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Holmes SD, Qato DM, Briesacher B, Zarowitz B, Brandt N, McArdle PF, Fleming S, Johnson A, Koethe B, Desai A, Lucas JA, Wastila L. Nursing Home Characteristics Associated with Antipsychotic Prescribing After Implementation of the National Antipsychotic Reduction Initiative (ARI). Clin Gerontol 2024; 47:778-788. [PMID: 38762776 PMCID: PMC11479835 DOI: 10.1080/07317115.2024.2346906] [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] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To describe nursing home (NH) characteristics associated with antipsychotic use and test whether associations changed after implementation of the National Partnership to Improve Dementia Care's antipsychotic reduction initiative (ARI). METHODS Longitudinal quasi-experimental design using data from multiple sources and piecewise linear mixed models were used for statistical analyses. RESULTS There was a significant decrease in monthly antipsychotic use across the study period (pre-ARI b = -0.0003, p <.001; post-ARI b = -0.0012, p <.001), which held after adjusting for NH characteristics. Registered nurse hours (b = -0.0026, p <.001), licensed practical nurse hours (b = -0.0019, p <.001), facility chain membership (b = -0.0013, p <.01), and health inspection ratings (b = -0.0003, p >.01) were associated with decreased antipsychotic use. Post-ARI changes in associations between NH characteristics and antipsychotic use were small and not statistically significant. CONCLUSIONS Decreases in antipsychotic use were associated with most NH characteristics, and associations persisted post-ARI. Further research is warranted to examine the interactions between ARI policy and NH characteristics on antipsychotic prescribing, as well as other NH factors, such as facility prescribing cultures and clinical specialty of staff. CLINICAL IMPLICATIONS Decreases in monthly antipsychotic use were observed following the ARI. The decreases in monthly antipsychotic use were associated with most NH characteristics, and these associations persisted during the post-ARI period.
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Affiliation(s)
- Sarah D. Holmes
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Danya M. Qato
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Practice, Science, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Becky Briesacher
- School of Pharmacy and Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Barbara Zarowitz
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Nicole Brandt
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Patrick F. McArdle
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sean Fleming
- Department of Practice, Science, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Abree Johnson
- Department of Practice, Science, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Benjamin Koethe
- School of Pharmacy and Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | | | - Linda Wastila
- Department of Practice, Science, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
- School of Pharmacy and Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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Harris DA, Maclagan LC, Pequeno P, Iaboni A, Austin PC, Rosella LC, Guan J, Maxwell CJ, Bronskill SE. Antipsychotic Discontinuation and New Trazodone Use in Ontario Nursing Homes: Evidence of Medication Substitution. J Am Med Dir Assoc 2024; 25:105113. [PMID: 38944053 DOI: 10.1016/j.jamda.2024.105113] [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: 04/09/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES An unintended consequence of efforts to reduce antipsychotic medications in nursing homes is the increase in use of other psychotropic medications; however, evidence of substitution remains limited. Our objective was to measure individual-level prescribing patterns consistent with substitution of trazodone for antipsychotics. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Residents of Ontario nursing homes aged 66-105 years with an admission assessment between April 1, 2010, and March 31, 2019, who were receiving an antipsychotic and had no antidepressant medication use at admission to the nursing home. METHODS We used linked health administrative data to examine changes in medication use over three quarterly assessments following admission. Antipsychotic and trazodone use were measured at each assessment. The rate of trazodone initiation was compared between residents no longer dispensed an antipsychotic (discontinued) and those with an ongoing antipsychotic (continued) using discrete time survival analysis, controlling for baseline resident characteristics. RESULTS We identified 13,306 residents dispensed an antipsychotic with no antidepressant use at admission (mean age 84 years, 61.5% women, 82.8% with dementia). As of the first quarterly assessment, nearly 20% of residents no longer received an antipsychotic and 9% received a new trazodone medication. Over time, residents who discontinued antipsychotics had a rate of trazodone initiation that was 82% higher compared to residents who continued (adjusted hazard ratio 1.82, 95% CI 1.66-2.00). CONCLUSIONS AND IMPLICATIONS Residents admitted to a nursing home with antipsychotic use had a higher rate of trazodone initiation if they discontinued (vs continued) an antipsychotic. These findings suggest antipsychotic substitution with trazodone after entering a nursing home.
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Affiliation(s)
- Daniel A Harris
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | | | - Andrea Iaboni
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura C Rosella
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Vector Institute, Toronto, Ontario, Canada
| | | | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada; Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan E Bronskill
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Xiong J, Bhimani R, McMahon S, Chi CL, Anderson L. How Do Nurses Assess Cognition in Adults With Neurological Conditions? A Scoping Review. Rehabil Nurs 2024; 49:169-182. [PMID: 39099023 DOI: 10.1097/rnj.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND According to epidemiological studies, neurological cognitive problems are increasingly prevalent in the aging population, with estimates that the number of people living with cognitive impairment will triple by 2050. Therefore, early detection in rehabilitation settings is needed to manage cognitive changes to ensure that individuals living with these conditions receive care and support that addresses their needs. PURPOSE This scoping review, based on the Arksey and O'Malley method, aims to investigate the cognitive assessments used for patients with neurological conditions in current nursing practice. METHOD PubMed, Ovid Medline, and CINAHL databases were searched to identify relevant articles published from 2017 to 2023 in English. Twenty-four articles met the inclusion criteria. Cognitive assessments were evaluated across acute care/hospital, outpatient/clinic, community, and long-term care/nursing home settings. RESULTS The Mini-Mental State Examination is the most frequently used tool across all settings except for long-term care. Cognition includes many different domains such as executive functioning and speed of processing information; however, most tools only capture memory. The nursing profession must expand its standardized nursing vocabulary to capture cognition better. CONCLUSIONS As rehabilitation nurses navigate diverse clinical environments, recognition of contextual nuances is important in selecting cognitive function measurement tools most suitable for their setting.
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Affiliation(s)
- Jiayue Xiong
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Rozina Bhimani
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Siobhan McMahon
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Chih-Lin Chi
- Institute for Health Informatics, University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Lisa Anderson
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
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Zhang T, McCreedy E, Dionne L, Conard R, Mor V. Agreement of Antipsychotic Use between Nursing Home Electronic Records and Minimum Data Set. J Am Med Dir Assoc 2024; 25:606-609.e1. [PMID: 37573885 PMCID: PMC10858287 DOI: 10.1016/j.jamda.2023.07.005] [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: 09/28/2022] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Nursing home (NH) Minimum Data Set (MDS) have frequently been used to measure medication use in epidemiologic studies, but there is little evidence on the accuracy of MDS-based medication records. We compared antipsychotic use estimated using 2 data sources-MDS and NH electronic medication administration records (eMAR). DESIGN Cross-sectional comparison. SETTING AND PARTICIPANTS This analysis was based on MDS and linked eMAR data of 604 NH residents with dementia at 54 NHs in 10 states, participating in a cluster-randomized pragmatic trial (METRIcAL), from June 2019 to February 2020. METHODS One admission, quarterly, or annual MDS assessment was chosen for each participant. The MDS assessment recorded the number of antipsychotic treatment days during a 7-day window. We then identified antipsychotic administrations during the corresponding window in the eMAR. We used Cohen kappa to assess agreement in the proportion of participants on antipsychotics during the week and used intraclass correlation coefficient (ICC) to assess the agreement of treatment days. We further used the eMAR data as a reference to calculate validity parameters. RESULTS A total of 29.5% of study participants were identified as antipsychotic users based on the MDS vs 28.3% based on the eMAR data (kappa value: 0.96). MDS-based average treatment duration was estimated to be 2.0, consistent with eMAR-based estimate (1.8 days, ICC: 0.96). The sensitivity was 98.8% (95% CI 95.8%-99.9%), the specificity was 97.9% (95% CI 96.1%-99.1%), the positive predictive value was 94.9% (95% CI 90.8%-97.3%), and the negative predictive value was 99.5% (95% CI 98.2%-99.9%). CONCLUSIONS AND IMPLICATIONS Agreement between the MDS and eMAR in antipsychotic use is high, suggesting that the MDS is a valid tool to measure antipsychotic use in epidemiologic studies. Further studies with large and diverse populations are warranted to confirm our findings.
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Affiliation(s)
- Tingting Zhang
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA.
| | - Ellen McCreedy
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Laura Dionne
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | | | - Vincent Mor
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA; Providence Veterans Administration Medical Center, Providence, RI, USA
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Yoon JM, Trinkoff AM, Kim M, Kim E. State-level nursing home in-service dementia training requirements and inappropriate psychotropic medication use. Geriatr Nurs 2023; 51:209-214. [PMID: 37011493 DOI: 10.1016/j.gerinurse.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Although non-pharmacological interventions, which are staff intensive, are recommended for behavioral symptoms of dementia, psychotropics are often prescribed in nursing homes (NHs), with insufficient nurse staffing levels and dementia care training. Since 2017, deficiency citations can be assigned for inappropriate psychotropics use (F-758 tag). Some states require in-service dementia training above federal minimums, but it is unknown whether extra dementia training requirements were related to fewer F-758 citations for residents with dementia and whether nurse staffing influenced the relationship between receiving F-758 citations and having additional state-level dementia training requirements. PURPOSE To relate F-758 citation occurrence to extra in-service dementia training regulations and to explore how the relationships are affected by nurse staffing levels. METHOD Generalized linear mixed models were used to examine F-758 citation occurrence in relation to state-level in-service dementia training regulations. Stratification was also conducted to compare the effects in NHs with low versus high nurse staffing. FINDINGS Requiring in-service dementia training with extra hours was inversely related to receiving F-758 tags. That relationship was also noted in NHs with lower registered nurse and certified nurse assistant staffing. DISCUSSION In-service dementia training may be helpful in reducing inappropriate psychotropics use, particularly in facilities with lower nurse staffing.
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Affiliation(s)
- Jung Min Yoon
- Ewha Womans University, College of Nursing, Seoul, South Korea.
| | | | - Miyoung Kim
- Ewha Womans University, College of Nursing, Seoul, South Korea.
| | - Eunjin Kim
- Ewha Womans University, College of Nursing, Seoul, South Korea.
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Trenaman SC, von Maltzahn M, Sketris I, Tamim H, Wang Y, Stewart SA. Patterns of Antipsychotic Dispensation to Long-Term Care Residents. J Am Med Dir Assoc 2023; 24:185-191.e6. [PMID: 36309099 DOI: 10.1016/j.jamda.2022.09.009] [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: 06/25/2022] [Revised: 08/29/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe dispensing patterns of antipsychotic medications to long-term care (LTC) residents and assess factors associated with continuation of an antipsychotic after a fall-related hospitalization. DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Nova Scotia Seniors Pharmacare Program (NSSPP) beneficiaries age 66 years and older who resided in LTC and received at least 1 dispensation of an antipsychotic within the study period of April 1, 2009, to March 31, 2017. METHODS Linkage of administrative claims data from the NSSPP and the Canadian Institute of Health Information Discharge Abstract Database identified LTC residents with an antipsychotic dispensation and from the subgroup of those dispensed antipsychotic medications who experienced a fall-related hospitalization. Antipsychotic dispensing patterns were reported with counts and means. Predictors of continuation of an antipsychotic after a fall-related hospitalization (sex, length of stay, days supplied, age, year of admission, rural/urban) were reported and analyzed with multiple logistic regression. RESULTS There were 19,164 unique NSSPP beneficiaries who were dispensed at least 1 prescription for an antipsychotic medication. Of those who received at least 1 antipsychotic dispensation 90% (n = 17,201) resided in LTC. A mean of 40% (n = 2637) of LTC residents received at least 1 antipsychotic dispensation in each year. Risperidone and quetiapine were dispensed most frequently. Of the 544 beneficiaries residing in LTC who survived a fall-related hospitalization, 439 (80.7%) continued an antipsychotic after hospital discharge. Female sex [OR 1.7, 95% CI (1.013‒2.943)], age 66‒69 [OR 4.587, 95% CI (1.4‒20.8)], 75-79 [OR 2.8, 95% CI (1.3‒6.3)], and 80‒84 years [OR 3.1, 95% CI (1.6‒6.4)] (compared with age 90+ years) were associated with increased risk of antipsychotic continuation. CONCLUSIONS AND IMPLICATIONS With 90% of antipsychotic dispensations in Nova Scotia being to LTC residents and 40% of LTC residents being dispensed antipsychotics in any year there is a need to address this level of antipsychotic dispensation to older adults.
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Affiliation(s)
| | - Maia von Maltzahn
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia.
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, Toronto, Ontario
| | - Yan Wang
- Health Data Nova Scotia, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia
| | - Samuel A Stewart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia
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Elefante C, Brancati GE, Torrigiani S, Amadori S, Ricciardulli S, Pistolesi G, Lattanzi L, Perugi G. Bipolar Disorder and Manic-Like Symptoms in Alzheimer's, Vascular and Frontotemporal Dementia: A Systematic Review. Curr Neuropharmacol 2023; 21:2516-2542. [PMID: 35794767 PMCID: PMC10616925 DOI: 10.2174/1570159x20666220706110157] [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: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different subtypes of dementia have not been thoroughly investigated. OBJECTIVES The main aim of this study is to systematically review clinical and therapeutic evidence about manic syndromes in patients with Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). Since manic-mixed episodes have been associated to negative outcomes in patients with dementia and often require medical intervention, we also critically summarized selected studies with relevance for the treatment of mania in patients with cognitive decline. METHODS A systematic review of the literature was conducted according to PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched up to February 2022. Sixty-one articles on patients with AD, VaD, or FTD and BD or (hypo) mania have been included. RESULTS Manic symptoms seem to be associated to disease progression in AD, have a greatly variable temporal relationship with cognitive decline in VaD, and frequently coincide with or precede cognitive impairment in FTD. Overall, mood stabilizers, and electroconvulsive therapy may be the most effective treatments, while the benefits of short-term treatment with antipsychotic agents must be balanced with the associated risks. Importantly, low-dose lithium salts may exert neuroprotective activity in patients with AD. CONCLUSION Prevalence, course, and characteristics of manic syndromes in patients with dementia may be differentially affected by the nature of the underlying neurodegenerative conditions.
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Affiliation(s)
- Camilla Elefante
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Samuele Torrigiani
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Salvatore Amadori
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Sara Ricciardulli
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Gabriele Pistolesi
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Lorenzo Lattanzi
- Psychiatry Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, Pisa, Italy
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Yoon JM, Trinkoff AM, Galik E, Storr CL, Lerner NB, Brandt N, Zhu S. Nurse staffing and deficiency of care for inappropriate psychotropic medication use in nursing home residents with dementia. J Nurs Scholarsh 2022; 54:728-737. [PMID: 35388951 DOI: 10.1111/jnu.12776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Psychotropic medications are used to manage behavioral symptoms of dementia in nursing homes despite limited efficacy and the risk of adverse effects, and may be considered an easier solution for the treatment of behavioral symptoms. However, non-pharmacologic interventions are preferable but are most effective with consistent staffing. To address this, the Centers for Medicare and Medicaid Services implemented additional regulatory scrutiny through F-tag for deficiencies of care, targeting inappropriate psychotropic medication use (F-758 tag). The purpose of this study was to examine associations between nurse staffing levels and the occurrence of deficiency citations for inappropriate psychotropic medication use in residents with dementia symptoms. DESIGN This was secondary data analysis of a cross-sectional study using CASPER (Certification and Survey Provider Enhanced Reporting) and PBJ (Payroll-Based Journal) data from 14,548 Medicare or Medicaid-certified facilities surveyed between December 1, 2017 and December 31, 2018. METHODS Staffing measures included nursing hours per resident day and registered nurse skill-mix. Generalized linear mixed models with facilities nested within states, were used to estimate the magnitude of the associations between the occurrence of inappropriate psychotropics use deficiency citations and nurse staffing levels. Covariates included facility location, size, ownership, the presence of dementia special care units, and the proportion of residents with dementia, depression, psychiatric disorders, mental behavioral symptoms, and residents with Medicare/Medicaid. RESULTS There were 1875 facilities with deficiency citations regarding inappropriate psychotropics use for residents with dementia. When controlling for covariates, facilities with greater hours per resident day for registered nurses (odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.44-0.67), certified nursing assistants (OR = 0.87, 95% CI = 0.77-0.99) and total nurse staff (OR = 0.87, 95% CI = 0.79-0.96) had significantly lower odds of inappropriate psychotropics use deficiency citations. Nursing homes with greater registered nurse skill-mix had significantly lower odds of receiving the deficiency tags (OR = 0.10, 95% CI = 0.04-0.26). CONCLUSION Citations for inappropriate psychotropic medication use among residents with dementia were less likely to occur in facilities with higher staffing levels for registered nurses, certified nursing assistants, total nurse staff, and greater registered nurse skill-mix. Facilities need to be equipped with adequate nurse staffing levels to facilitate the use of non-pharmacological interventions and reduce inappropriate psychotropic medication use. CLINICAL RELEVANCE Adequate nursing staffing is associated with fewer deficiencies related to the use of psychotropic medications to treat behavioral symptoms. Nursing home administrators and policymakers need to focus on assuring adequate nurse staffing levels to provide safe and high-quality dementia care.
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Affiliation(s)
- Jung Min Yoon
- Ewha Womans University, College of Nursing, Seoul, South Korea
| | | | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Carla L Storr
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Nancy B Lerner
- Ewha Womans University, College of Nursing, Seoul, South Korea
| | - Nicole Brandt
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Shijun Zhu
- Ewha Womans University, College of Nursing, Seoul, South Korea
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Forns J, Danysh HE, McQuay LJ, Turner ME, Dempsey C, Anthony MS, Demos G, Layton JB. Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States. BMC Geriatr 2022; 22:784. [PMID: 36203129 PMCID: PMC9541053 DOI: 10.1186/s12877-022-03489-3] [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: 08/03/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background Little is known about the incidence of clinical events and treatment patterns among older adults with dementia-related psychosis. Given that dementia-related psychosis comprises various dementia types, this study describes the incidence of clinical events and treatment patterns by dementia type after patients with dementia are diagnosed with psychosis. Methods Adults aged ≥ 65 years with dementia and newly diagnosed with psychosis were identified in US Medicare claims during 2013–2018. Baseline characteristics were evaluated at the time of the psychosis diagnosis. After the initial psychosis diagnosis, incidence rates (IRs) of clinical events (e.g., falls/fractures, infections, healthcare utilization), mortality, and patterns of antipsychotic treatment were described for each dementia type (Alzheimer’s disease [AD], Parkinson’s disease dementia [PDD], dementia with Lewy bodies [DLB], frontotemporal dementia [FTD], vascular dementia [VD], and unspecified dementia). Daily mean cumulative counts were estimated to describe the incidence of recurrent events over time. Mortality was described using Kaplan–Meier survival curves. Results We identified 484,520 patients with dementia-related psychosis: mean age, 84 years (standard deviation, 7.8); female, 66%. At the time of psychosis diagnosis, the most prevalent type of dementia was unspecified dementia (56%), followed by AD (31%), VD (12%), PDD (10%), DLB (3%), and FTD (< 1%), and most patients had scores indicating severe illness on the Charlson Comorbidity Index (71%) and frailty index (62%). Across all dementia types, IRs (per 100 person-years) were high for emergency department visits, oral anti-infective use, and urinary tract infections after the initial psychosis diagnosis. Patients with DLB had the highest incidence of most clinical outcomes. After 1 year of follow-up, the cumulative probability of death was about 30% for all dementia types, and after 5 years, was about 80% among patients with DLB, VD, AD, or PDD and about 60%-65% among patients with FTD or unspecified dementia. Conclusions Patients with dementia-related psychosis had a high burden of comorbidities, frailty, emergency department visits, infections, and death. Specifically, after DRP diagnosis, patients with DLB and VD had the highest burden of clinical events of interest. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03489-3.
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Affiliation(s)
- Joan Forns
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain.
| | - Heather E Danysh
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Waltham, MA, USA
| | - Lisa J McQuay
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Mary Ellen Turner
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, Princeton, NJ, USA
| | - Colleen Dempsey
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, Princeton, NJ, USA
| | - Mary S Anthony
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
| | - George Demos
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, San Diego, CA, USA
| | - J Bradley Layton
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
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10
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Lipori JP, Tu E, Shireman TI, Gerlach L, Coe AB, Ryskina KL. Factors Associated with Potentially Harmful Medication Prescribing in Nursing Homes: A Scoping Review. J Am Med Dir Assoc 2022; 23:1589.e1-1589.e10. [PMID: 35868350 PMCID: PMC10101239 DOI: 10.1016/j.jamda.2022.06.008] [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: 03/24/2022] [Revised: 06/07/2022] [Accepted: 06/12/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To summarize current evidence regarding facility and prescriber characteristics associated with potentially harmful medication (PHM) use by residents in nursing homes (NHs), which could inform the development of interventions to reduce this potentially harmful practice. DESIGN Scoping review. SETTING AND PARTICIPANTS Studies conducted in the United States that described facility and prescriber factors associated with PHM use in NHs. METHODS Electronic searches of PubMed/MEDLINE were conducted for articles published in English between April 2011 and November 2021. PHMs were defined based on the Beers List criteria. Studies testing focused interventions targeting PHM prescribing or deprescribing were excluded. Studies were characterized by the strengths and weaknesses of the analytic approach and generalizability. RESULTS Systematic search yielded 1253 articles. Of these, 29 were assessed in full text and 20 met inclusion criteria. Sixteen examined antipsychotic medication (APM) use, 2 anticholinergic medications, 1 sedative-hypnotics, and 2 overall PHM use. APM use was most commonly associated with facilities with a higher proportion of male patients, younger patients, and patients with severe cognitive impairment, anxiety, depression, and aggressive behavior. The use of APM and anticholinergic medications was associated with low registered nurse staffing ratios and for-profit facility status. No studies evaluated prescriber characteristics. CONCLUSIONS AND IMPLICATIONS Included studies primarily examined APM use. The most commonly reported facility characteristics were consistent with previously reported indicators of poor NH quality and NHs with patient case mix more likely to use PHMs.
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Affiliation(s)
- Jessica P Lipori
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Tu
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theresa I Shireman
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Lauren Gerlach
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Antoinette B Coe
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Kira L Ryskina
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Chappell V, Kirkham J, Seitz DP. Association Between Long-Term Care Facility Staffing Levels and Antipsychotic Use in US Long-Term Care Facilities. J Am Med Dir Assoc 2022; 23:1787-1792.e1. [PMID: 35926573 DOI: 10.1016/j.jamda.2022.06.029] [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: 11/03/2021] [Revised: 05/31/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Inappropriate use of antipsychotics is an indicator of quality of care in long-term care (LTC) facilities. There is evidence to suggest that staffing levels in LTC may be associated with the rates of inappropriate antipsychotic use. This study sought to examine the association between staffing and antipsychotic prescribing in LTC facilities. DESIGN Cross-sectional study investigated the association between reported staffing levels and the frequency of inappropriate antipsychotic prescribing at US LTC facilities between 2016 and 2018. SETTING AND PARTICIPANTS Data from the Nursing Home Compare and LTCFocus datasets were linked, which contain information from the Minimum Data Set database on facility characteristics and staffing measures from the Payroll-Based Journal system. A final sample set of 10,436 facilities was used. METHODS Descriptive statistics were calculated for all variables of interest. An unadjusted linear correlation analysis and linear regression were performed. Potential confounders were investigated by comparison across low-vs high-staffing facilities where adjusted for in regression analyses. RESULTS The mean staff level for the facilities was identified as 3.69 (SD = 0.67) staffing hours per patient per day, and the mean antipsychotic use rate across all facilities was 15.24% (SD = 8.62%). There was a 0.75% decrease in inappropriate antipsychotic prescribing per unit increase in overall staff-to-patient ratio. When looking at staffing types, a 3.09% decrease in inappropriate antipsychotic prescribing per unit increase in licensed staff hours. More specifically, we saw a 2.25% decrease per unit increase in RN staffing hours, a 1.83% decrease per unit increase in LPN staffing hours, and nursing aide staffing hours were not associated with antipsychotic use. CONCLUSIONS AND IMPLICATIONS These findings provide support for policy-based interventions to decrease antipsychotic use in LTC facilities by improving staffing skill mix and staffing levels. The results may also inform nursing staff education and training on antipsychotic prescribing practices.
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Affiliation(s)
- Victoria Chappell
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, ON, Canada
| | - Julia Kirkham
- Department of Psychiatry, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, Calgary, AB, Canada; Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, ON, Canada; Department of Psychiatry, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, Calgary, AB, Canada; Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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12
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Tomblin Murphy G, Sampalli T, Bourque Bearskin L, Cashen N, Cummings G, Elliott Rose A, Etowa J, Grinspun D, Jones EW, Lavoie-Tremblay M, MacMillan K, MacQuarrie C, Martin-Misener R, Oulton J, Ricciardelli R, Silas L, Thorne S, Villeneuve M. Investing in Canada’s nursing workforce post-pandemic: A call to action. Facets (Ott) 2022. [DOI: 10.1139/facets-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strategies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada.
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Affiliation(s)
- Gail Tomblin Murphy
- VP Research, Innovation and Discovery and Chief Nurse Executive, Nova Scotia Health, Halifax, NS B3H 1V7, Canada
| | - Tara Sampalli
- Senior Scientific Director, Research, Innovation and Discovery, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Lisa Bourque Bearskin
- Associate Professor, and Researcher, Thompson Rivers University, School of Nursing, Kamloops, BC V2C 0C8, Canada
| | - Nancy Cashen
- Interim Director, Nursing and Professional Practice, IWK Health, Halifax, NS B3K 6R8, Canada
| | - Greta Cummings
- College of Health Sciences, and Professor, Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Annette Elliott Rose
- VP Clinical Care and Chief Nurse Executive, IWK Health, Halifax, NS B3K 6R8, Canada
| | - Josephine Etowa
- Professor at the University of Ottawa’s Faculty of Health Sciences, School of Nursing, Ottawa, ON K1H 8M5, Canada
| | - Doris Grinspun
- Chief Executive Officer of the Registered Nurses’ Association of Ontario, Toronto, ON M2P 2A9, Canada
| | - Esyllt W. Jones
- Professor of History, University of Manitoba, Winnipeg, MB R3T 2M5, Canada
| | - Mélanie Lavoie-Tremblay
- Associate Professor and Vice-Dean research, innovation and entrepreneuriat, Faculty of Nursing, University of Montréal, Montréal, QC H3T 1A8, Canada
| | - Kathleen MacMillan
- Adjunct (retired) Dalhousie University, School of Nursing; Adjunct, University of Prince Edward Island, Faculty of Nursing, Charlottetown, PE C1A 4P3, Canada
| | - Cindy MacQuarrie
- Senior Director, Interprofessional Practice and Learning, IWK Health, Halifax, NS B3H 2Y9, Canada
| | - Ruth Martin-Misener
- Professor and the Director of the School of Nursing and Assistant Dean, Research, at the Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Judith Oulton
- Former Executive Director, Canadian Nurses Association, Ottawa, ON K1Z 7M4, Canada
| | - Rosemary Ricciardelli
- Professor, Sociology, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
| | - Linda Silas
- President of Canadian Federation of Nurses Unions, Ottawa, ON K1V 8X7, Canada
| | - Sally Thorne
- Professor, School of Nursing and Associate Dean, Faculty of Applied Science, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Michael Villeneuve
- Chief Executive Officer, Canadian Nurses Association, Ottawa, ON K1Z 7M4, Canada
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13
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Lim D, Liu D, Burston B. Impacts of 2012 update to the AGS beers criteria on potentially inappropriate antipsychotic medication use among older adults. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Iloanusi S, Mgbere O, Essien EJ. Polypharmacy among COVID-19 patients: A systematic review. J Am Pharm Assoc (2003) 2021; 61:e14-e25. [PMID: 34120855 PMCID: PMC8149164 DOI: 10.1016/j.japh.2021.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Polypharmacy, the concomitant use of 5 or more medications, is highly prevalent among older adults and individuals with multimorbid conditions and has been linked to suboptimal clinical outcomes in various diseases. However, little is known about the impact of polypharmacy on clinical outcomes among coronavirus disease 2019 (COVID-19) patients. OBJECTIVE This systematic review summarizes the available literature on the association between polypharmacy and specific drug classes, and clinical outcomes among COVID-19 patients. METHODS We conducted an electronic database search on Embase, Medline, Cochrane, Scopus, Google Scholar, clinicaltrials.gov, LITCOVID, PubMed, PubMed Central (PMC), and China national knowledge infrastructure for studies on Polypharmacy among COVID-19 patients using relevant combinations of the keywords. Only studies published between November 2019 to September 2020 were included. Seven articles out of 1502 unique articles met the inclusion criteria and were used for the current study. We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in conducting and reporting this systematic review. RESULTS The total sample size of all studies was 474,342, out of which 10,519 patients were COVID-19 positive, and 4818 COVID-19 positive patients experienced polypharmacy. Five out of the 7 included studies found associations between polypharmacy and negative clinical outcomes among COVID-19 patients. Polypharmacy was associated with increase in the relative risk of a positive COVID-19 test result (P < 0.01), death among male COVID-19 patients (P < 0.001), increase in the rate of acute kidney injury (P = 0.003), and adverse drug reactions (P < 0.001). Antipsychotic drugs were associated with severe COVID-19 morbidity (OR = 2.79; 95% CI 2.23-3.49) and increased risk of death among COVID-19 infected men (OR = 1.71; 95% CI 1.18-2.48) and women (OR = 1.96; 95% CI 1.41-2.73). CONCLUSION Polypharmacy and selected drug classes are associated with increased risk of adverse clinical outcomes among COVID-19 patients. Understanding these relationships can enhance risk stratification and evidence-based decision-making that may improve care and clinical outcomes of COVID-19 patients.
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15
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Forns J, Layton JB, Bartsch J, Turner ME, Dempsey C, Anthony M, Ritchey ME, Demos G. Increased risk of falls and fractures in patients with psychosis and Parkinson disease. PLoS One 2021; 16:e0246121. [PMID: 33503061 PMCID: PMC7840029 DOI: 10.1371/journal.pone.0246121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/10/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Evaluate whether the risk of falls and fractures differs between patients with Parkinson disease with psychosis (PDP) and patients with Parkinson disease (PD) without psychosis at similar disease stages. Methods Patients with PD without psychosis were identified in the Medicare claims databases (2008–2018) and followed from the first PD diagnosis date during the study period. Patients with a subsequent diagnosis of psychosis were included in the PDP group. Patients with PDP and PD without psychosis were propensity score-matched based on characteristics within blocks of time since cohort entry. The incidence rates (IRs), expressed per 100 person-years, and 95% confidence intervals (CIs) of falls and fractures were evaluated as composite and separate outcomes. Incidence rate ratios (IRRs) were used to compare patients with PDP and PD without psychosis in the matched cohort. Results 154,306 patients had PD without psychosis and no falls or fractures before cohort entry; the IR for falls and fractures was 11.41 events (95% CI, 11.29–11.53). 12,127 patients (7.8%) had a subsequent PDP diagnosis. PDP patients had a higher prevalence of most comorbidities and risk factors for falls and fractures than those without psychosis. The crude IR for falls and fractures among PDP patients was 29.03 events (95% CI, 28.27–29.81). PD without psychosis and PDP groups had more falls than fractures. After matching, 24,144 PD patients without psychosis (15.6%) and 12,077 PDP patients (99.6%) were retained. Matched PDP patients had a higher incidence of falls and fractures than PD patients without psychosis (IRR = 1.44; 95% CI, 1.39–1.49). The higher increased rate was noted separately for falls (IRR = 1.48; 95% CI, 1.43–1.54) and any fractures (IRR = 1.17; 95% CI, 1.08–1.27) as well as within specific types of fracture, including pelvis and hip fractures. Conclusions Our findings suggest a modest but consistently higher increased risk of falls and fractures in PDP patients compared with PD patients without psychosis.
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Affiliation(s)
- Joan Forns
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
- * E-mail:
| | - J. Bradley Layton
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
| | - Jennifer Bartsch
- Biometrics, RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
| | - Mary Ellen Turner
- ACADIA Pharmaceuticals Inc., San Diego, California, United States of America
| | - Colleen Dempsey
- ACADIA Pharmaceuticals Inc., San Diego, California, United States of America
| | - Mary Anthony
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
| | - Mary E. Ritchey
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
| | - George Demos
- ACADIA Pharmaceuticals Inc., San Diego, California, United States of America
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16
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Birtley NM, Phillips L. The business and practice of psychiatric advanced practice nursing in long term care. Arch Psychiatr Nurs 2020; 34:288-296. [PMID: 33032748 DOI: 10.1016/j.apnu.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 03/03/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Nancy M Birtley
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, MO, United States of America; Nancy M. Birtley, LLC, Psychiatric Consultation Services, St. Louis, MO, United States of America.
| | - Lorraine Phillips
- School of Nursing, College of Health Sciences, University of Delaware, Newark, DE, Unites States of America
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Tark A, Agarwal M, Dick AW, Song J, Stone PW. Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident's Place of Death. Am J Hosp Palliat Care 2020; 38:812-822. [PMID: 32878457 DOI: 10.1177/1049909120956650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Physician Orders for Life-Sustaining Treatment (POLST) program was developed to enhance quality of care delivered at End-of-Life (EoL). Although positive impacts of the POLST program have been identified, the association between a program maturity status and nursing home resident's likelihood of dying in their current care settings remain unanswered. This study aims to evaluate the impact of the POLST program maturity status on nursing home residents' place of death. Using multiple national-level datasets, we examined total 595,152 residents and their place of death. The result showed that the long-stay residents living in states where the program was mature status had 12% increased odds of dying in nursing homes compared that of non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes. The findings demonstrate that a well-structured and well-disseminated POLST program, combined with a continued effort to meet high standards of quality EoL care, can bring out positive health outcomes for elderly patients residing in care settings.
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Affiliation(s)
- Aluem Tark
- Columbia University School of Nursing, New York, NY, USA.,4083University of Iowa College of Nursing, Iowa City, IA, USA
| | - Mansi Agarwal
- Columbia University School of Nursing, New York, NY, USA
| | | | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
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Harrington C, Dellefield ME, Halifax E, Fleming ML, Bakerjian D. Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health Serv Insights 2020; 13:1178632920934785. [PMID: 32655278 PMCID: PMC7328494 DOI: 10.1177/1178632920934785] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Abstract
US nursing homes are required to have sufficient nursing staff with the
appropriate competencies to assure resident safety and attain or maintain the
highest practicable level of physical, mental, and psychosocial well-being of
each resident. Minimum nurse staffing levels have been identified in research
studies and recommended by experts. Beyond the minimum levels, nursing homes
must take into account the resident acuity to assure they have adequate staffing
levels to meet the needs of residents. This paper presents a guide for
determining whether a nursing home has adequate and appropriate nurse staffing.
We propose five basic steps to: (1) determine the collective resident acuity and
care needs, (2) determine the actual nurse staffing levels, (3) identify
appropriate nurse staffing levels to meet residents care needs, (4) examine
evidence regarding the adequacy of staffing, and (5) identify gaps between the
actual staffing and the appropriate nursing staffing levels based on resident
acuity. Data sources and specific methodologies are analyzed, compared, and
recommended. The goal is to assist nursing home nurses and administrators to
ensure adequate nursing home staffing levels that protect resident health,
safety, and well-being.
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Affiliation(s)
- Charlene Harrington
- Department of Social & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mary Ellen Dellefield
- Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Elizabeth Halifax
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Mary Louise Fleming
- Healthcare Administration and Interprofessional Leadership Program, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Debra Bakerjian
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA
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Temporal Trends in the Use of Anticholinergic Drugs Among Older People Living in Long-Term Care Facilities in Helsinki. Drugs Aging 2020; 37:27-34. [PMID: 31705445 PMCID: PMC6965041 DOI: 10.1007/s40266-019-00720-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The use of drugs with anticholinergic properties (DAPs) is common among older adults despite their known adverse effects, such as cognitive decline. Professionals should pay attention to DAPs, since evidence on their adverse effects has been accumulating during the last decade. However, to our knowledge previous studies exploring temporal trends in the use of DAPs are scarce. Objective The aim of this study was to assess temporal trends in the use of DAPs from 2003 to 2017 in long-term care facilities in Helsinki. Methods Four cross-sectional studies were conducted in 2003, 2007, 2011, and 2017. Participants included older people (≥ 65 years) living in nursing homes (NHs) in 2003 (n = 1979), 2011 (n = 1568), and 2017 (n = 750), and in assisted living facilities (ALFs) in 2007 (n = 1336), 2011 (n = 1556), and 2017 (n = 1673) in Helsinki, Finland. Data on demographics, medication use, and diagnoses were collected by structured questionnaires. The assessments were conducted as a point prevalence over 1 day. The use of DAPs and the total anticholinergic burden were defined by the Anticholinergic Risk Scale (ARS). Results In ALFs, there has been an increasing trend in the use of DAPs over a 10-year period (41.2% in 2007 and 53.7% in 2017). In NHs, by contrast, the use of DAPs remained quite stable (52.3% in 2003 and 52.4% in 2017). The burden of DAPs measured by ARS score decreased in NHs and remained stable in ALFs. Marked changes occurred in the DAPs used; antidepressants, especially mirtazapine, increased in both settings, whereas the use of hydroxyzine and urinary antispasmodics nearly disappeared. The proportion of users of DAP antipsychotics increased in ALFs. Participants with dementia had a lower anticholinergic burden than those without dementia, in both settings. Conclusions Despite increased knowledge of the harms of DAPs, they remain widely used. Physicians seem to be aware of the harms of DAPs among people with dementia, and some other favorable trends in prescribing were also observed. Clinicians should especially consider the indications behind the use of DAP antidepressants and antipsychotics, and carefully weigh their potential benefits and harms.
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Harrington C, Mollot R, Edelman TS, Wells J, Valanejad D. U.S. Nursing Home Violations of International and Domestic Human Rights Standards. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 50:62-72. [DOI: 10.1177/0020731419886196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a review of the international covenants and conventions and U.S. domestic laws and regulations that are designed to protect nursing home residents in the United States. Based on a review of research studies, government reports, and news reports, we found extensive evidence of widespread and systematic abuse and neglect of nursing home residents in the United States that needs urgent government action to protect the basic human rights of residents.
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Affiliation(s)
| | - Richard Mollot
- The Long Term Care Community Coalition, New York, NY, USA
| | | | - Janet Wells
- California Advocates for Nursing Home Reform, San Francisco, CA, USA
| | - Dara Valanejad
- School of Nursing, University of California, San Francisco, CA, USA
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21
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Shin JH, Shin IS. The effect of registered nurses on nursing home residents’ outcomes, controlling for organizational and health care market factors. Geriatr Nurs 2019; 40:296-301. [DOI: 10.1016/j.gerinurse.2018.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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