Protocol for the Development of the Fourth Edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline Using GRADE Methods

ABSTRACT

The National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and the Pan Pacific Pressure Injury Alliance are commencing a new (fourth) edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline . The fourth edition of the International Pressure Injury (PI) Guideline will be developed using GRADE methods to ensure a rigorous process consistent with evolving international standards. Clinical questions will address prevention and treatment of PIs, identification of individuals at risk of PIs, assessment of skin and tissues, and PI assessment. Implementation considerations supporting application of the guidance in clinical practice will be developed. The guideline development process will be overseen by a guideline governance group and methodologist; the guideline development team will include health professionals, educators, researchers, individuals with or at risk of PIs, and informal carers.This article presents the project structure and processes to be used to undertake a systematic literature search, appraise risk of bias of the evidence, and aggregate research findings. The methods detail how certainty of evidence will be evaluated; presentation of relative benefits, risks, feasibility, acceptability, and resource requirements; and how recommendations will be made and graded. The methods outline transparent processes of development that combine scientific research with best clinical practice. Strong involvement from health professionals, educators, individuals with PIs, and informal carers will enhance the guideline's relevance and facilitate uptake. This update builds on previous editions to ensure consistency and comparability, with methodology changes improving the guideline's quality and clarity.

The Effect of Advance Care Planning Intervention on Hospitalization Among Nursing Home Residents: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the effect of advance care planning (ACP) interventions on the hospitalization of nursing home residents.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Nursing homes and nursing home residents.

METHODS

A literature search was systematically conducted in 6 electronic databases (Embase, Ovid MEDLINE, Cochrane Library, CINAHL, AgeLine, and the Psychology & Behavioral Sciences Collection), in addition to hand searches and reference list checking; the articles retrieved were those published from 1990 to November 2021. The eligible studies were randomized controlled trials, controlled trials, and pre-post intervention studies describing original data on the effect of ACP on hospitalization of nursing home residents; these studies had to be written in English. Two independent reviewers appraised the quality of the studies and extracted the relevant data using the Joanna Briggs Institute abstraction form and critical appraisal tools. A study protocol was registered in PROSPERO (CRD42022301648).

RESULTS

The initial search yielded 744 studies. Nine studies involving a total of 57,180 residents were included in the review. The findings showed that the ACP reduced the likelihood of hospitalization [relative risk (RR) 0.54, 95% CI 0.47-0.63; I² = 0%)], it had no effect on emergency department (ED) visits (RR 0.60, 95% CI 0.31-1.42; I² = 99), hospice enrollment (RR 0.98, 95% CI 0.88-1.10; I² = 0%), mortality (RR 0.83, 95% CI 0.68-1.00; I² = 4%), and satisfaction with care (standardized mean difference: -0.04, 95% CI -0.14 to -0.06; I² = 0%).

CONCLUSION AND IMPLICATIONS

ACP reduced hospitalizations but did not affect the secondary outcomes, namely, ED visits, hospice enrollment, mortality, and satisfaction with care. These findings suggest that policy makers should support the implementation of ACP programs in nursing homes. More robust studies are needed to determine the effects of ACP on ED visits, hospice enrollment, mortality, and satisfaction with care.

Antihypertensive medication in frail older adults: A narrative review through a deprescribing lens

Purpose of review

The management of hypertension in frail older adults remains controversial, as these patients are underrepresented in clinical trials and practice guidelines. Overtreatment may cause harm while undertreatment may lead to greater risk of cardiovascular events. Our research aims to examine this controversy and provide guidance regarding deprescribing decisions in frail older adults.

Results

Current evidence suggests that there may be minimal cardiovascular benefit and significant harm of antihypertensive medication in the frail older adult population. A minority of hypertension guidelines provide sufficient recommendations for frail older adults, and there are limited tools available to guide clinical decision-making.

Conclusion

Randomized controlled trials and well-designed observational studies are needed to confirm the benefit-to-harm relationship of antihypertensive medication in frail older adults. Decision tools that comprehensively address antihypertensive deprescribing would be advantageous to help clinicians with hypertension management in this population. Clinicians should engage in shared decision-making with the patient and family to ensure that decisions regarding antihypertensive deprescribing best meet the needs of all involved.

Quality of Life Scores for Nursing Home Residents are Stable Over Time: Evidence from Minnesota

Quality of life (QoL) is important to nursing home (NH) residents, yet QoL is only publicly reported in a few states, in part because of concerns regarding measure stability. This study used QoL data from Minnesota, one of the few states that collects the measures, to test the stability of QoL over time. To do so, we assessed responses from two resident cohorts who were surveyed in subsequent years (2012-2013 and 2014-2015). Stability was measured using intra-class correlation (ICC) obtained from hierarchical linear models. Overall QoL had ICCs of 0.604 and 0.614, respectively. Our findings show that person-reported QoL has adequate stability over a period of one year. Findings have implications for higher adoption of person-reported QoL measure in long-term care.

Clinical profile of the SEM Scanner - Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning

INTRODUCTION

Pressure injuries (PIs) are a global health concern. Current PI care standards, including skin tissue assessments (STA) and health care professional (HCP) clinical judgment, diagnose visibly manifested PIs on the skin's surface, i.e. after the damage has already occurred. However, objective assessment of early-stage, non-visible, pressure-induced tissue damage is clinically impossible within the current standard of care. The SEM Scanner is the first device authorized by the Food and Drug Administration (FDA) that addresses this unmet clinical need.

AREAS COVERED

This review describes the novel sub-epidermal moisture (SEM) scanning technology of the device and summarizes the clinical safety and efficacy data that support the use of the scanner in routine PI care practice.

EXPERT OPINION

The clinical strategy for developing the SEM Scanner is noteworthy. SEM technology using anatomy-specific data enables HCPs to provide early PI prevention interventions before visible signs of tissue damage develop while the damage is still reversible. When adopted into routine practice, the device identifies an increased risk of developing PIs 5 days (median) earlier than STA. FDA clearance was based on bench studies and data from three foundational trials that demonstrate the diagnostic accuracy of the device algorithm significantly exceeding clinical judgment (p < 0.001).

Predictors of quality of life and attitude to ageing in older adults with and without dementia

OBJECTIVES

This study explored the quality of life (QoL) and attitudes to aging in older adults with and without dementia, and ascertained the main factors that predict QoL and attitude to ageing.

METHODS

A cross-sectional study involving 563 community-dwelling adults with (PwD) and without dementia (PwoD) >60 years of age was conducted in three Czech regions. A tools battery including the Quality of Life-Alzheimer's Disease Scale, Geriatric Depression Scale, Patient Dignity Inventory, Attitude to Aging Questionnaire (AAQ), Short Physical Performance Battery, and Barthel Index, were administered.

RESULTS

PwD had worse scores in QoL and AAQ (both p = 0.0001). Less depression (p < 0.001), better sense of dignity (p < 0.05), and lower pain (p < 0.05) in PwoD predicted better scoring for QoL and AAQ. Physical ability in PwoD (p < 0.05), living alone (p < 0.05) and self-sufficiency (p < 0.001) in PwDwere predictors influencing QoL.Age (p < 0.01) in PwoD, gender (p < 0.05) and physical ability (p < 0.001) in PwD influenced AAQ.

CONCLUSIONS

This research is the first study to show that dignity can influence the QoL and attitude to aging in community-dwelling older adults. Our findings suggest that depression and dignity are common predictors of QoL and AAQ in older adults with and without dementia.

Qualitative analyses of nursing home residents' quality of life from multiple stakeholders' perspectives

PURPOSE

Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these stakeholders to ascertain if staff and leadership align with resident-identified factors for "good" quality of life has become important to include in the literature. This study sought to identify contributory factors to resident quality of life, as well as analyze areas of commonality in qualitative responses.

METHODS

Semi-structured interviews were conducted at 46 Midwestern nursing homes, with residents (n = 138), nursing assistants (n = 138), social workers (n = 46), activities directors (n = 46), and administrators (n = 46), on whether each stakeholder felt residents had a good quality of life and the factors contributing to resident quality of life.

RESULTS

Overall, the majority of residents perceived their quality of life as "good," though differences were noted in their main contributing factors when compared to staff members' and management's perspectives. Findings also demonstrated that nursing assistants most closely aligned with resident perspectives.

CONCLUSIONS

Given the implications of resident satisfaction with quality of life on multiple facets of a nursing home (e.g., survey process, financial reimbursement), it remains ever critical for management to engage residents and to truly listen to resident perspectives to enhance and ensure an optimal quality of life.

The health-related quality of life of nursing workers: A cross-sectional study in medical institutions

AIMS

This study aimed to evaluate the health-related quality of life of nursing workers and influential factors.

BACKGROUND

Nursing workers are under great occupational stress. However, few population-level studies of nursing workers' health conditions have been reported from China.

DESIGN

This was a cross-sectional study conducted in 12 medical institutions in east China between January and March 2015.

METHODS

Social-demographic information, nursing workers' work-related information and health-related quality of life using the Chinese (mainland) version of the Short Form 36 health survey were collected by a self-administrated questionnaire.

RESULTS

Nursing workers reported significantly lower scores of the vitality, mental health dimensions, and mental component summary of the Short Form 36 survey compared with general population reference values. They scored significantly higher for five other dimensions and comparably for the physical role dimension. Pre-job training, families' positive attitudes to their job, and good relationships with clients were positively related with nursing workers' mental well-being.

CONCLUSION

To promote nursing workers' mental health, compulsory work-related training, voluntary psychological counselling, and targeted legislation are needed.

Concept synthesis of dignity in care for elderly facility residents

BACKGROUND

Protecting the dignity of elderly residents of facilities and providing dignified care can be difficult. Although attempts have been made from several aspects, dignity is considered an area in which less real impact has been made in both theory and practice.

OBJECTIVE

The objective of this study is to characterize the concept of dignity in care for elderly subjects in residential facilities from a practical perspective through concept synthesis.

RESEARCH DESIGN

This study includes in-depth interviews with residents of elderly facilities and a literature review.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 12 residents of seven facilities in three prefectures in Japan were recruited via purposive sampling, and 27 interviews were conducted. Each digitally recorded interview was transcribed verbatim. The interview data were analyzed based on hermeneutic phenomenological research. The literature was searched using PubMed, CINAHL, and Web of Science with combinations of terms such as dignity, elderly, and residential facilities and then selected according to the predefined inclusion criteria. The descriptions about dignity in the included studies were divided into codes and compared with the results of the interviews.

ETHICAL CONSIDERATIONS

This study was approved by the institutional review board of Nagoya University's Graduate School of Medicine.

FINDINGS AND DISCUSSION

There were 1728 data codes for the interviews from which four themes were generated. In the literature review, 3716 titles were searched, and 28 articles were selected. Combining these results, five following themes and a conceptual matrix were obtained: individual dignity not affected by others; dignified care in a narrow sense; elements of the staff side; dignity in relation to family members, friends, society, and other residents; and dignity in relation to nursing care facilities and the nursing care system.

CONCLUSION

According to the established matrix, we must consider the role of the care system, facility, family, and society in providing care with dignity and the individual dignity to residents and dignity in daily care.

Benchmarking life quality support interventions in long-term care using the Long-Term Care Quality of Life scale

We aimed to develop a graphical procedure for benchmarking quality of life care results using the Long-Term Care Quality of Life (LTC-QoL) scale. While clinical care quality benchmarking is now well established, similar research for quality of life (QOL) aged care benchmarking has received scant attention. Data from 10 facilities utilizing the LTC-QoL scale were analysed to establish baseline statistics for developing a graphical procedure for QOL benchmarking. Client LTC-QoL records were tested with varimax rotation factor analysis revealing three viable benchmarking themes: B1 (Self-efficacy), B2 (supporting relationships), and B3 (outlook on life) were selected for benchmark development utilizing Analysis of Means to generate graphical outputs using Minitab version 17.3.1. In this way, in the absence of verified industry standards, it is possible to compare organizations providing similar services using the same indicators, against group averages. In conclusion, the benchmarking protocol produced comparative information on three benchmarks for 10 facilities. Similar analysis is feasible for a single facility over time. The results of these analyses provide evidence for on-site discussion of quality of life care quality performance.

Relationship between activities of daily living and depression among older adults and the quality of life of family caregivers

Objective

The purposes of this study were to explore the associations of activities of daily living (ADL) and depression among older adults with family caregivers’ quality of life and provide evidence for improving family caregivers’ quality of life.

Methods

Older adults (n=395) and their family caregivers (n=395) were selected as participants. The ADL scale and Geriatric Depression Scale were used to assess ADL and depression among older adults, and the 36-Item Short Form Health Questionnaire (SF-36) was used to assess family caregivers’ quality of life. Descriptive statistics and multiple linear regression were used to analyze the data.

Results

The older adults’ ADL and depression scores were 21±7 and 11±6, respectively. Approximately 69.9% of older adults had declining or severely impaired ADL, and 47.1% had mild or moderate-to-severe depression. Family caregivers’ mean quality of life score was 529±100. There was a negative correlation of older adults’ ADL and depression with caregivers’ quality of life. The correlation coefficient between ADL and the SF-36 mental component summary score was stronger than it was with the SF-36 physical component summary score.

Conclusions

The ADL and depression of older adults influenced family caregivers’ quality of life. Psychological health deserves closer attention, especially that of caregivers of disabled older adults.

Priority issues for pressure injury research: An Australian consensus study

Pressure injuries are a significant health concern in all clinical settings. The current body of research on pressure injuries reported in the literature presents primarily low level evidence. The purpose of the current study was to identify and prioritize pressure injury research issues. The approach entailed evidence scoping and implementing a formal consensus process using a modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. Sixteen Australian pressure injury experts participated in five consensus voting rounds in May to June 2015. From 60 initial research issues, the experts reached agreement that 26 issues are a priority for future pressure injury research. The highest priorities were strategies to assess skin and tissues, appropriate outcome measures for indicators of pressure injury healing and recurrence, heel pressure off-loading and shear reduction strategies, economic cost of pressure injuries and their management and effectiveness of skin moisturizers and barrier products. Developing a prioritized research agenda, informed by clinical and academic pressure injury experts, can assist in reducing the burden of pressure injuries by identifying topics of the highest need for further research. A web-based nominal group voting process was successful in engaging expert decision-making and has wide-reaching international appeal in facilitating cost-effective consensus methodologies. The priority list generated from this research is currently used in Australia to inform government investment in pressure injury research.

The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer's disease: A matched case-control study

OBJECTIVES

Behavioral and psychological symptoms of dementia in individuals with Alzheimer's disease and caregiver characteristics may influence the decision to provide care at home or in a nursing home, though few studies examine this association near the actual time of nursing home placement. Using a matched case-control design, this study investigates the association between (1) total Neuropsychiatric Inventory score, (2) the Neuropsychiatric Inventory-4 (an agitation/aggression subscale), and (3) individual domains of the Neuropsychiatric Inventory and nursing home placement.

METHODS

Data from the South Carolina Alzheimer's disease Registry provides an opportunity to expand the literature by looking at cases at the time of nursing home care eligibility/placement and allowing for propensity-score-matched controls. Cases (n = 352) entered a nursing home within 6 months of study initiation; controls (n = 289) remained in the community. Registry data were combined with caregiver survey data, including the Neuropsychiatric Inventory. Conditional logistic regression was applied.

RESULTS

A 10% increase in the Neuropsychiatric Inventory score implied a 30% increase in odds of nursing home admission (odds ratio: 1.30; 95% confidence interval: 1.14-1.50), having married or male caregivers predicted nursing home placement. Cases versus controls were significantly more likely to have behavioral and psychological symptoms of dementia related to agitation/aggression 1 month prior to nursing home admission.

CONCLUSION

Interventions targeting behavioral and psychological symptoms of dementia without available effective interventions in individuals with Alzheimer's disease and caregiver support services are necessary to prevent or delay nursing home admission.

Quality of life in Chinese family caregivers for elderly people with chronic diseases

BACKGROUND

Inadequate studies have been conducted in China to examine quality of life in family caregivers. Quality of life in family caregivers for elderly people with chronic diseases was evaluated, and the demographic and characteristic factors of both elderly people and their caregivers were explored.

METHODS

The 36-Item Short Form Health Survey (SF-36) was used to assess health-related quality of life in 407 family caregivers caring for elderly people with chronic diseases in six communities on the Mainland China. The explanatory variables included family caregivers' demographic and other caregiving variables related to eldercare. Descriptive statistics and multiple linear regression analysis were used in the data analysis, performed via SPSS 17.0.

RESULTS

Mean SF-36 and physical and mental component scores were 66.14 ± 17.50, 70.06 ± 16.49, and 62.22 ± 18.51, respectively. The scores of caregivers' physical function and bodily pain were significantly higher, while the scores of caregivers' role limitations due to physical problems, general health, vitality, social function, mental health and role limitations due to emotional problems were significantly lower. Caregivers' ages, comorbidity, the perceived effects of caregiving on caregivers' social lives and elderly individuals' ages, marital status and Activities of Daily Living scores were significantly associated with the physical component score. In addition, caregivers' age, the affordability of the elderly person's healthcare expenses, the perceived effects of caregiving on caregivers' social lives, and elderly people's marital status and ADL scores were significantly associated with the mental component score.

CONCLUSION

Family caregivers for elderly people with chronic diseases showed poorer mental and better physical well-being. Factors of both elderly people and their caregivers impact the caregivers' quality of life. These findings highlight the importance of addressing mental health of family caregivers, and of providing economical support and psychological care for them.

Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011

Objectives: Racial/ethnic disparities in nursing homes (NHs) are associated with lower quality of care, and state Medicaid payment policies may influence NH quality. However, no studies analyzing disparities in NH quality of life (QoL) exist. Therefore, this study aims to estimate associations at the NH level between average number of QoL deficiencies and concentrations of racial/ethnic minority residents, and to identify effects of state Medicaid payment policies on racial/ethnic disparities. Method: Multivariable Poisson regression with NH random effects was used to determine the association between NH minority concentration in 2000 to 2010 and average number of QoL deficiencies in 2001 to 2011 at the NH level, and the effect of state NH payment policies on QoL deficiencies and racial/ethnic disparities in QoL deficiencies across NH minority concentrations. Results: Racial/ethnic disparities in QoL between high and low minority concentration NHs decrease over time, but are not eliminated. Case mix payment was associated with an increased disparity between high and low minority concentration NHs in QoL deficiencies. Discussion: NH managers and policy makers should consider initiatives targeting minority residents or low-performing NHs with higher minority concentrations for improvement to reduce disparities and address QoL deficiencies.

Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports

OBJECTIVES

Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings.

DESIGN

A prospective, observational, longitudinal cohort design.

SETTING

Nursing homes (NHs), assisted living facilities (ALFs), community.

PARTICIPANTS

A total of 470 older adults who were first-time recipients of LTSS.

MEASUREMENT

Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments.

RESULTS

Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001).

CONCLUSIONS

Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.

Frailty Index and Quality of Life in Nursing Home Residents: Results From INCUR Study

BACKGROUND

Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes. The aim of this study was to examine the relationship between frailty and health-related Quality of Life (QoL) in older nursing home patients.

METHODS

The study sample consisted of 590 patients aged 65 years or older. QoL was measured with the Visual Analogue Scale. Frailty was assessed using the Frailty Index as proposed by Rockwood and colleagues.

RESULTS

Mean age of the participants was 85.9 (standard deviation [SD] 7.6) years, with 73.6% being female. The mean Frailty Index was 0.40 (SD 0.07) and the mean value of QoL was 67.4 out of 100 (SD 25.9). Before and after adjusting for age, and stratification for sociodemographic, and health-related variables, no significant associations between frailty and QoL were reported.

CONCLUSION

In our study, the Frailty Index was not associated with QoL in nursing home residents.

Longitudinal Changes in Nursing Home Resident-Reported Quality of Life: The Role of Facility Characteristics

Improving quality of nursing homes (NHs) is a major social priority, yet few studies examine the role of facility characteristics for residents' quality of life (QOL). This study goes beyond cross-sectional analyses by examining the predictors of NH residents' QOL on the facility level over time. We used three data sources, namely resident interviews using a multidimensional measure of QOL collected in all Medicaid-certified NHs in Minnesota (N = 369), resident clinical data from the minimum data set, and facility-level characteristics. We examined change in six QOL domains from 2007 to 2010, using random coefficient models. Eighty-one facilities improved across most domains and 85 facilities declined. Size, staffing levels (especially activities staff), and resident case mix are some of the most salient predictors of QOL over time, but predictors differ by facility performance status. Understanding the predictors of facility QOL over time can help identify facility characteristics most appropriate for targeting with policy and programmatic interventions.

Predictors of Long-Term Care Facility Residents’ Self-Reported Quality of Life With Individual and Facility Characteristics in Canada

Objective: Identify predictors of long-term care (LTC) facility residents’ self-reported quality of life (QoL). Method: QoL of a convenience sample of 928 residents from 48 volunteer LTC facilities across six Canadian provinces was assessed using the inter–Resident Assessment Instrument (interRAI) Self-Report Nursing Home Quality of Life Survey. Multivariate regression models were used to identify predictors. Results: In logistic regression modeling, residents who were religious and socially engaged, had a positive global disposition, or resided in rural, private, or municipal facilities were less likely to report low QoL. Those with post-secondary education and who were dependent on activities of daily living were more likely to report low QoL. These factors, except for religiosity and residence in municipal facilities, were significant in generalized estimating equation (GEE) modeling. Discussion: QoL is significantly associated with select resident and LTC facility characteristics with implications for improving residents’ QoL and LTC facility programming, and guiding future research and social policy development.

Constructing the meaning of quality of life for residents in care homes in the Lebanon: perspectives of residents, staff and family

AIM

Located in two care homes in Lebanon, the study explores the perspectives of quality of life for a sample of older residents, care staff and family caregivers.

BACKGROUND

Quality of life for older people living in care homes is traditionally reported in the literature as a Westernised construct and so far little is known about its meanings from an Arabic cultural perspective and context. There is also a knowledge gap about the conditions of older people living in care homes in Lebanon.

METHOD

The study was a qualitative exploration of perspectives of quality of life of older residents, care staff and family caregivers. Two care homes for older people situated in Beirut took part in the study. Between 2010 and 2011 semi-structured interviews were undertaken with a sample of 20 residents, eight family caregivers and 11 care staff. Data were analysed using the constant comparative method.

FINDINGS

Four categories emerged from this analytical process: (i) maintaining family connectedness; (ii) engaging in worthwhile activities; (iii) maintaining and developing significant relationships; and (iv) holding and practicing spiritual beliefs. The emergence of these categories confirmed the complex, interrelated and multidimensional nature of quality of life for residents and other stakeholders.

CONCLUSION

The findings supplement an emerging body of knowledge about the composition of quality of life for older residents in Lebanon. Improving the quality of life of older residents will require action in respect of all of the domains identified in study.

IMPLICATIONS FOR PRACTICE

Moving nursing practice from task-based care to relationship-centred approaches was seen as pivotal in helping to develop quality of life for residents living in the participating care homes. The findings have implications for education, nursing practice and research in Lebanon and help start an evidence base for care.

Residents’ Self-Reported Quality of Life in Long-Term Care Facilities in Canada

La qualité de vie (QV) dont bénéficient les résidents des centres d'hébergement de soins de longue durée (SLD) est un résultat important des soins. Cette étude descriptive transversale a examiné la qualité de vie auto-declarée de résidents des établissements de SLD au Canada, tout en utilisant l'auto-évaluation interRAI Nursing Home Quality of Life Survey. Un objectif secondaire était de tester les propriétés pschométriques de l'instrument. Les tests psychométriques de l'instrument ont soutenu sa fiabilité et la validité de sa convergence et de son contenu pour l'évaluation de QV des résidents. Les résultats ont montré que les résidents ont évalués positivement plusieurs aspects de leur vie, comme d'avoir la vie privée lors des visites (76,9%) et l'honnêteté du personnel en traitant avec eux (73,6%). Les résidents ont accordé des taux inférieures à d'autres aspects, comme l'autonomie, la liaison entre le personnel et les résidents, et les relations personnelles. Les résultats suggèrent des lacunes importantes entre les philosophies de soins dans les établissements et leur traduction dans un environnement de soins ou les soins sont vraiment dirigés aux résidents. En outre, les résultats ont des implications potentielles pour la planification de soins aux résidents, la programmation de l'installation, le développement de la politique sociale et de la recherche future.

Non-capable residents: is the experience of dependence understood in nursing homes? A qualitative study

OBJECTIVE

The aim of the present study was to describe how dependence was experienced by Spanish nursing home residents with functional limitations.

METHODS

A qualitative phenomenological approach was followed. An initial purposeful sampling of Spanish residents in for-profit nursing homes in the southern area of Madrid was carried out. Theoretical sampling was also implemented in order to gain a more in-depth understanding of dependence. The inclusion criteria for nursing home residents were: aged 60 years old or older, having a functional impairment (Barthel Index <90), and lack of any cognitive impairment (Mini-Mental State Examination-Folstein >19) and able to communicate verbally in Spanish. Data were collected using unstructured and semi-structured interviews. The interviews were tape recorded and fully transcribed. Data collection was concluded once theoretical saturation was reached, and the data were analyzed using the Giorgi proposal.

RESULTS

A total of 30 residents (15 female and 15 male) with a mean age of 83 years were included. Two main themes that describe the significance of dependence in nursing homes emerged from the data: (i) remaining "capable", with one subtheme named "building the difference", where residents described their own dependence classification of "non-capable" residents; and (ii) "sharing life", with two subthemes named "living together with non-capable residents" and "sharing the environment". Being considered as "non-capable" is labelling the resident forever.

CONCLUSIONS

The dependence experience of Spanish nursing home residents might help us gain a deeper insight into their expectations about functional limitations, as well as to understand the change in the relationship between residents considered "non-capable", caregivers and the other residents.

[Factors associated with life satisfaction in a cohort of older people in Santiago, Chile]

OBJECTIVE

To evaluate the association between life satisfaction and socioeconomic status and self-reported health in a cohort of older people in Santiago, Chile, in 2005 and 2006.

METHODS

We interviewed 2002 individuals aged 65 to 67.9 years registered in 20 primary care centers in the city of Santiago. Participants were living independently with no cognitive impairment, suspected cancer or terminal diseases. We assessed life satisfaction using an abbreviated adaptation of a life satisfaction scale (scored from 0 to 11), and collected self-reported information on income, education, social support, and self-reported health and memory. We used a log-binomial model to analyze the association between life satisfaction scores (fourth quartile compared with the first) and socioeconomic and health variables.

RESULTS

There was a significant association (bivariate and multivariate analyses) between life satisfaction and income in men and with social support, self-reported health, memory, and diagnosis of joint problems, diabetes and hypertension in both sexes.

CONCLUSION

Social support, income and health status were independently associated with life satisfaction in older people aged 65-67.9 years in Santiago. Further studies are required to assess the temporal direction of the effect and the implications of these findings for public health policies in this population.

Does cognitive impairment influence quality of life among nursing home residents?

PURPOSE

We investigated the relationship between cognitive status and quality of life (QOL) of Minnesota nursing home (NH) residents and the relationship between conventional or Alzheimer's special care unit (SCU) placement and QOL. The study may inform development of dementia-specific quality measures.

DESIGN AND METHODS

Data for analyses came from face-to-face interviews with a representative sample of 13,130 Minnesota NH residents collected through the 2007 Minnesota NH Resident Quality of Life and Consumer Satisfaction survey. We examined 7 QOL domains: comfort, meaningful activities, privacy, environment, individuality, autonomy, relationships, and a positive mood scale. We applied multilevel models (resident and facility) to examine the relationship between the resident's score on each QOL domain and the resident's cognitive impairment (CI) level and SCU placement after controlling for covariates, such as activities of daily living dependency, pain, depression or psychiatric diagnosis, and length of stay.

RESULTS

Residents with more severe CI reported higher QOL in the domains of comfort and environment and lower QOL in activities, individuality, privacy and meaningful relationships, and the mood scale. Residents on SCU reported higher QOL in the meaningful activities, comfort, environment, and autonomy domains but had lower mood scores.

IMPLICATIONS

Our findings point to QOL domains that show significant variation by CI and thus may be of greatest interest to consumers, providers, advocacy groups, and other stakeholders committed to improving dementia care. Findings are particularly applicable to the development of NH quality indicators that more accurately represent the QOL of NH residents with CI.

Culture change models and resident health outcomes in long-term care

PURPOSE

To examine the scientific evidence for the effect of comprehensive culture change model implementation on resident health outcomes in long-term care.

DESIGN

In this integrated review, an electronic literature search was conducted for studies that examined the effect of comprehensive culture change models on long-term care residents' physical and psychosocial health.

METHODS

Eleven articles were thoroughly reviewed for outcomes related to resident health, and findings were integrated across models. Each study was assigned a level of evidence rating using the Scottish Intercollegiate Guidelines Network guidelines and an overall recommendation grade was determined.

FINDINGS

Evaluation of the literature indicates that results are conflicting, although potential resident benefits as a result of model implementation may exist, particularly in regard to psychosocial health outcomes.

CONCLUSIONS

Evidence regarding long-term care residents' health outcomes after comprehensive culture change model implementation is inconsistent, and the grade of the evidence makes practice recommendations difficult at this time. However, integrated findings across studies demonstrate potential psychosocial benefits to long-term care residents.

CLINICAL RELEVANCE

Nurses working in long-term care play a crucial role in the success of culture change initiatives as well as the health outcomes of residents. Empirical evidence for the effect of comprehensive culture change models on resident health outcomes supports reasonable expectations of their implementation and indicates areas for future research and translation into practice.

Adult day health center participation and health-related quality of life

PURPOSE

The purpose of this study was to assess the association between Adult Day Health Center (ADHC) participation and health-related quality of life.

DESIGN AND METHODS

Case-controlled prospective study utilizing the Medical Outcomes Survey Form 36 (SF-36) to compare newly enrolled participants from 16 ADHC programs with comparable community-dwelling older adults who did not attend an ADHC. Assessments were conducted at study enrollment, 6 and 12 months.

RESULTS

ADHC participants (n = 57) and comparison group subjects (n = 67) were similar at baseline in age, ethnic diversity, medical conditions, depression, cognition, immigration history, education, income, and marital status. Significantly more comparison group subjects lived alone (p = .002). One year after enrollment, the SF-36 domains role physical and role emotional improved significantly. Adjusted role physical scores for ADHC participants improved (23 vs. 36) but declined for the comparison group (38 vs. 26, time by group interaction p = .01), and role emotional scores improved for ADHC participants (62 vs.70) but declined for the comparison group (65 vs. 48, time by group interaction p = .02). Secondary analyses revealed that changes in daily physical functioning, depressed affect, or cognitive functioning did not explain the improvements found in role physical and role emotional scores for ADHC participants. No significant differences in trends for the 2 groups occurred for the SF-36 domains physical functioning, social functioning, and mental health.

IMPLICATIONS

ADHC participation may enhance older adults' quality of life. Quality of life may be a key measure to inform care planning, program improvement, and policy development of ADHC.