, T2N 4A1; ICES Queen's, Queen's University, 21 Arch St., Kingston, Ontario, Canada, K7L 3L3
| | - Joan Tranmer
- Queen's University, School of Nursing, 92 Barrie St., Kingston, Ontario, Canada K7L 3N6; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada, T2N 4A1
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20
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Hogeveen S, Hirdes JP, Heckman G, Keller H. Determinants of access of frail, community-residing older adults to geriatricians in Ontario. J Am Geriatr Soc 2023; 71:2810-2821. [PMID: 37143397 DOI: 10.1111/jgs.18382] [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: 08/16/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Little is known about determinants of access to community-based geriatricians. The Geriatric 5Ms™ describe geriatricians' core competencies and inform referrals to specialists for older adults with complex needs. We explored the association of the Geriatric 5Ms™ and other characteristics with outpatient access to geriatricians by home care (HC) clients. METHODS This was a population-based, retrospective cohort study of frail community-dwelling HC clients (≥60 years) with complex needs (n = 196,444). Health assessment information was linked to health services data in Ontario, Canada, 2012-2015. Multivariable generalized estimating equations were used to identify characteristics associated with geriatrician contact (≥1 visit in 90 days post-HC admission), including derived Geriatric 5Ms™ score, and predisposing, enabling, and need factors obtained from clinical assessments. RESULTS Only 5.2% of the cohort had outpatient geriatrician contact in Ontario, Canada. Derived Geriatric 5Ms™ score was associated with higher odds of contact, but the model had modest discriminatory power (c-statistic = 0.67). In the broader multivariable model, based on empirically included factors and adjusted for regional differences, age, worsening of decision-making, dementia, hallucinations, Parkinsonism, osteoporosis, and caregiver distress/institutionalization risk were associated with higher odds of geriatrician contact. Female sex, difficulties accessing home, impaired locomotion, recovery potential, hemiplegia/hemiparesis, and cancer, were associated with lower odds of contact. This model had good discriminatory power (c-statistic = 0.77). CONCLUSIONS Few frail, community-dwelling older adults receiving HC had any outpatient geriatrician contact. While the derived Geriatric 5Ms™ score was associated with contact, a broader empirical model performed better than the Geriatric 5Ms™ in predicting contact with an outpatient geriatrician. Contact was mainly driven by conditions common in older adults, but evidence suggests that geriatricians are not evaluating the most medically complex and unstable older adults in the community. These findings suggest a need to re-examine the referral process for geriatricians and the allocation of limited specialized resources.
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Affiliation(s)
- Sophie Hogeveen
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph's Health System, Toronto, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Heather Keller
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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21
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Guerbaai RA, Dollinger C, Kressig RW, Zeller A, Wellens NIH, Popejoy LL, Serdaly C, Zúñiga F. Factors associated with avoidable hospital transfers among residents in Swiss nursing homes. Geriatr Nurs 2023; 53:12-18. [PMID: 37399613 DOI: 10.1016/j.gerinurse.2023.06.015] [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: 04/15/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
Unplanned hospitalizations from nursing homes (NHs) may be considered potentially avoidable and can result in adverse resident outcomes. There is little information about the relationship between a clinical assessment conducted by a physician or geriatric nurse expert before hospitalization and an ensuing rating of avoidability. This study aimed to describe characteristics of unplanned hospitalizations (admitted residents with at least one night stay, emergency department visits were excluded) and to examine this relationship. We conducted a cohort study in 11 Swiss NHs and retrospectively evaluated data from the root cause analysis of 230 unplanned hospitalizations. A telephone assessment by a physician (p=.043) and the need for further medical clarification and treatment (p=<0.001) were the principal factors related to ratings of avoidability. Geriatric nurse experts can support NH teams in acute situations and assess residents while adjudicating unplanned hospitalizations. Constant support for nurses expanding their clinical role is still warranted.
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Affiliation(s)
- Raphaëlle-Ashley Guerbaai
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland; Rehabilitation, Ageing and Independent Living (RAIL) research centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Claudia Dollinger
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland; Lindenhofgruppe AG, Lindenhof Spital, Bern, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER & Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Nathalie I H Wellens
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Lori L Popejoy
- University of Missouri, Sinclair School of Nursing, Columbia, United States
| | | | - Franziska Zúñiga
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.
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22
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Anderson KK, Rodrigues R. Differences in clinical presentation at first hospitalization and the impact on involuntary admissions among first-generation migrant groups with non-affective psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1329-1341. [PMID: 36922459 DOI: 10.1007/s00127-023-02465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Some migrant and ethnic minority groups have a higher risk of coercive pathways to care; however, it is unclear whether differences in clinical presentation contribute to this risk. We sought to assess: (i) whether there were differences in clinician-rated symptoms and behaviours across first-generation immigrant and refugee groups at the first psychiatric hospitalization after psychosis diagnosis, and (ii) whether these differences accounted for disparities in involuntary admission. METHODS Using population-based health administrative data from Ontario, Canada, we constructed a sample (2009-2013) of incident cases of non-affective psychotic disorder followed for two years to identify first psychiatric hospitalization. We compared clinician-rated symptoms and behaviours at admission between first-generation immigrants and refugees and the general population, and adjusted for these variables to ascertain whether the elevated prevalence of involuntary admission persisted. RESULTS Immigrants and refugee groups tended to have lower ratings for affective symptoms, self-harm behaviours, and substance use, as well as higher levels of medication nonadherence and poor insight. Immigrant groups were more likely to be perceived as aggressive and a risk of harm to others, and both groups were perceived as having self-care issues. Adjustment for perceived differences in clinical presentation at admission did not attenuate the higher prevalence of involuntary admission for immigrant and refugee groups. CONCLUSIONS First-generation migrant groups may differ in clinical presentation during the early course of psychotic illness, although these perceived differences did not explain the elevated rates of involuntary admission. Further research using outpatient samples and tools with established cross-cultural validity are warranted.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada.
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
- ICES, London, ON, Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada
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23
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Lühnen J, Richter T, Calo S, Meyer G, Köpke S, Möhler R. Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database Syst Rev 2023; 8:CD008634. [PMID: 37650479 PMCID: PMC10471006 DOI: 10.1002/14651858.cd008634.pub3] [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] [Indexed: 09/01/2023]
Abstract
BACKGROUND Antipsychotic medications are regularly prescribed in care home residents for the management of behavioural and psychological symptoms of dementia (BPSD) despite questionable efficacy, important adverse effects, and available non-pharmacological interventions. Prescription rates are related to organisational factors, staff training and job satisfaction, patient characteristics, and specific interventions. Psychosocial intervention programmes aimed at reducing the prescription of antipsychotic drugs are available. These programmes may target care home residents (e.g. improving communication and interpersonal relationships) or target staff (e.g. by providing skills for caring for people with BPSD). Therefore, this review aimed to assess the effectiveness of these interventions, updating our earlier review published in 2012. OBJECTIVES To evaluate the benefits and harms of psychosocial interventions to reduce antipsychotic medication use in care home residents compared to regular care, optimised regular care, or a different psychosocial intervention. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 14 July 2022. SELECTION CRITERIA We included individual or cluster-randomised controlled trials comparing a psychosocial intervention aimed primarily at reducing the use of antipsychotic medication with regular care, optimised regular care, or a different psychosocial intervention. Psychosocial interventions were defined as non-pharmacological intervention with psychosocial components. We excluded medication withdrawal or substitution interventions, interventions without direct interpersonal contact and communication, and interventions solely addressing policy changes or structural interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Critical appraisal of studies addressed risks of selection, performance, attrition and detection bias, as well as criteria related to cluster randomisation. We retrieved data on the complex interventions on the basis of the TIDieR (Template for Intervention Description and Replication) checklist. Our primary outcomes were 1. use of regularly prescribed antipsychotic medication and 2. ADVERSE EVENTS Our secondary outcomes were 3. mortality; 4. BPSD; 5. quality of life; 6. prescribing of regularly psychotropic medication; 7. regimen of regularly prescribed antipsychotic medication; 8. antipsychotic medication administered 'as needed'; 9. physical restraints; 10. cognitive status; 11. depression; 12. activities of daily living; and 13. COSTS We used GRADE to assess certainty of evidence. MAIN RESULTS We included five cluster-randomised controlled studies (120 clusters, 8342 participants). We found pronounced clinical heterogeneity and therefore decided to present study results narratively. All studies investigated complex interventions comprising, among other components, educational approaches. Because of the heterogeneity of the results, including the direction of effects, we are uncertain about the effects of psychosocial interventions on the prescription of antipsychotic medication. One study investigating an educational intervention for care home staff assessed the use of antipsychotic medication in days of use per 100 resident-days, and found this to be lower in the intervention group (mean difference 6.30 days, 95% confidence interval (CI) 6.05 to 6.66; 1152 participants). The other four studies reported the proportion of participants with a regular antipsychotic prescription. Of two studies implementing an intervention to promote person-centred care, one found a difference in favour of the intervention group (between-group difference 19.1%, 95% CI 0.5% to 37.7%; 338 participants), while the other found a difference in favour of the control group (between-group difference 11.4%, 95% CI 0.9% to 21.9%; 862 participants). One study investigating an educational programme described as "academic detailing" found no difference between groups (odds ratio 1.06, 95% CI 0.93 to 1.20; 5363 participants). The fifth study used a factorial design to compare different combinations of interventions to supplement person-centred care. Results showed a positive effect of medication review, and no clear effect of social interaction or exercise. We considered that, overall, the evidence about this outcome was of low certainty. We found high-certainty evidence that psychosocial interventions intended primarily to reduce antipsychotic use resulted in little to no difference in the number of falls, non-elective hospitalisations, or unplanned emergency department visits. Psychosocial interventions intended primarily to reduce antipsychotic use also resulted in little to no difference in quality of life (moderate-certainty evidence), and BPSD, regular prescribing of psychotropic medication, use of physical restraints, depression, or activities of daily living (all low-certainty evidence). We also found low-certainty evidence that, in the context of these interventions, social interaction and medication review may reduce mortality, but exercise does not. AUTHORS' CONCLUSIONS All included interventions were complex and the components of the interventions differed considerably between studies. Interventions and intervention components were mostly not described in sufficient detail. Two studies found evidence that the complex psychosocial interventions may reduce antipsychotic medication use. In addition, one study showed that medication review might have some impact on antipsychotic prescribing rates. There were no important adverse events. Overall, the available evidence does not allow for clear generalisable recommendations.
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Affiliation(s)
- Julia Lühnen
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Clinical Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Tanja Richter
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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24
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MacFadden DR, Maxwell C, Bowdish D, Bronskill S, Brooks J, Brown K, Burrows LL, Clarke A, Langford B, Leung E, Leung V, Manuel D, McGeer A, Mishra S, Morris AM, Nott C, Raybardhan S, Sapin M, Schwartz KL, So M, Soucy JPR, Daneman N. Coronavirus Disease 2019 Vaccination Is Associated With Reduced Outpatient Antibiotic Prescribing in Older Adults With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2: A Population-Wide Cohort Study. Clin Infect Dis 2023; 77:362-370. [PMID: 36999314 PMCID: PMC10425187 DOI: 10.1093/cid/ciad190] [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: 02/01/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Antibiotics are frequently prescribed unnecessarily in outpatients with coronavirus disease 2019 (COVID-19). We sought to evaluate factors associated with antibiotic prescribing in outpatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS We performed a population-wide cohort study of outpatients aged ≥66 years with polymerase chain reaction-confirmed SARS-CoV-2 from 1 January 2020 to 31 December 2021 in Ontario, Canada. We determined rates of antibiotic prescribing within 1 week before (prediagnosis) and 1 week after (postdiagnosis) reporting of the positive SARS-CoV-2 result, compared to a self-controlled period (baseline). We evaluated predictors of prescribing, including a primary-series COVID-19 vaccination, in univariate and multivariable analyses. RESULTS We identified 13 529 eligible nursing home residents and 50 885 eligible community-dwelling adults with SARS-CoV-2 infection. Of the nursing home and community residents, 3020 (22%) and 6372 (13%), respectively, received at least 1 antibiotic prescription within 1 week of a SARS-CoV-2 positive result. Antibiotic prescribing in nursing home and community residents occurred, respectively, at 15.0 and 10.5 prescriptions per 1000 person-days prediagnosis and 20.9 and 9.8 per 1000 person-days postdiagnosis, higher than the baseline rates of 4.3 and 2.5 prescriptions per 1000 person-days. COVID-19 vaccination was associated with reduced prescribing in nursing home and community residents, with adjusted postdiagnosis incidence rate ratios (95% confidence interval) of 0.7 (0.4-1) and 0.3 (0.3-0.4), respectively. CONCLUSIONS Antibiotic prescribing was high and with little or no decline following SARS-CoV-2 diagnosis but was reduced in COVID-19-vaccinated individuals, highlighting the importance of vaccination and antibiotic stewardship in older adults with COVID-19.
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Affiliation(s)
- Derek R MacFadden
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
- ICES, Toronto, Canada
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada
| | - Colleen Maxwell
- ICES, Toronto, Canada
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Dawn Bowdish
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - James Brooks
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada
| | - Kevin Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
| | - Lori L Burrows
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - Bradley Langford
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
| | - Elizabeth Leung
- Unity Health Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Valerie Leung
- Public Health Ontario, Toronto, Canada
- Michael Garron Hospital, Toronto East Health Network, Toronto, Canada
| | | | | | - Sharmistha Mishra
- ICES, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | | | - Caroline Nott
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada
| | - Sumit Raybardhan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Pharmacy Department, North York General Hospital, Toronto, Canada
| | - Mia Sapin
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kevin L Schwartz
- ICES, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- Unity Health Toronto, Toronto, Canada
| | - Miranda So
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, Toronto, Canada
| | - Jean-Paul R Soucy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nick Daneman
- ICES, Toronto, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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25
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Mitchell L, Poss J, MacDonald M, Burke R, Keefe JM. Inter-provincial variation in older home care clients and their pathways: a population-based retrospective cohort study in Canada. BMC Geriatr 2023; 23:389. [PMID: 37365495 DOI: 10.1186/s12877-023-04097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In Canada, publicly-funded home care programs enable older adults to remain and be cared for in their home for as long as possible but they often differ in types of services offered, and the way services are delivered. This paper examines whether these differing approaches to care shape the pathway that home care clients will take. Older adult client pathways refer to trajectories within, and out of, the home care system (e.g., improvement, long term care (LTC) placement, death). METHODS A retrospective analysis of home care assessment data (RAI-HC was linked with health administrative data, long-term care admissions and vital statistics in Nova Scotia Health (NSH) and Winnipeg Regional Health Authority (WRHA). The study cohort consists of clients age 60 + years, admitted to home care between January 1, 2011 to December 31, 2013 and up to four years from baseline. Differences in home care service use, client characteristics and their pathways were tested across the two jurisdictions overall, and among the four discharge streams within jurisdictions using t-tests and chi-square tests of significance. RESULTS NS and WHRA clients were similar in age, sex, and marital status. NS clients had higher levels of need (ADL, cognitive impairment, CHESS) at base line and were more likely discharged to LTC (43% compared to 38% in WRHA). Caregiver distress was a factor correlated with being discharged to LTC. While a third remained as home care clients after 4 years; more than half were no longer in the community - either discharged to LTC placement or death. Such discharges occurred on average at around two years, a relatively short time period. CONCLUSIONS By following older clients over 4 years, we provide enhanced evidence of client pathways, the characteristics that influence these paths, as well as the length of time to the outcomes. This evidence is central to identification of clients at risk in the community and aids in planning for future home care servicing needs that will allow more older adults to remain living in the community.
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Affiliation(s)
| | - Jeffrey Poss
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | | | - Rosanne Burke
- Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada
| | - Janice M Keefe
- Department of Family Studies and Gerontology and Director, Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada
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26
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Abey-Nesbit R, Jamieson HA, Bergler HU, Kerse N, Pickering JW, Teh R. Chronic health conditions and mortality among older adults with complex care needs in Aotearoa New Zealand. BMC Geriatr 2023; 23:318. [PMID: 37217895 DOI: 10.1186/s12877-023-03961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/08/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Older people have more comorbidities than younger groups and multimorbidity will increase. Often chronic conditions affect quality of life, functional ability and social participation. Our study aim was to quantify the prevalence of chronic conditions over a three-year period and their association with mortality after accounting for demographics. METHODS We conducted a retrospective cohort study using routinely collected health data including community-dwelling older adults in New Zealand who had an interRAI Home Care assessment between 1 January 2017 and 31 December 2017. Descriptive statistics and differences between variables of interest among ethnic groups were reported. Cumulative density plots of mortality were developed. Logistic regression models adjusted for age and sex to estimate mortality were created independently for each combination of ethnicity and disease diagnosis. RESULTS The study cohort consisted of 31,704 people with a mean (SD) age of 82.3 years (8.0), and of whom 18,997 (59.9%) were female. Participants were followed for a median 1.1 (range 0 to 3) years. By the end of the follow-up period 15,678 (49.5%) people had died. Nearly 62% of Māori and Pacific older adults and 57% of other ethnicities had cognitive impairment. Diabetes the next most prevalent amongst Māori and Pacific peoples, and coronary heart disease amongst Non-Māori/Non-Pacific individuals. Of the 5,184 (16.3%) who had congestive heart failure (CHF), 3,450 (66.6%) died. This was the highest mortality rate of any of the diseases. There was a decrease in mortality rate with age for both sexes and all ethnicities for those with cancer. CONCLUSIONS Cognitive impairment was the most common condition in community dwelling older adults who had an interRAI assessment. Cardiovascular disease (CVD) has the highest mortality risk for all ethnic groups, and in non-Māori/non-Pacific group of advanced age, risk of mortality with cognitive impairment is as high as CVD risk. We observed an inverse for cancer mortality risk with age. Important differences between ethnic groups are reported.
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Affiliation(s)
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland, M&HS Building 507 - Bldg 507, 28 Park Ave, Grafton, 1850, 1023, Auckland, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Health Care, University of Auckland, M&HS Building 507 - Bldg 507, 28 Park Ave, Grafton, 1850, 1023, Auckland, New Zealand.
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Robitaille A, Garcia L, Terrera GM. Differences in the longitudinal change of behaviours related to dementia in long-term care: a growth mixture modelling approach. BMC Geriatr 2023; 23:254. [PMID: 37106334 PMCID: PMC10141941 DOI: 10.1186/s12877-023-03933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/25/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND There is still a need for more information about the different trajectories of responsive behaviours that people living with dementia present in long-term care homes (LTC). OBJECTIVE This study identified subgroups of individuals with similar trajectories of responsive behaviours related to dementia in LTC and evaluated the role of demographic variables, depressive symptomatology, social engagement, cognitive functioning, and activities of daily living (ADL) on class membership. METHODS Growth mixture models were run using data from the Continuing Care Reporting System. RESULTS Results suggest that change in responsive behaviours is best represented by seven classes of trajectories. The largest class was composed of individuals who presented the lowest frequency of behaviours upon entry in LTC that increased at a slow linear rate. The other classes were composed of individuals who presented different frequencies of behaviours upon entry in LTC and varying rates of change (e.g., individuals who presented a low frequency of behaviours upon entry in LTC that increased at a linear rate followed by a decrease in the later months, individuals who presented a high frequency of responsive behaviours upon entry in LTC and that remained stable). Cognitive functioning, social engagement, depressive symptomatology, and ADL were markers of class membership. CONCLUSIONS These findings can help identify individuals at increased risk of presenting a high frequency of responsive behaviours and highlight interventions that could decrease behaviours in LTC.
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Affiliation(s)
- Annie Robitaille
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
- Centre of Excellence, Perley Health, Ottawa, ON, Canada.
| | - Linda Garcia
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Graciela Muniz Terrera
- Ohio University Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
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Hogan DB, Campitelli MA, Bronskill SE, Iaboni A, Barry HE, Hughes CM, Gill SS, Maxwell CJ. Trends and correlates of concurrent opioid and benzodiazepine and/or gabapentinoid use among Ontario nursing home residents. J Am Geriatr Soc 2023. [PMID: 36942992 DOI: 10.1111/jgs.18320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND A concern with long-term opioid use is the increased risk arising when opioids are used concurrently with drugs that can potentiate their associated adverse effects. The drugs most often encountered are benzodiazepines (BZDs) and gabapentinoids. Our study objectives were to examine trends in the concurrent use of opioids and BZDs, or gabapentinoids, in a Canadian nursing home population over an 11-year period, and current resident-level correlates of this concurrent use. METHODS We conducted a population-based, repeated cross-sectional study among Ontario nursing home residents (>65 years) dispensed opioids between April 2009 and February 2020. For the last study year, we examined cross-sectional associations between resident characteristics and concurrent use of opioids with BZDs or gabapentinoids. Linked data on nursing home residents from clinical and health administrative databases was used. The yearly proportions of residents who were dispensed an opioid concurrently with a BZD or gabapentinoid were plotted with percent change derived from log-binomial regression models. Separate modified Poisson regression models estimated resident-level correlates of concurrent use of opioids with BZDs or gabapentinoids. RESULTS Over the study period, among residents dispensed an opioid there was a 53.2% relative decrease (30.7% to 14.4%) in concurrent BZD and a 505.4% relative increase (4.4% to 26.6%) in concurrent gabapentinoid use. In adjusted models, increasing age and worsening cognition were inversely associated with the concurrent use of both classes, but most other significantly related covariates were unique to each drug class (e.g., sex and anxiety disorders for BZD, pain severity and presence of pain-related conditions for gabapentinoids). CONCLUSIONS Co-administration of BZDs or gabapentinoids in Ontario nursing home residents dispensed opioids remains common, but the pattern of co-use has changed over time. Observed covariates of concurrent use in 2019/20 suggest distinct but overlapping resident populations requiring consideration of the relative risks versus benefits of this co-use and monitoring for potential harm.
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Affiliation(s)
- David B Hogan
- Department of Medicine, Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea Iaboni
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Heather E Barry
- School of Pharmacy, Primary Care Research Group, Queen's University Belfast, Belfast, UK
| | - Carmel M Hughes
- School of Pharmacy, Primary Care Research Group, Queen's University Belfast, Belfast, UK
| | - Sudeep S Gill
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Mofina A, Miller J, Tranmer J, Li W, Donnelly C. The association between receipt of home care rehabilitation services and acute care hospital utilization in clients with multimorbidity following an acute care unit discharge: a retrospective cohort study. BMC Health Serv Res 2023; 23:269. [PMID: 36934243 PMCID: PMC10024414 DOI: 10.1186/s12913-023-09116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/27/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Individuals experiencing multimorbidity have more complex healthcare needs, use more healthcare services, and access multiple service providers across the healthcare continuum. They also experience higher rates of functional decline. Rehabilitation therapists are well positioned to address these functional needs; however, little is known about the influence of rehabilitation therapy on patient outcomes, and subsequent unplanned healthcare utilization for people with multimorbidity. The aims of this study were to: 1) describe and compare the characteristics of people with multimorbidity receiving: home care rehabilitation therapy alone, other home care services without rehabilitation therapy, and the combination of home care rehabilitation therapy and other home care services, and 2) determine the association between home care rehabilitation therapy and subsequent healthcare utilization among those recently discharged from an acute care unit. METHODS This retrospective cohort study used linked health administrative data housed within ICES, Ontario, Canada. The cohort included long-stay home care clients experiencing multimorbidity who were discharged from acute care settings between 2007-2015 (N = 43,145). Descriptive statistics, ANOVA's, t-tests, and chi-square analyses were used to describe and compare cohort characteristics. Multivariable logistic regression was used to understand the association between receipt of rehabilitation therapy and healthcare utilization. RESULTS Of those with multimorbidity receiving long-stay home care services, 45.5% had five or more chronic conditions and 46.3% required some assistance with ADLs. Compared to people receiving other home care services, those receiving home care rehabilitation therapy only were less likely to be readmitted to the hospital (OR = 0.78; 95% CI: 0.73-0.83) and use emergency department services (OR = 0.73; 95% CI: 0.69-0.78) within the first 3-months following hospital discharge. CONCLUSIONS Receipt of rehabilitation therapy was associated with less unplanned healthcare service use when transitioning from hospital to home among persons with multimorbidity. These findings suggest rehabilitation therapy may help to reduce the healthcare burden for individuals and health systems. Future research should evaluate the potential cost savings and health outcomes associated with providing rehabilitation therapy services for people with multimorbidity.
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Affiliation(s)
- Amanda Mofina
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, ON, Canada
- ICES, Queen's, Kingston, ON, Canada
| | | | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Angevaare MJ, Joling KJ, Smalbrugge M, Choi H, Twisk JWR, Hertogh CMPM, van Hout HPJ. Psychological Resilience in Older Residents of Long-Term Care Facilities: Occurrence and Associated Factors. J Am Med Dir Assoc 2023; 24:382-389.e4. [PMID: 36592940 DOI: 10.1016/j.jamda.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/31/2022] [Accepted: 12/03/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The researchers aimed to (1) explore the occurrence of psychological resilience in the face of a major life stressor and conflict in older residents of long-term care facilities (LTCFs), and (2) identify factors associated with resilience in this population. DESIGN Longitudinal cohort study using the Dutch InterRAI-LTCF cohort. SETTING AND PARTICIPANTS Older residents (≥60 years old) of 21 LTCFs in the Netherlands. METHODS The researchers selected 2 samples of residents who had at least 2 assessments surrounding (1) an incident major life stressor, or (2) incident conflict with other resident or staff. A resilient outcome was operationalized as not having clinically meaningful mood symptoms at the post-stressor assessment and equal or fewer mood symptoms at the post-stressor relative to the pre-stressor assessment. The researchers used 2 resilience outcomes per stressor: 1 based on observer-reported mood symptoms and 1 based on self-reported mood symptoms. The most important factors from among 21 potential resilience factors for each of the 4 operationalizations of resilience were identified using a backward selection procedure with 2-level generalized estimating equations analyses. RESULTS Forty-eight percent and 50% of residents were resilient in the face of a major life stressor, based on observer-reported (n = 248) and self-reported (n = 211) mood, respectively. In the face of conflict, 26% and 51% of the residents demonstrated resilience, based on the observer-reported (n = 246) and self-reported (n = 183) mood, respectively. Better cognitive functioning, a strong and supportive relationship with family, participation in social activities, and better self-reported health were most strongly associated with resilience in the face of a major life stressor. Better communicative functioning, absence of psychiatric diagnoses, a strong and supportive relationship with family, not being lonely, social engagement, and not reminiscing about life were most strongly associated with resilience in the face of conflict. CONCLUSIONS AND IMPLICATIONS Factors with a social aspect appear to be particularly important to psychological resilience in older LTCF residents, and provide a potential target for intervention in the LTCF setting.
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Affiliation(s)
- Milou J Angevaare
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hyoungshim Choi
- Department of Nursing, Hansei University, Gunpo, Gyeonggi, South Korea
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Zazzara MB, Villani ER, Palmer K, Fialova D, Corsonello A, Soraci L, Fusco D, Cipriani MC, Denkinger M, Onder G, Liperoti R. Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study. Front Med (Lausanne) 2023; 10:1091246. [PMID: 36817789 PMCID: PMC9929152 DOI: 10.3389/fmed.2023.1091246] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
Background Frailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5-9 medications) or hyperpolypharmacy (≥10 drugs), have an increased risk of death and (ii) whether any association is modified by the co-presence of frailty or disability. Methods Cohort study with longitudinal mortality data including 4,023 residents from 50 European and 7 Israeli NH facilities (mean age = 83.6 years, 73.2% female) in The Services and Health for Elderly in Long Term care (SHELTER) cohort study. Participants were evaluated with the interRAI-LongTerm Care assessment tool. Frailty was evaluated with the FRAIL-NH scale. Hazard ratio (HR) of death over 12 months was assessed with stratified Cox proportional hazards models adjusted for demographics, facilities, and cognitive status. Results 1,042 (25.9%) participants were not on polypharmacy, 49.8% (n = 2,002) were on polypharmacy, and 24.3% (n = 979) on hyperpolypharmacy. Frailty and disability mostly increased risk of death in the study population (frailty: HR = 1.85, 95%CI 1.49-2.28; disability: HR = 2.10, 95%CI 1.86-2.47). Among non-frail participants, multimorbidity (HR = 1.34, 95%CI = 1.01-1.82) and hyperpolypharmacy (HR = 1.61, 95%CI = 1.09-2.40) were associated with higher risk of death. Among frail participants, no other factors were associated with mortality. Polypharmacy and multimorbidity were not associated with mortality after stratification for disability. Conclusions Frailty and disability are the strongest predictors of death in NH residents. Multimorbidity and hyperpolypharmacy increase mortality only in people without frailty. These findings may be relevant to identify patients who could benefit from tailored deprescription.
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Affiliation(s)
- Maria Beatrice Zazzara
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,*Correspondence: Maria Beatrice Zazzara ✉
| | - Emanuele Rocco Villani
- Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Emanuele Rocco Villani ✉
| | - Katie Palmer
- Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Daniela Fialova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Andrea Corsonello
- Unit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, Italy
| | - Domenico Fusco
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Maria Camilla Cipriani
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Michael Denkinger
- AGAPLESION Bethesda Ulm, Geriatric Research Ulm University and Geriatric Center Ulm/Alb Donau, Ulm, Germany
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
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Mörttinen-Vallius HP, Huhtala HSA, Hartikainen SA, Jämsen ERK. The Association of Long-Term Opioid Use With Health Care and Home Care Service Use Among Aged Home Care Clients. J Am Med Dir Assoc 2022:S1525-8610(22)00920-3. [PMID: 36581308 DOI: 10.1016/j.jamda.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/04/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare health care and home care service utilization, mortality, and long-term care admissions between long-term opioid users and nonusers among aged home care clients. DESIGN A retrospective cohort study based on the Resident Assessment Instrument-Home Care (RAI-HC) assessments and electronic medical records. SETTING AND PARTICIPANTS The study sample included all regular home care clients aged ≥65 years (n = 2475), of whom 220 were long-term opioid users, in one city in Finland (population base 222,000 inhabitants). METHODS Health care utilization, mortality, and long-term care admissions over a 1-year follow-up were recorded from electronic medical records, and home care service use from the RAI-HC. Negative binomial and multivariable logistic regression, adjusted for several socioeconomic and health characteristics, were used to analyze the associations between opioid use and health and home care service use. RESULTS Compared with nonusers, long-term opioid users had more outpatient consultations (incidence rate ratio 1.26; 95% CI 1.08-1.48), home visits (1.23; 1.01-1.49), phone contacts (1.38; 1.13-1.68), and consultations without a patient attending a practice (1.22; 1.04-1.43) after adjustments. A greater proportion of long-term opioid users than nonusers had at least 1 hospitalization (49% vs 41%) but the number of inpatient days did not differ after adjustments. The home care nurses' median work hours per week were 4.3 (Q1-Q3 1.5-7.7) among opioid users and 2.8 (1.0-6.1) among nonusers. Mortality and long-term care admissions were not associated with opioid use. CONCLUSIONS AND IMPLICATIONS Long-term opioid use in home care clients is associated with increased health care utilization regardless of the severity of pain and other sociodemographic and health characteristics. This may indicate the inability of health care organizations to produce alternative treatment strategies for pain management when opioids do not meet patients' needs. The exact reasons for opioid users' greater health care utilization should be examined in future.
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Affiliation(s)
| | | | - Sirpa A Hartikainen
- Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Esa R K Jämsen
- Faculty of Medicine (Clinicum), University of Helsinki, Helsinki, Finland; Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
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Egbujie BA, Northwood M, Turcotte LA, McArthur C, Berg K, Heckman GA, Wagg AS, Hirdes JP. Predictors of improvement in urinary incontinence in the postacute setting: A Canadian cohort study. Neurourol Urodyn 2022; 41:1749-1763. [PMID: 36040456 PMCID: PMC9805031 DOI: 10.1002/nau.25018] [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: 05/04/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine factors associated with improvement in urinary incontinence (UI) for long-stay postacute, complex continuing care (CCC) patients. DESIGN A retrospective cohort investigation of patients in a CCC setting using data obtained from the Canadian Institute for Health Information's Continuing Care Reporting System collected with interRAI Minimum Data Set 2.0. SETTING AND PARTICIPANTS Individuals aged 18 years and older, were admitted to CCC hospitals in Ontario, Canada, between 2010 and 2018. METHODS Multivariable logistic regression was used to determine the independent effects of predictors on UI improvement, for patients who were somewhat or completely incontinent on admission and therefore had the potential for improvement. RESULTS The study cohort consisted of 18 584 patients, 74% (13 779) of which were somewhat or completely incontinent upon admission. Among those patients with potential for improvement, receiving bladder training, starting a new medication 90 days prior (odds ratio, OR: 1.54 [95% confidence interval, CI: 1.36-1.75]), and triggering the interRAI Urinary Incontinence Clinical Assessment Protocol to facilitate improvement (OR: 1.36 [95% CI: 1.08-1.71]) or to prevent decline (OR: 1.32 [95% CI: 1.13-1.53]) were the strongest predictors of improvement. Conversely, being totally dependent on others for transfer (OR: 0.62 [95% CI: 0.42-0.92]), is rarely or never understood (OR: 0.65 [95% CI: 0.50-0.85]), having a major comorbidity count of ≥3 (OR: 0.72 [95% CI: 0.59-0.88]), Parkinson's disease, OR: 0.77 (95% CI: 0.62-0.95), Alzheimer/other dementia, OR: 0.83 (95% CI: 0.74-0.93), and respiratory infections, OR: 0.57 (95% CI: 0.39-0.85) independently predicted less likelihood of improvement in UI. CONCLUSIONS AND IMPLICATIONS Findings of this study suggest that improving physical function, including bed mobility, and providing bladder retraining have strong positive impacts on improvement in UI for postacute care patients. Evidence generated from this study provides useful care planning information for care providers in identifying patients and targeting the care that may lead to better success with the management of UI.
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Affiliation(s)
| | | | - Luke A. Turcotte
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Caitlin McArthur
- School of PhysiotherapyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Katherine Berg
- Department of Physical TherapyUniversity of TorontoTorontoOntarioCanada
| | - George A. Heckman
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada,Schlegel Research Chair in Geriatric MedicineSchlegel‐University of Waterloo Research Institute for AgingWaterlooOntarioCanada
| | - Adrian S. Wagg
- Department of Medicine, Division of Geriatric MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - John P. Hirdes
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
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Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy. Aging Clin Exp Res 2022; 34:3123-3130. [PMID: 36239853 PMCID: PMC9562060 DOI: 10.1007/s40520-022-02269-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
Background Little is known on how frailty influences clinical outcomes in persons with specific multimorbidity patterns. Aims To investigate the interplay between multimorbidity and frailty in the association with mortality in older individuals living in nursing homes (NH). Methods We considered 4,131 NH residents aged 60 years and over, assessed through the interRAI LTCF instrument between 2014 and 2018. Follow-up was until 2019. Considering four multimorbidity patterns identified via principal component analysis, subjects were stratified in tertiles (T) with respect to their loading values. Frailty Index (FI) considered 23 variables and a cut-off of 0.24 distinguished between high and low frailty levels. For each pattern, all possible combinations of tertiles and FI were evaluated. Their association (Hazard Ratio [HR] and 95% confidence interval) with mortality was tested in Cox regression models. Results In the heart diseases and dementia and sensory impairments patterns, the hazard of death increases progressively with patterns expression and frailty severity (being HR T3 vs. T1 = 2.36 [2.01–2.78]; HR T3 vs. T1 = 2.12 [1.83–2.47], respectively). In heart, respiratory and psychiatric diseases and diabetes, musculoskeletal and vascular diseases patterns, frailty seems to have a stronger impact on mortality than patterns’ expression. Discussion Frailty increases mortality risk in all the patterns and provides additional prognostic information in NH residents with different multimorbidity patterns. Conclusions These findings support the need to routinely assess frailty. Older people affected by specific groups of chronic diseases need a specific care approach and have high risk of negative health outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02269-8.
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Shieu BM, Toles M, Hoben M, Schwartz TA, Beeber AS, Anderson RA. A Cross-Sectional, Correlational Study Comparing Individual Characteristics of Younger and Older Nursing Home Residents Using Western Canadian Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0. J Am Med Dir Assoc 2022; 23:1878-1882.e3. [PMID: 36065097 DOI: 10.1016/j.jamda.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To compare characteristics of nursing home (NH) residents by age categories in Western Canada. DESIGN A cross-sectional, correlational analysis of secondary data. SETTING AND PARTICIPANTS 89,231 residents living in Western Canada NHs in the provinces of Alberta, Manitoba, and British Columbia in 2016 and 2017. METHODS Resident characteristics (age, sex, marital status, body mass index, medical diagnoses, cognitive function, physical function, depressive symptoms) came from the Resident Assessment Instrument-Minimum Data Set 2.0 and were analyzed using chi-square, analysis of variance, and post hoc pairwise tests. Human developmental stage age categories were used to create 5 age groups: 18-34, 35-50, 51-64, 65-80, and 81 years and older. RESULTS The demographics, medical diagnoses, cognitive function, and physical function characteristics of NH residents among 5 age groups differed considerably (all P < .001). Residents aged 18-34 years were predominately male, never married, with a higher incidence of paralysis and traumatic brain injury. Residents aged 35-50 years had a higher incidence of stroke and multiple sclerosis, and residents aged 51-64 years mainly were morbidly obese and more prone to depression. Residents aged 65-80 years were predominately married and more prone to diabetes, and residents aged 81 years and older were predominately widowed, with a higher incidence of dementia compared with others. CONCLUSIONS AND IMPLICATIONS Findings describe the uniqueness of younger NH age groups and indicate that the youngest NH residents often have the severe disability and a modest support system (as defined by partnered status) compared to older residents in NHs. Future studies must analyze longitudinal data that track the growth of, and changes in, residents' health and functional status.
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Affiliation(s)
- Bianca M Shieu
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA.
| | - Mark Toles
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - Matthias Hoben
- University of Alberta Faculty of Nursing, Edmonton, AB, Canada
| | - Todd A Schwartz
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - Anna S Beeber
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Ruth A Anderson
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
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Predictive factors of nonfatal self-harm among community-dwelling older adults assessed for support services. Int Psychogeriatr 2022; 34:813-826. [PMID: 33336632 DOI: 10.1017/s1041610220003853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand. METHODS interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales. RESULTS A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36-181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51-5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26-4.03), at-risk alcohol use (2.38, 1.30-4.35), and bipolar disorder (2.18, 1.25-3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36-0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35-0.89). CONCLUSION Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up.
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Iacono A, Campitelli MA, Bronskill SE, Hogan DB, Iaboni A, Maclagan LC, Gomes T, Tadrous M, Evans C, Gruneir A, Guan Q, Hadjistavropoulos T, Cotton C, Gill SS, Seitz DP, Ho J, Maxwell CJ. Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis. Drugs Aging 2022; 39:811-827. [PMID: 35976489 PMCID: PMC9381389 DOI: 10.1007/s40266-022-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Background Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management. Objectives The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity. Methods We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018–2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents’ health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents’ characteristics and opioid use, overall and across strata capturing pain frequency and intensity. Results Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57–0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66–0.72) or dementia (aRR = 0.76, 95% CI 0.74–0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32–1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74–1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28–1.38), or antidepressants (aRR = 1.31, 95% CI 1.27–1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata. Conclusions Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00972-9.
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Affiliation(s)
- Anita Iacono
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Susan E Bronskill
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tara Gomes
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Unity Health, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrea Gruneir
- ICES, Toronto, ON, Canada.,Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Qi Guan
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Cecilia Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Sudeep S Gill
- ICES, Toronto, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Dallas P Seitz
- ICES, Toronto, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joanne Ho
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. .,ICES, Toronto, ON, Canada. .,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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Angevaare MJ, Joling KJ, Smalbrugge M, Hertogh CMPM, Twisk JWR, van Hout HPJ. The Effects of the 2020 COVID-19 Lockdown on Mood, Behavior, and Social and Cognitive Functioning in Older Long-Term Care Residents. J Am Med Dir Assoc 2022; 23:1608.e9-1608.e18. [PMID: 35964663 PMCID: PMC9276644 DOI: 10.1016/j.jamda.2022.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
Objectives We aimed to explore the effects of the Dutch COVID-19 lockdown (March 20–May 25, 2020) on mood, behavior, and social and cognitive functioning of older residents of long-term care facilities (LTCFs) prospectively. Design Mixed methods: historically controlled longitudinal cohort study and focus groups. Setting and Participants Residents of Dutch LTCFs. Methods Residents who were assessed during and prior to the lockdown were compared to residents of the same wards with 2 assessments prior to the lockdown. We used mixed models and generalized estimating equation analyses to explore differences in changes in mood, withdrawal and aggressive behavior, loneliness and conflict, and cognition and delirium. We also explored whether the effect of the lockdown differed for different subgroups. In 2 online focus groups, LTCF care professionals, ranging from care staff to physicians, reflected on their experiences of the effect of the lockdown and the cohort study results. Results The lockdown group of 298 residents was compared to the control group of 625 residents. Self-reported mood symptoms showed a slightly greater increase during the lockdown. During the first half of the lockdown, the level of conflict with other residents decreased whereas it increased in the control group. The subgroup with moderate-severe cognitive impairment showed a decrease in withdrawal during the lockdown, whereas the group with no-mild cognitive impairment showed a statistically nonsignificant relative increase. Professionals described great individual variation in the effects of the lockdown on residents. Facilities attempted to preserve the experienced positive effects, for example, by promoting tranquility in shared rooms and continuing to organize individualized ward-based activities. Conclusions and Implications We did not find clinically relevant negative effects of the lockdown on mood, behavior, and social and cognitive functioning in older residents of LTCFs at the group level. Possibly, staff mitigated the negative effects at the group level. Meanwhile, they learned lessons that they continue to apply to enhance resident well-being.
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Affiliation(s)
- Milou J Angevaare
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hein P J van Hout
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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McArthur C, Faller-Saunders A, Turcotte LA, Joanna Sinn CL, Berg K, Morris JN, Hirdes JP. Examining the effect of the first wave of the COVID-19 pandemic on home care recipients’ instrumental activities of daily living capacity. J Am Med Dir Assoc 2022; 23:1609.e1-1609.e5. [PMID: 35843290 PMCID: PMC9233999 DOI: 10.1016/j.jamda.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/06/2022] [Accepted: 06/18/2022] [Indexed: 11/11/2022]
Abstract
Objective To examine the effect of the pandemic on, and factors associated with, change in home care (HC) recipients’ capacity for instrumental activities of daily living. Design Retrospective cohort study. Setting and participants HC recipients in Ontario, Canada, between September 1, 2018, and August 31, 2020, who were not totally dependent on others and not severely cognitively impaired at baseline. Methods Data were collected with the interRAI Home Care assessment. Outcomes of interest were declines in instrumental activities of daily living. Factors hypothesized to be associated with declining function were entered as independent variables into multivariable generalized estimating equations, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Those significant at P < .01 were retained in the final models. Results There were 6786 and 5019 HC recipients in the comparison and pandemic samples, respectively. Between baseline and follow-up for the 2 groups, 34.1% and 42.1% of HC recipients declined in shopping, whereas 25.2% and 30.5% declined in transportation capacity in the comparison and pandemic sample, respectively. For shopping, those with cognitive impairment (OR 0.83, 95% CI 0.76-0.89) and receiving formal care (OR 0.72, 95% CI 0.62-0.85) were less likely to decline, whereas those who were older (OR 1.91, 95% CI 1.69-2.16) and had unstable health (OR 1.31, 95% CI 1.16-1.48) were more likely. For transportation, those receiving informal (OR 0.71, 95% CI 0.61-0.81) or formal care (OR 0.56, 95% CI 0.47-0.67) were less likely to decline, whereas those who were older (OR 1.81, 95% CI 1.58-2.07) and had unstable health (OR 1.35, 95% CI 1.119-1.54) were more likely. Conclusions and implications The pandemic was associated with a decline in HC recipients’ capacity for shopping and transportation. HC recipients who are older and have unstable health may benefit from preventive strategies.
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Patterns of home care assessment and service provision before and during the COVID-19 pandemic in Ontario, Canada. PLoS One 2022; 17:e0266160. [PMID: 35353856 PMCID: PMC8966998 DOI: 10.1371/journal.pone.0266160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/16/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective was to compare home care episode, standardised assessment, and service patterns in Ontario's publicly funded home care system during the first wave of the COVID-19 pandemic (i.e., March to September 2020) using the previous year as reference. STUDY DESIGN AND SETTING We plotted monthly time series data from March 2019 to September 2020 for home care recipients in Ontario, Canada. Home care episodes were linked to interRAI Home Care assessments, interRAI Contact Assessments, and home care services. Health status measures from the patient's most recent interRAI assessment were used to stratify the receipt of personal support, nursing, and occupational or physical therapy services. Significant level and slope changes were detected using Poisson, beta, and linear regression models. RESULTS The March to September 2020 period was associated with significantly fewer home care admissions, discharges, and standardised assessments. Among those assessed with the interRAI Home Care assessment, significantly fewer patients received any personal support services. Among those assessed with either interRAI assessment and identified to have rehabilitation needs, significantly fewer patients received any therapy services. Among patients receiving services, patients received significantly fewer hours of personal support and fewer therapy visits per month. By September 2020, the rate of admissions and services had mostly returned to pre-pandemic levels, but completion of standardised assessments lagged behind. CONCLUSION The first wave of the COVID-19 pandemic was associated with substantial changes in Ontario's publicly funded home care system. Although it may have been necessary to prioritise service delivery during a crisis situation, standardised assessments are needed to support individualised patient care and system-level monitoring. Given the potential disruptions to home care services, future studies should examine the impact of the pandemic on the health and well-being of home care recipients and their caregiving networks.
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Social engagement and distress among home care recipients during the COVID-19 pandemic in Ontario, Canada: a retrospective cohort study. J Am Med Dir Assoc 2022; 23:1101-1108. [PMID: 35577010 PMCID: PMC9013660 DOI: 10.1016/j.jamda.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
Objectives To examine factors associated with distressing social decline and withdrawal during the COVID-19 pandemic for home care recipients. Design Retrospective cohort. Setting and participants Home care recipients age 18 years or older in Ontario, Canada without severe cognitive impairment with an assessment and follow-up between September 1, 2018 and August 31, 2020. Methods Data were collected using the interRAI home care. Outcomes of interest were distressing decline in social participation and social withdrawal. Independent variables were entered into multivariable longitudinal generalized estimating equations. Interaction terms with the pandemic were tested. Those significant at P < .01 were retained in final models and reported as odds ratios (ORs), 95% confidence intervals (CIs). Results We compared 26,492 and 19,126 home care recipients before and during the pandemic, respectively. The pandemic was associated with greater odds of experiencing distressing social decline (OR 1.28, 95% CI 1.22‒1.34) and withdrawal (OR 1.09, 95% CI 1.04‒1.15). Living alone (OR 1.13, 95% CI 1.05‒1.22), frailty (OR 3.21, 95% CI 2.76‒3.73), health instability (OR 2.22, 95% CI 2.02‒2.44), and depression (OR 2.14, 95% CI 2.01‒2.29) increased the odds of distressing social decline. Older age (OR 0.71, 95% CI 0.65‒0.77), functional impairment (OR 0.58, 95% CI 0.51‒0.67), and receiving caregiving (OR 0.73, 95% CI 0.67‒0.79) decreased the odds. Home care recipients with mild/moderate dementia were less likely to experience distressing social decline during the pandemic. Those who lived alone were more likely. Frailty (OR 9.49, 95% CI 7.69‒11.71) and depression (OR 2.76, 95% CI 2.55‒3.00) increased the odds of social withdrawal. Functional impairment (OR 0.32, 95% CI 0.27‒0.39), congestive heart failure (OR 0.77, 95% CI 0.70‒0.84), and receiving caregiving (OR 0.50, 95% CI 0.46‒0.55) decreased the odds. Home care recipients age 18‒64 years and older than 75 years were less likely to experience social withdrawal during the pandemic. Conclusions and implications Social support interventions should focus on supporting those living alone, with frailty, health instability, or depression.
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Park SH, Cho YS. Predictive validity of the Cornell Scale for depression in dementia among older adults with and without dementia: A systematic review and meta-analysis. Psychiatry Res 2022; 310:114445. [PMID: 35190341 DOI: 10.1016/j.psychres.2022.114445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 12/29/2022]
Abstract
This review analyzes the predictive validity of the Cornell Scale for Depression in Dementia (CSDD), considering cognitive function. Electronic searches were performed using MEDLINE, EMBASE, CINAHL, and PsycINFO databases. Overall, 20 studies were reviewed, including 3,499 older adults, with and without dementia, who satisfied the selection criteria. Participants were stratified into the dementia, non-dementia, and mixed groups, and the diagnostic performance of the CSDD was assessed using receiver operating characteristic (ROC) curves. In the dementia and non-dementia groups, the area under the curve was ≥ 0.9, confirming high accuracy of the test. The pooled sensitivity was the highest in the dementia group (0.87), followed by the mixed group (0.84) and non-dementia group (0.82). In the subgroup analysis based on the Mini-Mental State Examination (MMSE), the ROC curve was 0.90 for older adults with MMSE scores < 15 and 0.87 for those with an MMSE score ≥ 15. Therefore, the CSDD can be considered excellent tool for assessing depression in all older adults, although its predictive ability is better for older adults with dementia compared to that in those without dementia. It can be used as a first-line screening tool for depression, regardless of cognitive function.
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Villani ER, Fusco D, Franza L, Onder G, Bernabei R, Colloca GF. Characteristics of patients with cancer in European long-term care facilities. Aging Clin Exp Res 2022; 34:671-678. [PMID: 34590240 PMCID: PMC8894167 DOI: 10.1007/s40520-021-01972-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Purpose Up to 26% of residents in nursing homes (NHs) are affected by cancer. Their care represents a challenge, because NHs are not usually considered a setting focused on oncologic management and care. The aim of this paper is to describe socio-demographic and clinical features of patients with cancer residing in European NHs. Methods Cross-sectional study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Participants were assessed through the interRAI-LTCF, which includes cancer assessment. Results Among 4140 participants (mean age 83.4 years; female 73%), 442 (10.7%) had cancer. Patients with cancer had a higher prevalence of do-not-resuscitate directives compared to those without cancer (21.1% vs 16.5%, p = 0.019). Variables directly associated with cancer were male sex (adj OR 1.67, 95% CI 1.36–2.05), pain (adj OR 1.43, 95% CI 1.16–1.77), fatigue (adj OR 1.25, 95% CI 1.01–1.55), polypharmacy (adj OR 1.59, 95% CI 1.21–2.08) and falls (adj OR. 1.30, 95% CI 1.01–1.67). Dementia was inversely associated with cancer (adj OR 0.74, 95% CI 0.58–0.94). Symptomatic drugs such as opioids (23.5% vs 12.2, p < .001), NSAIDS (7.2% vs 3.9%, p = 0.001), antidepressants (39.1% vs 33.8%, p = 0.026) and benzodiazepines (40.3% vs 34.3, p = 0.012) were all prescribed more in participants with cancer compared to those without cancer. Conclusions Cancer patients are prevalent in European NHs and they show peculiar characteristics. Studies are needed to evaluate the impact of a supportive care approach on the management of NHs residents with cancer throughout all its phases, until the end-of-life care
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Affiliation(s)
- Emanuele Rocco Villani
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy.
| | - Domenico Fusco
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Laura Franza
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Choi JY, Kim H, Jung YI, Chun S, Yoo S, Lim JY, Ko JY, Park K, Kim KI. Factors associated with anticholinergic burden among older patients in long-term care hospitals in Korea. Korean J Intern Med 2022; 37:468-477. [PMID: 35176208 PMCID: PMC8925946 DOI: 10.3904/kjim.2021.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Drugs with anticholinergic properties (DAPs) are associated with adverse health outcomes in older patients. The objective of this study was to evaluate the factors that determine the prescribing of more DAPs in long-term care hospitals (LTCHs) in Korea. In addition, the current patterns of DAP prescription were explored using a novel platform, which can collect data from LTCHs. METHODS This was a Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) sub-study, which is a pragmatic, cluster-randomized, controlled trial. The Health-RESPECT platform was used to collect prescribed medication data of 466 patients (aged ≥ 65 years) from seven LTCHs. DAPs were identified using the Korean Anticholinergic Burden Scale (KABS). Physical frailty, cognitive function, functional status, and quality of life were evaluated. RESULTS Among 466 LTCH patients, 88.8% (n = 414) were prescribed DAPs, and the prevalence of high KABS (≥ 3) was 70.4% (n = 328). The drugs that contributed most to the total KABS were quetiapine (20.7%), chlorpheniramine (19.5%), tramadol (9.8%), cimetidine (5.8%), and furosemide (3.6%). Polypharmacy, higher body mass index, less dependence, better communication and cognitive functions, and poorer quality of life were associated with high KABS. CONCLUSION Although the patients with a high burden of DAPs were less dependent and had better cognitive and communication functions, they had poorer quality of life. DAP use in LTCH patients should be monitored carefully, and the risk/ benefit relationship for their use should be considered.
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Affiliation(s)
- Jung-Yeon Choi
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
- Institute on Aging, Seoul National University, Seoul, Korea
| | - Young-il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul, Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Young Lim
- Institute on Aging, Seoul National University, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Young Ko
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kayoung Park
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang-il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Garland A, Keller H, Quail P, Boscart V, Heyer M, Ramsey C, Vucea V, Choi N, Bains I, King S, Oshchepkova T, Kalashnikova T, Kroetsch B, Steer J, Heckman G. BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial. Age Ageing 2022; 51:6552807. [PMID: 35325020 PMCID: PMC8946666 DOI: 10.1093/ageing/afac049] [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: 09/24/2021] [Revised: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. Objective Assess a comprehensive, person-centred ACP approach. Design Unblinded, cluster randomised trial. Setting Fourteen control and 15 intervention NHs in three Canadian provinces, 2018–2020. Subjects 713 residents (442 control, 271 intervention) aged ≥65 years, with elevated mortality risk. Methods The intervention was a structured, \documentclass[12pt]{minimal}
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}{}$\sim$\end{document}60-min discussion between a resident, substitute decision-maker (SDM) and nursing home staff to: (i) confirm SDMs’ identities and role; (ii) prepare SDMs for medical emergencies; (iii) explain residents’ clinical condition and prognosis; (iv) ascertain residents’ preferred philosophy to guide decision-making and (v) identify residents’ preferred options for specific medical emergencies. Control NHs continued their usual ACP processes. Co-primary outcomes were: (a) comprehensiveness of advance care planning, assessed using the Audit of Advance Care Planning, and (b) Comfort Assessment in Dying. Ten secondary outcomes were assessed. P-values were adjusted for all 12 outcomes using the false discovery rate method. Results The intervention resulted in 5.21-fold higher odds of respondents rating ACP comprehensiveness as being better (95% confidence interval [CI] 3.53, 7.61). Comfort in dying did not differ (difference = −0.61; 95% CI −2.2, 1.0). Among the secondary outcomes, antimicrobial use was significantly lower in intervention homes (rate ratio = 0.79, 95% CI 0.66, 0.94). Conclusions Superior comprehensiveness of the BABEL approach to ACP underscores the importance of allowing adequate time to address all important aspects of ACP and may reduce unwanted interventions towards the end of life.
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Affiliation(s)
- Allan Garland
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Keller
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Patrick Quail
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College, Kitchener, Ontario, Canada
| | - Michelle Heyer
- School of Health and Life Sciences, Conestoga College, Kitchener, Ontario, Canada
| | - Clare Ramsey
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vanessa Vucea
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nora Choi
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ikdip Bains
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Seema King
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tatiana Oshchepkova
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Brittany Kroetsch
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica Steer
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Mele B, Watt J, Wu P, Azeem F, Lew G, Holroyd–Leduc J, Goodarzi Z. Detecting depression in persons living in long-term care: a systematic review and meta-analysis of diagnostic test accuracy studies. Age Ageing 2022; 51:6540127. [PMID: 35231088 DOI: 10.1093/ageing/afac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Depressive disorders are common in long-term care (LTC), however, there is no one process used to detect depressive disorders in this setting. Our goal was to describe the diagnostic accuracy of depression detection tools used in LTC settings. METHODS We conducted a systematic review and meta-analysis of diagnostic accuracy measures. The databases PubMed, EMBASE, PsycINFO and CINAHL were searched from inception to 10 September 2021. Studies involving persons living in LTC, assisted living residences or facilities, comparing diagnostic accuracy of depression tools with a reference standard, were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess risk of bias. RESULTS We identified 8,463 citations, of which 20 studies were included in qualitative synthesis and 19 in meta-analysis. We identified 23 depression detection tools (including different versions) that were validated against a reference standard. At a cut-off point of 6 on the Geriatric Depression Scale-15 (GDS-15), the pooled sensitivity was 73.6% (95% confidence interval (CI) 43.9%-76.5%), specificity was 76.5% (95% CI 62.9%-86.7%), and an area under the curve was 0.83. There was significant heterogeneity in these analyses. There was insufficient data to conduct meta-analysis of other screening tools. The Nursing Homes Short Depression Inventory (NH-SDI) had a sensitivity ranging from 40.0% to 98.0%. The 4-item Cornell Scale for Depression in Dementia (CSDD) had the highest sensitivity (67.0%-90.0%) for persons in LTC living with dementia. CONCLUSIONS There are 23 tools validated for detection of depressive disorders in LTC, with the GDS-15 being the most studied. Tools developed specifically for use in LTC settings include the NH-SDI and CSDD-4, which provide briefer options to screen for depression. However, more studies of both are needed to examine tool accuracy using meta-analyses.
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Affiliation(s)
- Bria Mele
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pauline Wu
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Canada
| | - Feeha Azeem
- Business Management Masters Program, York University, Toronto, Ontario M3J 1P3, Canada
| | - Grace Lew
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd–Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
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Zúñiga F, Guerbaai RA, de Geest S, Popejoy LL, Bartakova J, Denhaerynck K, Trutschel D, Basinska K, Nicca D, Kressig RW, Zeller A, Wellens NIH, de Pietro C, Desmedt M, Serdaly C, Simon M. Positive effect of the INTERCARE nurse-led model on reducing nursing home transfers: A nonrandomized stepped-wedge design. J Am Geriatr Soc 2022; 70:1546-1557. [PMID: 35122238 PMCID: PMC9305956 DOI: 10.1111/jgs.17677] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/04/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
Background Unplanned nursing home (NH) transfers are burdensome for residents and costly for health systems. Innovative nurse‐led models of care focusing on improving in‐house geriatric expertise are needed to decrease unplanned transfers. The aim was to test the clinical effectiveness of a comprehensive, contextually adapted geriatric nurse‐led model of care (INTERCARE) in reducing unplanned transfers from NHs to hospitals. Methods A multicenter nonrandomized stepped‐wedge design within a hybrid type‐2 effectiveness‐implementation study was implemented in 11 NHs in German‐speaking Switzerland. The first NH enrolled in June 2018 and the last in November 2019. The study lasted 18 months, with a baseline period of 3 months for each NH. Inclusion criteria were 60 or more long‐term care beds and 0.8 or more hospitalizations per 1′000 resident care days. Nine hundred and forty two long‐term NH residents were included between June 2018 and January 2020 with informed consent. Short‐term residents were excluded. The primary outcome was unplanned hospitalizations. A fully anonymized dataset of overall transfers of all NH residents served as validation. Analysis was performed with segmented mixed regression modeling. Results Three hundred and three unplanned and 64 planned hospitalizations occurred. During the baseline period, unplanned transfers increased over time (β1 = 0.52), after which the trend significantly changed by a similar but opposite amount (β2 = −0.52; p = 0.0001), resulting in a flattening of the average transfer rate throughout the postimplementation period (β1 + β2 ≈ 0). Controlling for age, gender, and cognitive performance did not affect these trends. The validation set showed a similar flattening trend. Conclusion A complex intervention with six evidence‐based components demonstrated effectiveness in significantly reducing unplanned transfers of NH residents to hospitals. INTERCARE's success was driven by registered nurses in expanded roles and the use of tools for clinical decision‐making. See related Editorial by Kaehr et al. in this issue.
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Affiliation(s)
- Franziska Zúñiga
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Raphaëlle-Ashley Guerbaai
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Sabina de Geest
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Lori L Popejoy
- University of Missouri, Sinclair School of Nursing, Columbia, USA
| | - Jana Bartakova
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Kris Denhaerynck
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Diana Trutschel
- Department of Computational Biology, Institut Pasteur, Paris, France
| | - Kornelia Basinska
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Dunja Nicca
- Institut of Epidemiology, Biostatistics and Prevention, University of Zürich, Zürich, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Nathalie I H Wellens
- Directorate General of Health, Department of Public Health and Social Affairs of the Canton of Vaud, Lausanne, Switzerland.,La Source School of Nursing, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Carlo de Pietro
- The department of Business economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Mario Desmedt
- Foundation Asile des Aveugles, Lausanne, Switzerland
| | | | - Michael Simon
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Department of Nursing, Nursing & Midwifery Research Unit, Bern, Switzerland
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Chamberlain SA, Bronskill SE, Hsu Z, Youngson E, Gruneir A. Resident loneliness, social isolation and unplanned emergency department visits from supportive living facilities: a population-based study in Alberta, Canada. BMC Geriatr 2022; 22:21. [PMID: 34979960 PMCID: PMC8725434 DOI: 10.1186/s12877-021-02718-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/13/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Supportive living (SL) facilities are intended to provide a residential care setting in a less restrictive and more cost-effective way than nursing homes (NH). SL residents with poor social relationships may be at risk for increased health service use. We describe the demographic and health service use patterns of lonely and socially isolated SL residents and to quantify associations between loneliness and social isolation on unplanned emergency department (ED) visits. METHODS We conducted a retrospective cohort study using population-based linked health administrative data from Alberta, Canada. All SL residents aged 18 to 105 years who had at least one Resident Assessment Instrument-Home Care (RAI-HC) assessment between April 1, 2013 and March 31, 2018 were observed. Loneliness and social isolation were measured as a resident indicating that he/she feels lonely and if the resident had neither a primary nor secondary caregiver, respectively. Health service use in the 1 year following assessment included unplanned ED visits, hospital admissions, admission to higher levels of SL, admission to NH and death. Multivariable Cox proportional hazard models examined the association between loneliness and social isolation on the time to first unplanned ED visit. RESULTS We identified 18,191 individuals living in Alberta SL facilities. The prevalence of loneliness was 18% (n = 3238), social isolation was 4% (n = 713). Lonely residents had the greatest overall health service use. Risk of unplanned ED visit increased with loneliness (aHR = 1.10, 95% CI: 1.04-1.15) but did not increase with social isolation (aHR = 0.95, 95% CI: 0.84-1.06). CONCLUSIONS Lonely residents had a different demographic profile (older, female, cognitively impaired) from socially isolated residents and were more likely to experience an unplanned ED visit. Our findings suggest the need to develop interventions to assist SL care providers with how to identify and address social factors to reduce risk of unplanned ED visits.
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Affiliation(s)
- Stephanie A Chamberlain
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, 6-50 University Terrace, Edmonton, Alberta, T6G 2T4, Canada.
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Management & Evaluation, Dalla Lana School of Public Health, Institute of Health Policy, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Zoe Hsu
- Data and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Erik Youngson
- Data and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, 6-50 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
- ICES, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Outcomes of advance care directives after admission to a long-term care home: DNR the DNH? BMC Geriatr 2022; 22:22. [PMID: 34979935 PMCID: PMC8725447 DOI: 10.1186/s12877-021-02699-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Residents of long-term care homes (LTCH) often experience unnecessary and non-beneficial hospitalizations and interventions near the end-of-life. Advance care directives aim to ensure that end-of-life care respects resident needs and wishes. Methods In this retrospective cohort study, we used multistate models to examine the health trajectories associated with Do-Not-Resuscitate (DNR) and Do-Not-Hospitalize (DNH) directives of residents admitted to LTCH in Ontario, Alberta, and British Columbia, Canada. We adjusted for baseline frailty-related health instability. We considered three possible end states: change in health, hospitalization, or death. For measurements, we used standardized RAI-MDS 2.0 LTCH assessments linked to hospital records from 2010 to 2015. Results We report on 123,003 LTCH residents. The prevalence of DNR and DNH directives was 71 and 26% respectively. Both directives were associated with increased odds of transitioning to a state of greater health instability and death, and decreased odds of hospitalization. The odds of hospitalization in the presence of a DNH directive were lowered, but not eliminated, with odds of 0.67 (95% confidence interval 0.65–0.69), 0.63 (0.61–0.65), and 0.47 (0.43–0.52) for residents with low, moderate and high health instability, respectively. Conclusion Even though both DNR and DNH orders are associated with serious health outcomes, DNH directives were not frequently used and often overturned. We suggest that policies recommending DNH directives be re-evaluated, with greater emphasis on advance care planning that better reflects resident values and wishes.
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Borkent JW, van Hout HPJ, Feskens EJM, Naumann E, de van der Schueren MAE. Behavioral and Cognitive Problems as Determinants of Malnutrition in Long-Term Care Facilities, a Cross-Sectional and Prospective Study. J Nutr Health Aging 2022; 26:749-759. [PMID: 35934819 DOI: 10.1007/s12603-022-1827-3] [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: 10/16/2022]
Abstract
OBJECTIVES To investigate the cross-sectional and prospective associations between behavior and cognitive problems and malnutrition in long-term care facilities (LTCF). DESIGN Cross-sectional and prospective routine care cohort study. SETTING 6874 Residents in Dutch LTCFs (period 2005-2020). PARTICIPANTS Data were obtained from the InterRAI-LTCF instrument. Cross-sectional analyses on prevalence of malnutrition at admission included 3722 residents. Prospective analyses studied incident malnutrition during stay (total follow-up time 7104 years) and included data of 1826 residents with first measurement on admission ('newly-admitted') and n=3152 with first measurement on average ~1 year after admission ('existing'). MEASUREMENTS InterRAI scales for communication problems (CS), aggressive behavior (ABS), social engagement (RISE), depressive symptoms (DRS), cognitive performance (CPS) and the total number of behavior and cognitive problems were investigated as independent variables and malnutrition (ESPEN 2015 definition) as dependent variable in regression analyses. Results were stratified for gender and group 'newly-admitted' vs. 'existing'. RESULTS On admission, 9.5% of residents was malnourished. In men, low social engagement was associated with prevalence of malnutrition. In women, all behavior and cognitive problems except depression were associated with malnutrition in the unadjusted analyses, but this attenuated in the full model taking all problems into account. The incidence of malnutrition during stay amounted to 8.9%. No significant associations of behavior and cognitive problems with malnutrition incidence were seen in 'newly-admitted' male residents while in 'existing' male residents all determinants were significantly associated. In 'newly-admitted' female residents CS, ABS and CPS, and in 'existing' female residents CS, RISE, ABS and CPS were significantly associated with incident malnutrition. All associations slightly attenuated after adjustment. Malnutrition incidence increased with increasing number of combined behavior and cognitive problems. CONCLUSION Residents with behavior and cognitive problems are at an increased risk of being malnourished at admission, or becoming malnourished during stay in a LTCF, especially residents with multiple behavior and cognitive problems.
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Affiliation(s)
- J W Borkent
- Jos W. Borkent, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands,
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