1
|
Keller H, Iraniparast M, Morrison-Koechl J, Lengyel C, Carrier N, Slaughter SE. Weight Loss and Weight Gain: Multi-Level Determinants Associated with Resident 3-Month Weight Change in Long-Term Care. J Nutr Gerontol Geriatr 2023; 42:15-29. [PMID: 36695567 DOI: 10.1080/21551197.2023.2169429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study examined factors associated with weight change in 535 residents in 32 long term care homes where 3-month weight records were available. Trained researchers and standardized measures (e.g., nutrition status, food intake, home characteristics) were used to collect data; weight change was defined as ±2.5%. Just over 25% of the sample lost and 21% gained weight. Weight stability was compared to loss or gain. Weight loss was associated with being male, malnourished (MNA-SF or BMI <25), energy and protein intake and oral nutritional supplement use, while weight gain was associated with being female, and a physically (e.g., less noise) and socially supportive dining room. Weight stability was associated with better cognition. A high proportion of residents had a significant weight change in 3 months. Modifiable factors associated with weight stability or gain suggest focusing interventions that promote food intake and improve the mealtime environment.
Collapse
Affiliation(s)
- Heather Keller
- Schlegel-UW Research Institute of Aging, Waterloo, Canada
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Maryam Iraniparast
- School of Public Health and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Jill Morrison-Koechl
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Christina Lengyel
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada
| | - Natalie Carrier
- School of Food, Nutrition and Family Studies, Université de Moncton, Moncton, Canada
| | | |
Collapse
|
2
|
Kuhnow J, Hoben M, Weeks LE, Barber B, Estabrooks CA. Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study. Can Geriatr J 2022; 25:328-335. [PMID: 36505912 PMCID: PMC9684024 DOI: 10.5770/cgj.25.623] [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] [Indexed: 12/05/2022] Open
Abstract
Background Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. Results A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.
Collapse
Affiliation(s)
- Jason Kuhnow
- Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Matthias Hoben
- School of Health Policy & Management, York University, Toronto, ON
| | - Lori E. Weeks
- School of Nursing, Dalhousie University, Halifax, NS
| | | | | |
Collapse
|
3
|
Jiang X, Wang Y, Wang Y, Zhou M, Huang P, Yang Y, Peng F, Wang H, Li X, Zhang L, Cai F. Application of an infrared thermography-based model to detect pressure injuries: a prospective cohort study. Br J Dermatol 2022; 187:571-579. [PMID: 35560229 DOI: 10.1111/bjd.21665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is challenging to detect pressure injuries at an early stage of their development. OBJECTIVES To assess the ability of an infrared thermography (IRT)-based model, constructed using a convolution neural network, to reliably detect pressure injuries. METHODS A prospective cohort study compared validity in patients with pressure injury (n = 58) and without pressure injury (n = 205) using different methods. Each patient was followed up for 10 days. RESULTS The optimal cut-off values of the IRT-based model were 0·53 for identifying tissue damage 1 day before visual detection of pressure injury and 0·88 for pressure injury detection on the day visual detection is possible. Kaplan-Meier curves and Cox proportional hazard regression model analysis showed that the risk of pressure injury increased 13-fold 1 day before visual detection with a cut-off value higher than 0·53 [hazard ratio (HR) 13·04, 95% confidence interval (CI) 6·32-26·91; P < 0·001]. The ability of the IRT-based model to detect pressure injuries [area under the receiver operating characteristic curve (AUC)lag 0 days , 0·98, 95% CI 0·95-1·00] was better than that of other methods. CONCLUSIONS The IRT-based model is a useful and reliable method for clinical dermatologists and nurses to detect pressure injuries. It can objectively and accurately detect pressure injuries 1 day before visual detection and is therefore able to guide prevention earlier than would otherwise be possible. What is already known about this topic? Detection of pressure injuries at an early stage is challenging. Infrared thermography can be used for the physiological and anatomical evaluation of subcutaneous tissue abnormalities. A convolutional neural network is increasingly used in medical imaging analysis. What does this study add? The optimal cut-off values of the IRT-based model were 0·53 for identifying tissue damage 1 day before visual detection of pressure injury and 0·88 for pressure injury detection on the day visual detection is possible. Infrared thermography-based models can be used by clinical dermatologists and nurses to detect pressure injuries at an early stage objectively and accurately.
Collapse
Affiliation(s)
- Xiaoqiong Jiang
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yu Wang
- Medical Engineering Office, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuxin Wang
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Min Zhou
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Pan Huang
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yufan Yang
- The Second Clinical College, Wenzhou Medical University, Wenzhou, China
| | - Fang Peng
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Haishuang Wang
- Cardiovascular Medicine Deparment, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Liping Zhang
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fuman Cai
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
4
|
Chung ML, Widdel M, Kirchhoff J, Sellin J, Jelali M, Geiser F, Mücke M, Conrad R. Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020761. [PMID: 35055583 PMCID: PMC8776011 DOI: 10.3390/ijerph19020761] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 01/27/2023]
Abstract
Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals' evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.
Collapse
Affiliation(s)
- Man-Long Chung
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
- Correspondence:
| | - Manuel Widdel
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Julian Kirchhoff
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Julia Sellin
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (M.M.)
| | - Mohieddine Jelali
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
| | - Martin Mücke
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (M.M.)
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
| |
Collapse
|
5
|
Neziraj M, Andersson M, Hellman P, Axelsson M, Kumlien C. Prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes: A focus group study with nurse aides, registered nurses and managers. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
6
|
Predictors of incident malnutrition-a nutritionDay analysis in 11,923 nursing home residents. Eur J Clin Nutr 2021; 76:382-388. [PMID: 34239065 PMCID: PMC8907076 DOI: 10.1038/s41430-021-00964-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/30/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022]
Abstract
Background/Objectives Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) < 20 at FU) was analyzed in univariate generalized estimated equation (GEE) models. Significant (p < 0.1) variables were selected for multivariate GEE-analyses. Effect estimates are presented as odds ratios and their respective 99.5%-confidence intervals. Results Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.
Collapse
|
7
|
Gusdal AK, Johansson-Pajala RM, Arkkukangas M, Ekholm A, Zander V. Preventing Falls and Malnutrition among Older Adults in Municipal Residential Care in Sweden: A Registry Study. SAGE Open Nurs 2021; 7:23779608211026161. [PMID: 34286078 PMCID: PMC8267024 DOI: 10.1177/23779608211026161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/28/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Older adults in municipal residential care are among the most vulnerable and in need of most care. The prevalence of negative events, such as falls and malnutrition, is increased among these older adults. The need for strategies to prevent falls and malnutrition is emphasized in guidelines and systematic, individualized risk assessments are prerequisites for adequate interventions. Objectives The overall purpose of this study was to investigate the assessed risks of, and risk factors for, falling and malnutrition and the correlations between these assessed risks among older women and men in residential care. Further, the purpose was to investigate the consistency between planned and performed interventions among women and men assessed as at risk. Methods A cross-sectional registry study based on risk assessment data in the Swedish national quality registry, Senior Alert. Altogether, 5,919 older adults ≥65 in nursing homes and dementia care units in 19 municipalities in Sweden were included. Results Of the older adults, 77% were at risk of falls, and 59% were at risk of malnutrition. The most prevalent risk factors for falls were previous falls and not being cognitively oriented; and for malnutrition were having mild or severe dementia or depression. A significant positive correlation between the risk of falling and the risk of malnutrition was found. Less than half of the planned interventions for falls and malnutrition were performed. Care staff’s least common interventions to prevent falls were balance, muscular function, and strength training, which contrasts with the recommendations; interventions to prevent malnutrition were only partially adhering to recommendations. Conclusions This cross-sectional registry study points towards the importance of using an evidence-based approach, based on adherence to recommended guidelines, in the prevention of falling and malnutrition. Further, the implementation of clinical practice guidelines is needed, which requires educational training for care staff and supportive leadership.
Collapse
Affiliation(s)
- Annelie K Gusdal
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | | | | | - Anna Ekholm
- Research and Development in Sörmland, Eskilstuna, Sweden
| | - Viktoria Zander
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| |
Collapse
|
8
|
Charles A, Buckinx F, Locquet M, Reginster JY, Petermans J, Gruslin B, Bruyère O. Prediction of Adverse Outcomes in Nursing Home Residents According to Intrinsic Capacity Proposed by the World Health Organization. J Gerontol A Biol Sci Med Sci 2021; 75:1594-1599. [PMID: 31562812 DOI: 10.1093/gerona/glz218] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the predictive value of the domains of intrinsic capacity (ie, cognition, locomotion, sensory, vitality, and psychosocial) proposed by the World Health Organization (WHO) on the 3-year adverse health outcomes of nursing home residents. METHODS A 3-year incidence of mortality, falls, repeated falls, and autonomy decline (ie, a one-unit increase in the Katz score) was assessed in a cohort of Belgian nursing home residents. Cognition was assessed using the Mini-Mental State Examination (MMSE). For locomotion, balance, gait speed and chair stand performance were evaluated by the Short Physical Performance Battery test. The sensory domain was measured using the Strawbridge questionnaire for audition and vision. For vitality, abdominal circumference, body mass index, nutritional status (by Mini Nutritional Assessment [MNA]) and handgrip strength were assessed. Psychosocial status was evaluated by the EQ-5D and the Center for Epidemiological Studies Depression scale. Missing data were handled by multiple imputations. Cox proportional hazard models, logistic regressions, and analysis of variance were used for the analyses. RESULTS In the multivariable model, a one-unit increase in balance performance and in the nutrition score decreased the probability of death by 12% (Hazard ratio [HR] = 0.88; 95% confidence interval [CI] 0.78-0.99) and 4% (HR = 0.96; 95% CI 0.93-0.99), respectively. The risk of falling decreased when there was a one-unit increase in balance performance (HR = 0.87, 95% CI 0.79-0.96) and in the nutrition score (HR = 0.96, 95% CI 0.93-0.98). No association was found for intrinsic capacity and repeated falls. Low scores in nutrition (odds ratio = 0.86, 95% CI 0.77-0.96) were associated with a higher probability of autonomy decline. CONCLUSION Some domains of intrinsic capacity predicted health outcomes among nursing home residents. Nutrition and balance should be regularly checked among this population.
Collapse
Affiliation(s)
- Alexia Charles
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium
| | - Fanny Buckinx
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium
| | - Médéa Locquet
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium.,Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | | | - Bastien Gruslin
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium.,Department of Sport and Rehabilitation Sciences, University of Liège, Belgium
| |
Collapse
|
9
|
Baixinho CL, Dixe MDA. Practices of caregivers when evaluating the risk of falls in the admission of older adults to nursing homes. Dement Neuropsychol 2020; 14:379-386. [PMID: 33354291 PMCID: PMC7735058 DOI: 10.1590/1980-57642020dn14-040008] [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] [Indexed: 12/02/2022] Open
Abstract
Falls are a complex problem for the older population residing in nursing homes. Despite recommendations, many difficulties remain in the evaluation of and systematic information on fall risk factors.
Collapse
Affiliation(s)
- Cristina Lavareda Baixinho
- Nursing School of Lisbon, Nursing Research & Development Unit - Lisbon, Portugal.,Center for Innovative Care and Health Technology (ciTechcare) - Leiria, Portugal
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology (ciTechcare) - Leiria, Portugal.,Health School, Polytechnic of Leiria - Leiria, Portugal
| |
Collapse
|
10
|
Ernsth Bravell M. Higher prevalence of pressure ulcers in people receiving palliative care is not necessarily an indicator of poor care. Evid Based Nurs 2020; 23:110. [PMID: 31666287 DOI: 10.1136/ebnurs-2019-103156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
|
11
|
Skin temperature and vascular attributes as early warning signs of pressure injury. J Tissue Viability 2020; 29:258-263. [PMID: 32878738 DOI: 10.1016/j.jtv.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aimed to validate the skin temperature on sacral region and vascular attributes as early warning signs of pressure injury. METHODS Totally 415 patients admitted to the adult intensive care unit from August 2018 to April 2019 were prospectively screened. Daily blood pressure and blood glucose affecting vascular attributes and the relative skin temperature of sacral region were measured for 10 consecutive days. Collect the changes of these indicators during the occurrence of pressure injury. The optimal cut-off values of indicators were determined by X-tile analysis. The risk ratios of indicators associated with pressure injury were compared using the Cox proportional hazards regression model. RESULTS There were no obvious interactions among blood pressure, blood glucose and relative skin temperature (P > 0.05). The optimal cutoff value for above indicators was 63.5 mmHg, 9.9 mmol/L and -0.1 °C, respectively. The incidence of pressure injury peaked on the 4th and 5th day after hospitalization when categorizing the patients into low- and high-risk groups according to the cutoff values (P < 0.05). Based on relative skin temperature, patients in the high-risk group were more likely to develop pressure injury (hazard ratio = 6.36, 95% confidence interval = 3.91, 10.36), when compared to the other two indicators of blood pressure and blood glucose. CONCLUSION Stringent skin temperature and vascular attributes measurements were necessary for preventing pressure injury. Nursing measures should be taken according to warning sings to reduce the incidence of pressure injury.
Collapse
|
12
|
Adamuz J, Juvé-Udina ME, González-Samartino M, Jiménez-Martínez E, Tapia-Pérez M, López-Jiménez MM, Romero-Garcia M, Delgado-Hito P. Care complexity individual factors associated with adverse events and in-hospital mortality. PLoS One 2020; 15:e0236370. [PMID: 32702709 PMCID: PMC7377913 DOI: 10.1371/journal.pone.0236370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/02/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients’ electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular fragility, extreme weight, uncontrolled pain, male sex, length of stay and admission to a medical ward. High-tech hospital admission was associated with an increased risk of adverse events and a reduced risk of in-hospital mortality. The area under the ROC curve for both outcomes was > 0.75 (95% IC: 0.78–0.83). Conclusions Several care complexity individual factors were associated with adverse events and in-hospital mortality. Prior identification of complexity factors may have an important effect on the early detection of acute deterioration and on the prevention of poor outcomes.
Collapse
Affiliation(s)
- Jordi Adamuz
- Nursing knowledge management and information systems department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Maria-Eulàlia Juvé-Udina
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
| | - Maribel González-Samartino
- Nursing knowledge management and information systems department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Jiménez-Martínez
- Infectious Disease Department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Tapia-Pérez
- Nursing knowledge management and information systems department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - María-Magdalena López-Jiménez
- Nursing knowledge management and information systems department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Romero-Garcia
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Delgado-Hito
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
13
|
Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
|
14
|
Wang S, Varas-Diaz G, Dusane S, Wang Y, Bhatt T. Slip-induced fall-risk assessment based on regular gait pattern in older adults. J Biomech 2019; 96:109334. [PMID: 31564458 PMCID: PMC8191506 DOI: 10.1016/j.jbiomech.2019.109334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 12/26/2022]
Abstract
Aging-associated fall-risk assessment is crucial for fall prevention. Thus, this study aimed to develop a prognostic model to predict fall-risk following an unexpected over-ground slip perturbation based on normal gait pattern in healthy older adults. 112 healthy older adults who experienced a novel slip in a safe laboratory environment were included. Their slip trial and natural walking trial immediately prior to it were analyzed. To identify the best fall-risk predictive model, gait related variables including step length, segment angles, center of mass state, and ground reaction force (GRF) were determined and inputted into a stepwise logistic regression. The optimal slip-induced fall prediction model was based on the right thigh angle at slipping foot touchdown (TD), the maximum GRF of the slipping limb after TD, and the momentum change from TD to recovery foot liftoff (LO), with an overall prediction accuracy of 75.9%, predicting 74.5% of falls (sensitivity) and 77.2% of recoveries (specificity). Conversely, a model based on clinical and demographic measures predicted 78.2% of falls and 47.4% of recoveries, resulting in a much lower overall accuracy of 62.5%. The fall-risk model based on normal gait pattern which was developed for slip-induced perturbations in healthy older adults was able to provide a high predictive accuracy. This information could provide insight about the ideal normal gait measures which could be used to contribute towards development of therapeutic strategies related to dynamic balance and fall prevention to enhance preventive interventions in populations with high-risk for slip-induced falls.
Collapse
Affiliation(s)
- Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Gonzalo Varas-Diaz
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Shamali Dusane
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Yiru Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, United States.
| |
Collapse
|
15
|
Aging, Mastication, and Malnutrition and Their Associations with Cognitive Disorder: Evidence from Epidemiological Data. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40496-019-0220-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Zimmermann J, Swora M, Pfaff H, Zank S. Organizational factors of fall injuries among residents within German nursing homes: secondary analyses of cross-sectional data. Eur J Ageing 2019; 16:503-512. [PMID: 31798374 DOI: 10.1007/s10433-019-00511-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The present study explored risk factors for fall injuries among nursing home residents, with a specific focus on the influence of organizational structure within facilities and their environment, which have been insufficiently investigated in the European context. For the analyses, secondary data collected in 2016 from 220 nursing homes across Germany were used. As a risk adjustment, two separate models were calculated for fall injuries among residents without (N = 7320) and with cognitive impairment (N = 8633). Results showed that residents without cognitive impairment had a decreased risk of fall injuries by 40.1% (P < 0.01), while those with cognitive impairment were at an increased risk of 23.8% (P < 0.05) when living in facilities that had dementia care units. However, disparities were found between federal states for both groups of residents (P < 0.05 vs. P < 0.01, respectively). Similarly, a higher proportion of registered nurses were associated with decreased risk of fall injuries among cognitively impaired residents (45.6%), which differed between federal states (P < 0.01). Facilities with homelike environments had a 16.7% (P < 0.05) lower risk of fall injuries among cognitively impaired residents than did traditionally organized facilities. Further research is needed to explain the disparities between German federal states using representative samples.
Collapse
Affiliation(s)
- Jaroslava Zimmermann
- 1Graduate School GROW - Gerontological Research on Well-Being, University of Cologne, Cologne, Germany
| | - Michael Swora
- 2Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences & Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- 2Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences & Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Susanne Zank
- 3Rehabilitative Gerontology, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| |
Collapse
|
17
|
Trinks A, Hägglin C, Nordvall D, Rothenberg E, Wijk H. The impact of a national quality register in the analysis of risks and adverse events among older adults in nursing homes and hospital wards—a Swedish Senior Alert survey. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s40886-018-0077-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
18
|
Cameron EJ, Bowles SK, Marshall EG, Andrew MK. Falls and long-term care: a report from the care by design observational cohort study. BMC FAMILY PRACTICE 2018; 19:73. [PMID: 29793427 PMCID: PMC5968500 DOI: 10.1186/s12875-018-0741-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/18/2018] [Indexed: 11/24/2022]
Abstract
Background Falls and the resulting complications are common among frail older adults. We aimed to explore risk factors and potential prevention strategies for falls in elderly residents of Long-Term Care Facilities (LTCF). Methods This was a cross sectional study design using data from the Care by Design (CBD) study, within Nova Scotia’s Capital District Health Authority. This observational time series cohort study collected data before, during and after the implementation of CBD, a new model of coordinated primary care in LTCF. Here, we analyzed data collected after the implementation of CBD (September 1, 2011- February 28, 2012). Results Falls were frequent; 56.2% of our sample of 395 residents fell at least once. In univariate analyses, male gender (p = 0.009), dementia (p = 0.005), and use of Selective Serotonin Reuptake Inhibitors or Selective Serotonin-Norepinepherine Reuptake Inhibitors (SSRI/SNRI) (p = 0.084) showed statistically significant associations with having fallen. Benzodiazepine use appeared to be protective for falls (p = 0.058). In a fully adjusted multivariable linear regression model, dementia (β coefficient 0.96, 95% CI: 0.83,1.84; p = 0.032), visual impairment (β 0.84, 95% CI: 0.13,1.56; p = 0.021), and use of any PIMs (β 0.34, 95% CI: 0.037,0.65; p = 0.028) were associated with increased risk of having fallen. Benzodiazepine use remained associated with reduced numbers of falls (p = 0.009), and SSRI/SNRI use was associated with increased numbers of falls (p = 0.007). Male gender was associated with increased falls in the model which excluded frailty (p = 0.022), though gender lost statistical significance once frailty was added to the model (p = 0.06). Conclusions In our sample of LTCF residents, falls were common. Cognitive impairment, male gender, visual impairment, PIM use and use of SSRI/SNRI medications were associated with increased risk of falls, while benzodiazepine use appeared to be associated with a decreased risk of having fallen. Falls remain an important problem among LTC residents. Screening for falls during patient encounters is recommended, along with further research to identify risk factors and target interventions. Electronic supplementary material The online version of this article (10.1186/s12875-018-0741-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Emily J Cameron
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Susan K Bowles
- Department of Pharmacy, Nova Scotia Health Authority-Central Zone, Halifax, NS, Canada.,Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
| | | | - Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada.
| |
Collapse
|
19
|
Schoberer D, Eglseer D, Halfens RJG, Lohrmann C. Development and evaluation of brochures for fall prevention education created to empower nursing home residents and family members. Int J Older People Nurs 2018; 13:e12187. [PMID: 29369510 DOI: 10.1111/opn.12187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/22/2017] [Indexed: 01/08/2023]
Abstract
AIMS AND OBJECTIVES In this study, we describe the development of evidence- and theory-based fall prevention educational material and its evaluation from the users' perspectives. BACKGROUND To reduce risk factors for falling in nursing homes, nursing staff must enact multifactorial fall prevention intervention programmes. A core component of these programmes is to educate residents and their family members, both verbally and in a written form. However, users can only benefit from educational material if it is based on current scientific evidence, easy to understand and process and customised. DESIGN We followed a structured procedure during the development process, while considering various aspect of quality. To assess the understandability and usefulness of the resulting educational materials, we conducted a qualitative content analysis study. METHODS The educational materials development process incorporated several iterative steps including a systematic literature search and the application of frameworks for designing and writing the materials. To evaluate the material, we performed six focus group discussions separately with residents, family members and nursing staff from two nursing homes (total of 32 participants). RESULTS Residents' brochures included clear information on avoiding external risks as well as coping strategies after a fall event. Family members' brochures were more comprehensive, including both concrete tips and outlining the advantages and disadvantages of interventions. Residents and family members had no difficulties understanding the material and tried to apply the content to their individual situations. Nursing staff commented on some ambiguities and incongruities relating to current nursing care practice. CONCLUSIONS By involving users in the development of evidence-based educational materials, nursing staff can achieve a high acceptance rate for the materials and motivate users to address the topic. IMPLICATIONS FOR PRACTICE The involvement of users is essential for developing educational material that meets users' needs. Educational material should be used as part of an overall strategy to educate residents and family members in nursing homes.
Collapse
Affiliation(s)
- Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Ruud J G Halfens
- Department of Health Services Research, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| |
Collapse
|
20
|
Liang M, Chen Q, Zhang Y, He L, Wang J, Cai Y, Li L. Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies. Oncotarget 2017; 8:14516-14524. [PMID: 28036285 PMCID: PMC5362422 DOI: 10.18632/oncotarget.14312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 01/21/2023] Open
Abstract
Diabetes is a major cause of morbidity for patients undergoing surgery and can increase the incidence of some postoperative complications such as bedsores. We conducted a meta-analysis of observational studies to examine whether patients with diabetes undergoing surgery had high risk of bedsore. We performed a systematic literature search in Pubmed, Embase and the Cochrane Library Central Register of Controlled Trials database from inception to November 2016. Studies were selected if they reported estimates of the relative risk (RR) for bedsore risk in postoperative diabetic patients compared with that of in non-diabetic patients. Random-effects meta-analysis was conducted to pool the estimates. A total of 16 studies with 24,112 individuals were included in our meta-analysis. The pooled RR of bedsore development for patients with diatetes was 1.77 (95% CI 1.45 to 2.16). The results of subgroup analyses were consistent when stratified by surgery type, study design, research region, sample size, inclusion period, analysis method and study quality. There was evidence of publication bias among studies and a sensitivity analysis using the Duval and Tweedie “trim-and-fill” method did not significantly alter the pooled results (adjusted RR 1.17, 95% CI 1.02 to 1.36).This meta-analysis provides indications that diabetic patients undergoing surgery could have a higher risk of developing bedsores. Further large-scale prospective trials should be implemented to comfirm the association.
Collapse
Affiliation(s)
- Mining Liang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Qiongni Chen
- Department of Nursing, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, China
| | - Yang Zhang
- Nursing Teaching and Research Institute, Medical College of Guangxi University of Science and Technology, Liuzhou, Guangxi Province, China
| | - Li He
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jianjian Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yiwen Cai
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lezhi Li
- Department of Nursing, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, China
| |
Collapse
|
21
|
Simmons SF, Schnelle JF, Sathe NA, Slagle JM, Stevenson DG, Carlo ME, McPheeters ML. Defining Safety in the Nursing Home Setting: Implications for Future Research. J Am Med Dir Assoc 2016; 17:473-81. [DOI: 10.1016/j.jamda.2016.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022]
|