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Hanan DM, Lyons KS, Mahoney EK, Irwin KE, Flanagan JM. Barriers and facilitators to caring for individuals with serious persistent mental illness in long-term care. Arch Psychiatr Nurs 2024; 51:25-29. [PMID: 39034086 DOI: 10.1016/j.apnu.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/20/2023] [Accepted: 05/10/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Many older adults in the United States with serious persistent mental illness reside in long-term facilities, and evidence suggests increasing numbers of long-term care residents with serious persistent mental illness. Healthcare professionals in these settings may face challenges in providing care to these residents. The purpose of this study was to describe health care professionals' perceptions of the barriers and facilitators to caring for long-term care residents with serious persistent mental illness. METHODS A qualitative descriptive design was employed. RESULTS Ten healthcare professionals working in long-term care were interviewed. Themes that emerged from the interviews were: coming to know the individual and their unique needs takes time; offering choices and being flexible facilitates trust; respecting the inherent worth of each individual promotes caring. CONCLUSIONS Caring for individuals with serious persistent mental illness in long-term care requires an individualized, person-centered approach.
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Affiliation(s)
- Diana M Hanan
- Simmons University, College of Natural, Behavioral, and Health Sciences, 300 The Fenway, Boston, MA 02115, United States of America.
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Maloney Hall 231, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, United States of America.
| | - Ellen K Mahoney
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, United States of America.
| | - Kelly E Irwin
- Harvard Medical School, Collaborative Care and Community Engagement Program, Massachusetts General Cancer Center, Yawkey 10B, 55 Fruit Street, Boston, MA 02114, United States of America.
| | - Jane M Flanagan
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, United States of America.
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2
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Huan T, Intrator O, Simning A, Boockvar K, Grabowski DC, Cai S. Mental Health Treatment Among Nursing Home Residents With Alzheimer's Disease and Related Dementias. J Am Med Dir Assoc 2024; 25:105088. [PMID: 38885931 DOI: 10.1016/j.jamda.2024.105088] [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: 02/15/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES To examine the prevalence of mental health treatment among nursing home (NH) long-stay residents with Alzheimer's disease and related dementias (ADRD) and explore factors associated with utilization. DESIGN Retrospective cohort study. Minimum Data Set data (April 2017-September 2018), Medicare Master Beneficiary Summary File, Part B Carrier file and Part D prescription file were used to identify mental illness and ADRD diagnoses, patient characteristics, and mental health treatment. SETTING AND PARTICIPANTS All US Medicare- or Medicaid-certified NHs. Fee-for-service Medicare beneficiaries aged 65 and older who had a quarterly or annual Minimum Data Set assessment with ADRD and were enrolled in Medicare Parts B and D. Two cohorts: residents with both ADRD and psychiatric disorders; residents with ADRD only. METHODS Primary outcomes: receipt of (1) any mental health treatment (medication or psychotherapy); (2) any psychotherapy in a calendar quarter. SECONDARY OUTCOMES antipsychotics, antidepressants, hypnotics, antiepileptics, short-session ( ≤ 30 minutes), long-session ( ≥ 45 minutes), and family/group psychotherapy. Covariates included predisposing, enabling characteristics, and needs factors. Generalized Estimating Equation models of quarterly data, nested within patients, were estimated for each outcome among each cohort. RESULTS Analyses included 1,913,945 resident-quarter observations from 503,077 unique NH long-stay residents. Overall, 68.5% of NH long-stay residents with ADRD have psychiatric disorders; of these, 85% received mental health treatment. African American or Hispanic residents were less likely to use antidepressants. African American residents or residents living in rural locations were less likely to receive long-session psychotherapy. Hispanic residents were more likely to receive long-session psychotherapy. Residents in minority groups were more likely to receive group/family psychotherapy. CONCLUSIONS AND IMPLICATIONS Most of NH long-stay residents with ADRD had psychiatric disorders and most of them received treatment. Antidepressants or long-session psychotherapy were less likely to be provided to African American residents. Factors that determine the efficacy of mental health treatment and reasons for the racial disparities require further exploration.
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Affiliation(s)
- Tianwen Huan
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA; Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, NY, USA.
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA; Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Adam Simning
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA; Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Kenneth Boockvar
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama, Birmingham, AL, USA; Geriatrics Research, Education, and Clinical Center, Birmingham VA Health Care System, Birmingham, AL, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA; Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, NY, USA
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Jun H, Grabowski DC. Mental health in nursing homes: The role of immigration in the long-term care workforce. Soc Sci Med 2024; 351:116978. [PMID: 38761455 PMCID: PMC11180551 DOI: 10.1016/j.socscimed.2024.116978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/05/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024]
Abstract
One-fourth of nursing home residents are diagnosed with anxiety disorders and approximately half live with depression. Nursing homes have long struggled with staffing shortages, and the lack of care has further heightened the risk of poor mental health. A key solution to both problems could be immigration. Prior studies have documented how immigrant labor could strengthen the long-term care workforce. We add to this picture by exploring the impact of immigrant inflows on the mental health outcomes of nursing home residents. Using a nationally representative dataset and a shift-share instrumental variable approach, we find empirical evidence that immigration reduces diagnoses of depression and anxiety, the use of antidepressant and antianxiety drugs, and self-assessed symptoms of depression. The results are robust to several sensitivity tests. We further find that the effect is more substantial in facilities with lower direct care staff hours per resident and with likely more immigrants without citizenship. Language barriers tend to be a minor issue when providing essential care. The findings suggest that creating a policy framework that directs immigrant labor to the long-term care sector can mutually benefit job-seeking immigrants and nursing home residents.
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Affiliation(s)
- Hankyung Jun
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA.
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
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Temkin-Greener H, Guo W, McGarry B, Cai S. Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement. J Am Med Dir Assoc 2024; 25:917-922. [PMID: 38575115 PMCID: PMC11065589 DOI: 10.1016/j.jamda.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Assess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. DESIGN 2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for up to 2 years to track their NH placement. We used data from the Medicare Enrollment Database, the Medicare Beneficiary Summary File, Minimum Data Set, and a national directory of state-licensed AL communities. AL residents were identified using a validated, previously reported 9-digit zip code methodology. SETTING AND PARTICIPANTS A cross-sectional study sample included 289,350 Medicare beneficiaries in 17,265 AL communities across 50 states and in the District of Columbia. METHODS The outcome was permanent NH placement: a continuous stay for more than 90 days. Key independent variable was presence of SMI-schizophrenia, bipolar disorder, and major depression. Other covariates included sociodemographic factors and presence of other chronic conditions, including ADRD. A linear probability model with robust SEs, and AL-level random effects, was used to test the association between SMI diagnoses, ADRD, and their interactions on NH placement. RESULTS More than half (55.65%) of AL residents had a diagnosis of SMI, among them 93.2% had major depression, 28.5% schizophrenia, and 22.2% bipolar disorder. Individuals with schizophrenia and bipolar disorder had a significantly lower probability of NH placement, a 32% and a 15% decrease relative to the cohort mean, respectively. Placement risk was significantly greater for residents with ADRD compared to those without, increasing for those who also had schizophrenia or bipolar disorder, 12.9% and 1.5% relative to the sample mean, respectively. CONCLUSION AND IMPLICATIONS Presence of schizophrenia and bipolar disorder, in conjunction with ADRD, significantly increases the risk of long-term NH placement, suggesting that ALs may not be well prepared to care for these residents.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
| | - Wenhan Guo
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Brian McGarry
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
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Ma KJ, Lin YJ, Liu CS, Tseng PY, Wang SH, Yao CY, Wang JY. Association between 14 candidate genes, PM2.5, and affective disorders: a study of the Taiwan Biobank. BMC Public Health 2023; 23:2346. [PMID: 38012695 PMCID: PMC10683147 DOI: 10.1186/s12889-023-16764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Most studies have focused on the risk factors, treatment, and care of affective psychosis, and several have reported a relationship between ambient air quality and this psychosis. Although an association has been reported between psychosis and genes, studies mainly explored the associations between one type of psychosis and one gene; few have identified genes related to affective psychosis. This study investigates the genetic and environmental factors of affective psychosis. METHODS In this retrospective longitudinal study, 27 604 participants aged 30-70 were selected from Taiwan Biobank. The participants' propensity scores were calculated based on their demographic information, and propensity score matching was performed to divide the participants into an experimental (i.e., affective psychosis) and control group at a 1:5 ratio. Plink was used to analyze the major and minor types of gene expression related to affective psychosis, and PM2.5 exposure was incorporated into the analyses. RESULTS According to the generalized estimating equation analysis results, 8 single nucleotide polymorphisms (SNPs) belonging to the ANK3, BDNF, CACNA1C, and GRID1 genotypes were significantly correlated with depressive disorder (P < .001), with the majority belonging to the ANK3 and CACNA1C. A total of 5 SNPs belonging to the CACNA1C, GRID1, and SIRT1 genotypes were significantly correlated with bipolar disorder (P < .001), with the majority belonging to the CACNA1C. No significant correlation was identified between ambient air pollution and affective psychosis. CONCLUSIONS CACNA1C and GRID1 are common SNP genotypes for depressive disorder and bipolar disorder and should be considered associated with affective psychosis.
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Affiliation(s)
- Kai-Jie Ma
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Yi-Ju Lin
- Department of Administration, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Ying Tseng
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical, Lee's General Hospital, Yuanli Town, Miaoli, Taiwan
| | - Shi-Heng Wang
- Interdisciplinary Freshmen Program of Public Health, China Medical University, Taichung, Taiwan
| | - Chi-Yu Yao
- Attending physician Department of psychiatry, An-nan hospital, Tainan, Taiwan.
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.
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Tseng PY, Wu CL, Chen JD, Ma KJ, Yao CY, Wang JY. Association between use of different long-term care services and risks of mental disorder and mortality as well as medical utilization. Front Psychiatry 2023; 14:1073030. [PMID: 37850103 PMCID: PMC10577215 DOI: 10.3389/fpsyt.2023.1073030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/04/2023] [Indexed: 10/19/2023] Open
Abstract
Objective This study sought to investigate mental disorder and mortality risks and medical utilization among various long-term care (LTC) services and examine the associated factors. Methods This retrospective cohort study used data from the National Health Insurance Research Database of the entire population of Taiwan recorded between 2006 and 2017. A total of 41,407 patients using LTC (study group) were identified and propensity score-matched with 41,407 LTC nonusers (control group) at a ratio of 1:1 according to sex, age, salary-based premium, comorbidity index score, and urbanization level. Patients were divided into four groups according to LTC service type. The age distribution was as follows: 50-60 years (10.47%), 61-70 years (14.48%), 71-80 years (35.59%), and 81 years and older (39.45%). The mean age was 70.18 years and 53.57% of female participants were included. The major statistical methods were the Cox proportional hazards model and the general linear model (GLM). Results Users of both institutional and inhome LTC services had the highest risk of mental disorder [adjusted hazard ratio (aHR) = 3.2]. The mean mortality rate in LTC nonusers was 46.2%, whereas that in LTC users was 90.4%, with the highest found among the users of both institutional and inhome LTC (90.6%). The institutional LTC users had the shortest survival time (4.1 years). According to the adjusted Cox model analysis, the odds of mortality was significantly higher among institutional LTC users than among inhome LTC users (aHR = 1.02). After the adjustment of covariates, adjusted GLM model results revealed that the annual medical expenditure per capita of LTC nonusers was NT$46,551, which was 1.6 times higher that of LTC users. Conclusion Users of both institutional and inhome LTC services have higher risk of mental disorder, shorter survival time, and lower medical utilization.
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Affiliation(s)
- Pei-Ying Tseng
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical, Lee’s General Hospital, Miaoli, Taiwan
| | - Chia-Ling Wu
- Hospital Accreditation Department, Joint Commission of Taiwan, Taipei, Taiwan
| | - Jen-De Chen
- Department of Sports, National Changhua University of Education, Changhua, Taiwan
| | - Kai-Jie Ma
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chi-Yu Yao
- Department of Psychiatry, An-Nan Hospital, Tainan, Taiwan
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
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Chen AC, Grabowski DC. Nursing Homes Underreport Antipsychotic Use but Overreport Diagnoses Qualifying for Appropriate Use. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad022. [PMID: 38322323 PMCID: PMC10846688 DOI: 10.1093/haschl/qxad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Antipsychotic drug use in U.S. nursing homes remains a priority concern, but less is understood about the characteristics associated with reporting. Using linked Medicare claims and Minimum Data Set (MDS) assessments for long-stay nursing home residents from January 2018 to December 2019, we assessed the consistency of antipsychotic drug reporting and diagnosis of conditions (schizophrenia, Tourette's syndrome, and Huntington's disease) which qualify as appropriate drug use across data sources by calculating reporting rates in facility-reported MDS and Medicare claims. The antipsychotic reporting outcome is conditional on claims reporting while the condition reporting outcomes are conditional on MDS reporting. We found underreporting (87% reporting rate) in facility-reported antipsychotic use relative to Medicare claims. In contrast, we found overreporting of the qualifying conditions with a number of facility-reported diagnoses unsupported by a corresponding claims diagnosis. Only 54.8% of schizophrenia, 46.5% of Tourette's syndrome, and 72.4% of Huntington's disease diagnoses reported in the MDS had a claims diagnosis. There was also variation in reporting odds for antipsychotic drug use by dual-eligibility status and race, with higher odds for dual-eligible and lower odds for Black residents These findings suggest CMS should continue investigating the source of reporting discrepancies in antipsychotic drug use and qualifying diagnoses.
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Affiliation(s)
| | - David C Grabowski
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
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Barooah A, Nadash P. Admission and Care of Individuals with Mental Illness in Massachusetts Nursing Homes: An Exploratory Study. J Appl Gerontol 2023; 42:252-258. [PMID: 36190950 DOI: 10.1177/07334648221131186] [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: 01/18/2023] Open
Abstract
Rising rates of mental illness in nursing homes (NHs) led Congress to pass the 1987 Pre-Admission Screening and Resident Review (PASRR) mandate, aimed at limiting inappropriate institutionalization of people with mental illness (MI) and ensuring appropriate service of NH residents with MI. The law's flexibility results in significant cross-state variations. This study explores Massachusetts' experiences with PASRR implementation, using semi-structured interviews (N=8) with key informants representing major stakeholders. Thematic Content Analysis was used for analysis.Four themes emerged as follows: 1) PASRR screens MI, insufficient in ensuring services, 2) NHs face challenges implementing PASRR, 3) inadequate community-based services increase pressure on NHs, and 4) reactions to PASRR revisions were mixed. Participants agreed that PASRR's first aim was met-avoiding inappropriate institutionalization-but not the second-ensuring appropriate services, and highlighted the limited community alternatives for serving people with MI. More research is needed to understand state variations in PASRR implementation.
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Affiliation(s)
- Adrita Barooah
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA
| | - Pamela Nadash
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA
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Bartlett VL, Ross JS, Balasuriya L, Rhee TG. Association of Psychiatric Diagnoses and Medicaid Coverage with Length of Stay Among Inpatients Discharged to Skilled Nursing Facilities. J Gen Intern Med 2022; 37:3070-3079. [PMID: 35048298 PMCID: PMC9485316 DOI: 10.1007/s11606-021-07320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inpatients with psychiatric diagnoses often require higher levels of care in skilled nursing facilities (SNFs) and are more likely to be covered by Medicaid, which reimburses SNFs at significantly lower rates than Medicare and commercial payors. OBJECTIVE To characterize factors affecting length of stay in inpatients discharged to SNFs. DESIGN A retrospective cross-sectional study design using 2016-2018 data from National Inpatient Sample. PARTICIPANTS Inpatients aged ≥ 40 who were discharged to SNFs. EXPOSURES Primary discharge diagnosis (medical, psychiatric, or substance use) and primary payor. MAIN OUTCOMES AND MEASURES Length of stay, categorized non-exclusively as >3 days, >7 days, or > 14 days. RESULTS Among 9,821,155 inpatient discharges to SNFs between 2016 and 2018, 95.7% had medical primary discharge diagnoses, 3.3% psychiatric diagnoses, and 1.0% substance use diagnoses; Medicare was the most common primary payor (83.3%), followed by private insurance (7.9%), Medicaid (6.6%), and others (2.2%). Median length of stay for all patients was 5.0 days (interquartile range [IQR], 3.0-8.0), 5.0 (IQR, 3.0-8.0) for those with medical diagnoses, 8.0 (IQR, 4.0-15.0) for psychiatric diagnoses, and 5.0 (IQR, 3.0-8.0) for substance use diagnoses. After multivariable adjustment, compared to patients with medical diagnoses, patients with psychiatric diagnoses were more likely to have hospital stays > 3, > 7, and > 14 days, respectively (p < 0.001). Compared to Medicare patients, Medicaid patients were more likely to have hospital stays > 3, > 7, and > 14 days, respectively (p < 0.001). Compared to patients with medical diagnoses, those with psychiatric diagnoses were also more likely to have lengths of stay 1 times, 1.5 times, and 2 times greater than the national geometric mean length of stay for that diagnosis-related group (p < 0.001). CONCLUSIONS Patients discharged to SNFs after inpatient hospitalization for psychiatric diagnoses and with Medicaid coverage were more likely to have longer lengths of stay than patients with medical diagnoses and those with Medicare coverage, respectively.
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Affiliation(s)
| | - Joseph S Ross
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
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Tyler DA, Kordomenos C, Ingber MJ. Reducing Hospitalizations Among Nursing Facility Residents: Policy Environment and Suggestions for the Future in Seven States. J Gerontol Nurs 2022; 48:10-16. [PMID: 35914083 DOI: 10.3928/00989134-20220629-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study examined the policy and market context existing in the seven states where the Centers for Medicare & Medicaid Services (CMS) Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents took place. Stakeholder organizations with knowledge of the skilled nursing facility environment but who were not directly involved with the CMS Initiative were interviewed to assess the impact of policies and programs affecting transfers to the hospital from long-term care facilities. Focused interviews were used to identify areas of quality improvement as well as market forces that contributed to hospitalization rates. Interviews were qualitatively coded and emerging patterns and themes were identified. Market pressures were similar across states. Few policies were found that may have affected the Initiative, but most states had regional coalitions focused on improving some aspect of care. When asked what else could be done to reduce hospitalizations among nursing facility residents, participants across the stakeholder organizations suggested greater presence of physicians and nurse practitioners in nursing facilities, better training around behavioral health issues for frontline staff, and more advance care planning and education for families regarding end of life. [Journal of Gerontological Nursing, 48(8), 10-16.].
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Plys E, Levy CR, Brenner LA, Vranceanu AM. Let’s Integrate! The Case for Bringing Behavioral Health to Nursing Home–Based Post-Acute and Subacute Care. J Am Med Dir Assoc 2022; 23:1461-1467.e7. [DOI: 10.1016/j.jamda.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
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Jester DJ, Molinari V, Bowblis JR, Dobbs D, Zgibor JC, Andel R. Abuse and Neglect in Nursing Homes: The Role of Serious Mental Illness. THE GERONTOLOGIST 2022; 62:1038-1049. [PMID: 35022710 DOI: 10.1093/geront/gnab183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing homes (NH) are serving a large number of residents with serious mental illness (SMI). We analyze the highest ("High-SMI") quartile of NHs based on the proportion of residents with SMI and compare NHs on health deficiencies and the incidence of deficiencies given for resident abuse, neglect, and involuntary seclusion. RESEARCH DESIGN AND METHODS We used national Certification and Survey Provider Enhanced Reports (CASPER) data for all freestanding certified NHs in the continental United States from 2014 to 2017 (14,698 NHs; 41,717 recertification inspections; 246,528 deficiencies). Differences in the number of deficiencies, a weighted deficiency score, the deficiency grade, and the facility characteristics associated with deficiencies for abuse, neglect, and involuntary seclusion were examined in High-SMI. Incidence rate ratios (IRR) and odds ratios (OR) were reported with 95% confidence intervals. RESULTS High-SMI NHs did not receive more deficiencies or a greater weighted deficiency score per recertification inspection. Deficiencies given to High-SMI NHs were associated with a wider scope, especially Pattern (IRR:1.03;[1.00, 1.07]) and Widespread (IRR:1.07;[1.02, 1.11]). High-SMI NHs were more likely to be cited for resident abuse and neglect (OR:1.49;[1.23, 1.81]) and the policies to prohibit and monitor for abuse and neglect (OR:1.18;[1.08, 1.30]) in comparison to all other NHs. DISCUSSION AND IMPLICATIONS Although resident abuse, neglect, and involuntary seclusion are rarely cited, these deficiencies are disproportionately found in High-SMI NHs. Further work is needed to disentangle the antecedents to potential resident abuse and neglect in those with mental healthcare needs.
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Affiliation(s)
- Dylan J Jester
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Victor Molinari
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - John R Bowblis
- Department of Economics and Scripps Gerontology Center, Miami University, Oxford, OH
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Janice C Zgibor
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Ross Andel
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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Bucy T, Moeller K, Bowblis JR, Shippee N, Fashaw-Walters S, Winkelman T, Shippee T. Serious Mental Illness in the Nursing Home Literature: A Scoping Review. Gerontol Geriatr Med 2022; 8:23337214221101260. [PMID: 35573081 PMCID: PMC9096203 DOI: 10.1177/23337214221101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
Nursing homes (NH) and other institutional-based long-term care settings are not considered an appropriate place for the care of those with serious mental illness, absent other medical conditions or functional impairment that warrants skilled care. Despite policy and regulatory efforts intended to curb the unnecessary placement of people with serious mental illness (SMI) in these settings, the number of adults with SMI who receive care in NHs has continued to rise. Through a scoping review, we sought to summarize the available literature describing NH care for adults with SMI from 2000 to 2020. We found that SMI was operationalized and measured using a variety of methods and diagnoses. Most articles focused on a national sample, with the main unit of analysis being at the NH resident-level and based on analysis of secondary data sets. Understanding current evidence about the use of NHs by older adults with SMI is important to policy and practice, especially as we continue to grapple as a nation with how to provide quality care for older adults with SMI.
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Affiliation(s)
- Taylor Bucy
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kelly Moeller
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - John R Bowblis
- Farmer School of Business, Miami University, Oxford, OH, USA
| | - Nathan Shippee
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Tyler Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Tetyana Shippee
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
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14
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Hugunin J, Yuan Y, Baek J, Clark RE, Rothschild AJ, Lapane KL, Ulbricht CM. Characteristics of Working-Age Adults With Schizophrenia Newly Admitted to Nursing Homes. J Am Med Dir Assoc 2021; 23:1227-1235.e3. [PMID: 34919836 DOI: 10.1016/j.jamda.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Persons aged <65 years account for a considerable proportion of US nursing home residents with schizophrenia. Because they are often excluded from psychiatric and long-term care studies, a contemporary understanding of the characteristics and management of working-age adults (22-64 years old) with schizophrenia living in nursing homes is lacking. This study describes characteristics of working-age adults with schizophrenia admitted to US nursing homes in 2015 and examines variations in these characteristics by age and admission location. Factors associated with length of stay and discharge destination were also explored. DESIGN This is a cross-sectional study using the Minimum Data Set 3.0 merged to Nursing Home Compare. SETTING AND PARTICIPANTS This study examines working-age (22-64 years) adults with schizophrenia at admission to a nursing home. METHODS Descriptive statistics of resident characteristics (sociodemographic, clinical comorbidities, functional status, and treatments) and facility characteristics (ownership, geography, size, and star ratings) were examined overall, stratified by age and by admission location. Generalized estimating equation models were used to explore the associations of age, discharge to the community, and length of stay with relevant resident and facility characteristics. Coefficient estimates, adjusted odds ratios, and 95% CIs are presented. RESULTS Overall, many of the 28,330 working-age adults with schizophrenia had hypertension, diabetes, and obesity. Those in older age subcategories tended to have physical functional dependencies, cognitive impairments, and clinical comorbidities. Those in younger age subcategories tended to exhibit higher risk of psychiatric symptoms. CONCLUSIONS AND IMPLICATIONS Nursing home admission is likely inappropriate for many nursing home residents with schizophrenia aged <65 years, especially those in younger age categories. Future psychiatric and long-term care research should include these residents to better understand the role of nursing homes in their care and should explore facility-level characteristics that may impact quality of care.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robin E Clark
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA; UMass Memorial Healthcare, Worcester, MA, USA
| | - Kate L Lapane
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine M Ulbricht
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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15
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Roach M, Hiatt RA, Black S. COMMENTARY: Quality of Health Care in Nursing Homes. J Infect Dis 2021; 225:555-556. [PMID: 34618903 PMCID: PMC8754694 DOI: 10.1093/infdis/jiab516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mack Roach
- Department of Radiation Oncology, University of California San Francisco
| | - Robert A Hiatt
- Department of Epidemiology & Biostatistics, University of California San Francisco
| | - Steven Black
- Emeritus, University of Cincinnati Children's Hospital
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16
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Fashaw-Walters SA, McCreedy E, Bynum JPW, Thomas KS, Shireman TI. Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD. J Am Geriatr Soc 2021; 69:3623-3630. [PMID: 34590709 DOI: 10.1111/jgs.17464] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/04/2021] [Accepted: 06/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous research demonstrated an increase in the reporting of schizophrenia diagnoses among nursing home (NH) residents after the Centers for Medicare & Medicaid Services National Partnership to Improve Dementia Care. Given known health and healthcare disparities among Black NH residents, we examined how race and Alzheimer's and related dementia (ADRD) status influenced the rate of schizophrenia diagnoses among NH residents following the partnership. METHODS We used a quasi-experimental difference-in-differences design to study the quarterly prevalence of schizophrenia among US long-stay NH residents aged 65 years and older, by Black race and ADRD status. Using 2011-2015 Minimum Data Set 3.0 assessments, our analysis controlled for age, sex, measures of function and frailty (activities of daily living [ADL] and Changes in Health, End-stage disease and Symptoms and Signs scores) and behavioral expressions. RESULTS There were over 1.2 million older long-stay NH residents, annually. Schizophrenia diagnoses were highest among residents with ADRD. Among residents without ADRD, Black residents had higher rates of schizophrenia diagnoses compared to their nonblack counterparts prior to the partnership. Following the partnership, Black residents with ADRD had a significant increase of 1.7% in schizophrenia as compared to nonblack residents with ADRD who had a decrease of 1.7% (p = 0.007). CONCLUSIONS Following the partnership, Black NH residents with ADRD were more likely to have a schizophrenia diagnosis documented on their MDS assessments, and schizophrenia rates increased for Black NH residents with ADRD only. Further work is needed to examine the impact of "colorblind" policies such as the partnership and to determine if schizophrenia diagnoses are appropriately applied in NH practice, particularly for black Americans with ADRD.
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Affiliation(s)
- Shekinah A Fashaw-Walters
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.,Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ellen McCreedy
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Julie P W Bynum
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.,Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Theresa I Shireman
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
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17
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Brown MT, Mutambudzi M. Risk of Nursing Home Use among Older Americans: The Impact of Psychiatric History and Trajectories of Cognitive Function. J Gerontol B Psychol Sci Soc Sci 2021; 77:577-588. [PMID: 33720295 DOI: 10.1093/geronb/gbab045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Mental illness and cognitive functioning may be independently associated with nursing home use. We investigated the strength of the association between baseline (1998) psychiatric history, eight-year cognitive function trajectories, and prospective incidence of nursing home use over a ten-year period while accounting for relevant covariates in U.S. adults aged 65 and older. We hypothesized that self-reported baseline history of psychiatric, emotional or nervous problems would be associated with greater risk of nursing home use, and that cognition trajectories with the greatest decline would be associated with subsequent higher risk of nursing home use. METHODS We used eight waves (1998-2016) of Health and Retirement Study data for adults aged 65 years and older. Latent class mixture modeling identified four distinct cognitive function trajectory classes (1998-2006): low-declining, medium-declining, medium-stable, high-declining. Participants from the 1998 wave (N = 5628) were classified into these four classes. Competing risks regression analysis modeled the sub-hazard of nursing home use between 2006 and 2016 as a function of baseline psychiatric history and cognitive function trajectories. RESULTS Psychiatric history was independently associated with greater risk of nursing home use (SHR 1.26, 95% CI 1.06-1.51, p<.01), net the effects of life course variables. Further, "low declining" (SHR 2.255, 95% CI 1.70-2.99, p<.001) and "medium declining" (2.103, 95% CI 1.69-2.61, p<.001) trajectories predicted increased risk of nursing home use. DISCUSSION Evidence of these associations can be used to educate policymakers and providers about the need for appropriate psychiatric training for staff in community-based and residential long-term care programs.
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18
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van der Wolf E, van Hooren SAH, Waterink W, Lechner L. Psychiatric and behavioral problems and well-being in gerontopsychiatric nursing home residents. Aging Ment Health 2021; 25:277-285. [PMID: 31847540 DOI: 10.1080/13607863.2019.1695738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Gerontopsychiatric nursing home residents are residents with a chronic mental condition (not dementia), in combination with one or more physical disorders. Psychiatric and behavioral problems are common within this population. The objective of this study is to examine these behaviors and their relationship to the level of both observed and self-rated well-being in the gerontopsychiatric population. METHOD Both gerontopsychiatric residents, and their primary formal caregiver in several nursing homes in The Netherlands were asked to participate in a structured interview concerning psychiatric and behavioral problems and resident well-being. Psychiatric and behavioral problems were measured with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and the Cohen Mansfield Agitation Index (CMAI). Well-being was measured through the self-rated Laurens Well-being Inventory for Gerontopsychiatry (LWIG), and the observer rated Laurens Well-being Observations for Gerontopsychiatry (LWOG). RESULTS A total of 126 residents participated in the study with ages varying from 42 to 90. Different types of chronic mental disorders such as schizophrenia spectrum disorder, bipolar disorders and personality disorders were prevalent in the population. Most psychiatric and behavioral problems are associated with lower observed and self-rated well-being. For irritability and affective problem behaviors the relationship with well-being was the most evident. CONCLUSION In daily care practice the relationship between well-being and psychiatric and behavioral problems should be taken into account in care planning and treatment. To further explore the direction and details of this relationship, more research is needed.
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Affiliation(s)
- Elja van der Wolf
- Laurens, Residential Care Center 'De Oudelandse Hof', Berkel en Rodenrijs, The Netherlands.,Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Susan A H van Hooren
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands.,Faculty of Healthcare, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Research Centre for the Arts Therapies, KenVaK, Heerlen, The Netherlands
| | - Wim Waterink
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
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19
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Howard EP, Martin L, Heckman GA, Morris JN. Does the Person-Centered Care Model Support the Needs of Long-Term Care Residents With Serious Mental Illness and Intellectual and Developmental Disabilities? Front Psychiatry 2021; 12:704764. [PMID: 34867509 PMCID: PMC8632811 DOI: 10.3389/fpsyt.2021.704764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Person-centered care approaches continue to evolve in long-term care (LTC). At the same time, these settings have faced increased challenges due to a more diverse and complex population, including persons with intellectual and developmental disabilities (IDD) and serious mental illness (SMI). This study examined the mental, social, and physical wellbeing of residents with different diagnoses, within a person-centered care model. It was hypothesized that individual wellbeing would be comparable among all residents, regardless of primary diagnosis. The study cohort was drawn from all admissions to long-term care facilities in the USA from 2011 to 2013. Data are based on admission, 3 and 6 month follow-up Minimum Data Set (MDS) 3.0 assessments. The groups examined included: schizophrenia, other psychotic disorders, IDD, dementia, and all others (i.e., none of the above diagnoses). The wellbeing outcomes were depression (mental), pain (physical), and behaviors (social). All residents experienced improvements in pain and depression, though the group without the examined diagnoses experienced the greatest gains. Behaviors were most prevalent among those with psychotic disorders; though marked improvements were noted over time. Improvement also was noted among persons with dementia. Behavior worsened over time for the three other groups. In particular, those with IDD experienced the highest level of worsening at 3-month follow-up, and continued to worsen. The results suggest person-centered care in US nursing homes provides the necessary foundation to promote mental and physical wellbeing in persons with complex needs, but less so for social wellbeing.
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Affiliation(s)
- Elizabeth P Howard
- Connell School of Nursing, Boston College, Newton, MA, United States.,Hebrew SeniorLife, The Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, United States
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.,Centre for Education and Research on Aging and Health, Thunder Bay, ON, Canada
| | - George A Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
| | - John N Morris
- Hebrew SeniorLife, The Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, United States
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20
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Orth J, Li Y, Simning A, Temkin-Greener H. Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability? J Am Geriatr Soc 2020; 68:2643-2649. [PMID: 33460044 PMCID: PMC8269953 DOI: 10.1111/jgs.16772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Despite high prevalence of behavioral health (BH) manifestations among nursing home (NH) residents, availability of BH services in this care setting is often inadequate. Our objective was to examine associations between availability of BH services and the presence of severe depression, suicidal ideation (SI), and severe aggressive behaviors (ABs) among NH residents. DESIGN Cross-sectional. SETTING/PARTICIPANTS This study used 2017 survey data about BH service availability obtained from 1,051 NHs. The Minimum Data Set (MDS) was used to identify long-stay residents in these facilities (N = 101,238) and the prevalence of BH manifestations. Descriptive statistics and multivariable logistic regressions were used. MEASUREMENTS We constructed measures of three severe BH manifestations based on the MDS: presence of depression, SI, and ABs. Three independent measures of service availability based on survey items asked about degrees of inadequate (1) staff BH education, (2) coordination/collaboration between facility/community providers, and (3) facility infrastructure (ie, ability to make referrals/transport residents to services). RESULTS Odds of severe depression were 21% higher (odds ratio [OR] = 1.21; P < .001) when NHs reported inadequate BH staff education. Residents with SI had 13% higher odds (OR = 1.13; P = .027) of living in NHs that reported inadequate coordination between facility and community providers. Severe ABs were 10% more likely among residents in NHs reporting inadequate facility infrastructure (OR = 1.10; P = .002) and 7% more likely in facilities with self-reported inadequate coordination between facility/community providers (OR = 1.07; P = .019). Several facility-level factors (eg, staffing, training, turnover) were also statistically significantly associated with these severe BH manifestations. CONCLUSION Residents in NHs reporting inadequate BH services were more likely to experience adverse severe BH manifestations even after controlling for individual and facility-level risk factors. Higher nurse staffing and more staff psychiatric training were associated with lower prevalence of severe BH manifestations. Policy changes and modifications to Medicaid NH reimbursements may be warranted to better incentivize NHs to improve provision of BH services.
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Affiliation(s)
- Jessica Orth
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Adam Simning
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
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21
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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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22
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Tori K, Kalligeros M, Nanda A, Shehadeh F, van Aalst R, Chit A, Mylonakis E. Association between dementia and psychiatric disorders in long-term care residents: An observational clinical study. Medicine (Baltimore) 2020; 99:e21412. [PMID: 32756140 PMCID: PMC7402876 DOI: 10.1097/md.0000000000021412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We examine the relationship between dementia and psychiatric disorder diagnoses among long-term care residents in nursing homes across the state of Rhode Island (RI), USA.Observational clinical study.Two hundred fifty-five residents with and without the diagnosis of dementia were included in this study.Prevalence analysis was used to elucidate information on psychiatric disorders in the overall cohort, and among residents with dementia. Questions from the quality of life questionnaire (EQ-5D-3L) that provides information on self-care, anxiety/depression, and resident's view of how healthy they are, were used to evaluate their association with dementia and psychiatric disorders. A logistic regression analysis was conducted to understand the relationship between dementia and mental illness diagnoses in long-term care facilities. Finally, a subgroup logistic regression analysis was performed for residents with Alzheimer disease.65.1% of all residents suffered from at least 1 psychiatric disorder. Anxiety was the most common diagnosis (36.5%), followed by depression (28.6%), and insomnia (14.9%). There was a positive and statistically significant association between any mental illness diagnosis and dementia (adjusted OR: 3.73; 95% CI: 1.34-10.41). Bipolar disorder and insomnia were negatively and statistically significantly associated with dementia (adjusted OR: 0.17; 95% CI: 0.03-0.89 AND adjusted OR: 0.39; 95% CI: 0.16-0.96 respectively). Age and COPD were also statistically associated with dementia (adjusted OR: 1.07; 95% CI: 1.03-1.11 AND adjusted OR: 0.28, 95% CI: 0.12-0.66). Alzheimer disease was positively and significantly associated with the diagnosis of any mental illness (adjusted OR: 3.77; 95% CI: 1.17-12.20).We studied the relationship between dementia and diagnoses of psychiatric disorders present in long-term care residents. We found that residents with a diagnosis of dementia were more likely to suffer from at least 1 psychiatric disorder. Further work is needed to establish the neuropathophysiological relationship between psychiatric disorders and dementia.
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Affiliation(s)
| | | | - Aman Nanda
- Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School, Providence, RI
| | | | - Robertus van Aalst
- Regional Epidemiology and Health Economics, Sanofi Pasteur, Swiftwater, PA
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Ayman Chit
- Regional Epidemiology and Health Economics, Sanofi Pasteur, Swiftwater, PA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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23
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Brennan PL, Greenbaum MA, Lemke S, Schutte KK. Mental health disorder, pain, and pain treatment among long-term care residents: Evidence from the Minimum Data Set 3.0. Aging Ment Health 2019; 23:1146-1155. [PMID: 30404536 DOI: 10.1080/13607863.2018.1481922] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This study evaluated: (a) associations between long-term care residents' mental health disorder diagnoses and their pain self-reports and pain treatments, and (b) the extent to which communication, cognitive, and physical functioning problems help explain disparities in the pain and pain treatments of long-term care residents with and without mental health disorders. Method: Minimum Data Set 3.0 records of 8,300 residents of Department of Veterans Affairs Community Living Centers were used to determine statistically unadjusted and adjusted cross-sectional associations between residents' mental health diagnoses and their pain and pain treatments. Results: Residents diagnosed with dementia and serious mental illness (SMI) were less likely, and those diagnosed with depressive disorder, post-traumatic stress disorder (PTSD), and substance use disorder (SUD) were more likely, to report recent, severe, and debilitating pain. Among residents affirming recent pain, those with dementia or SMI diagnoses were twice as likely to obtain no treatment for their pain and significantly less likely to receive as-needed pain medication and non-pharmacological pain treatments than were other residents. Those with either depressive disorder or PTSD were more likely, and those with SUD less likely, to obtain scheduled pain medication. In general, these associations remained even after statistically adjusting for residents' demographic characteristics, other mental health disorder diagnoses, and functioning. Conclusion: Long-term care residents with mental health disorders experience disparities in pain and pain treatment that are not well-explained by their functioning deficits. They may benefit from more frequent, thorough pain assessments and from more varied and closely tailored pain treatment approaches.
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Affiliation(s)
- Penny L Brennan
- a Institute for Health & Aging, University of California , San Francisco, San Francisco , CA
| | - Mark A Greenbaum
- b Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System , Palo Alto , CA.,c National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System , Menlo Park , CA
| | - Sonne Lemke
- d Program Evaluation and Resource Center, VA Palo Alto Health Care System , Menlo Park , CA
| | - Kathleen K Schutte
- e Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , CA
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24
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McGarry BE, Joyce NR, McGuire TG, Mitchell SL, Bartels SJ, Grabowski DC. Association between High Proportions of Seriously Mentally Ill Nursing Home Residents and the Quality of Resident Care. J Am Geriatr Soc 2019; 67:2346-2352. [PMID: 31355443 DOI: 10.1111/jgs.16080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/11/2019] [Accepted: 06/15/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To examine the association between the quality of care delivered to nursing home residents with and without a serious mental illness (SMI) and the proportion of nursing home residents with SMI. DESIGN Instrumental variable study. Relative distance to the nearest nursing home with a high proportion of SMI residents was used to account for potential selection of patients between high- and low-SMI facilities. Data were obtained from the 2006-2010 Minimum Data Set assessments linked with Medicare claims and nursing home information from the Online Survey, Certification, and Reporting database. SETTING Nursing homes with high (defined as at least 10% of a facility's population having an SMI diagnosis) and low proportions of SMI residents. PARTICIPANTS A total of 58 571 Medicare nursing residents with an SMI diagnosis (ie, schizophrenia or bipolar disorder) and 558 699 individuals without an SMI diagnosis who were admitted to the same nursing homes. MEASUREMENTS Outcomes were nursing home quality measures: (1) use of physical restraints, (2) any hospitalization in the last 3 months, (3) use of an indwelling catheter, (4) use of a feeding tube, and (5) presence of pressure ulcer(s). RESULTS For individuals with SMI, admission to a high-SMI facility was associated with a 3.7 percentage point (95% confidence interval [CI] = 1.4-6.0) increase in the probability of feeding tube use relative to individuals admitted to a low-SMI facility. Among individuals without SMI, admission to a high-SMI facility was associated with a 1.7 percentage point increase in the probability of catheter use (95 CI = .03-3.47), a 3.8 percentage point increase in the probability of being hospitalized (95% CI = 2.16-5.44), and a 2.1 percentage point increase in the probability of having a feeding tube (95% CI = .43-3.74). CONCLUSION Admission to nursing homes with high concentrations of residents with SMI is associated with worse outcomes for both residents with and without SMI. J Am Geriatr Soc 67:2346-2352, 2019.
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Affiliation(s)
- Brian E McGarry
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nina R Joyce
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Thomas G McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Susan L Mitchell
- Hebrew Senior Life Institute for Aging Research, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stephen J Bartels
- The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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25
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Lacey C, Manuel J, Schluter PJ, Porter RJ, Pitama S, Jamieson HA. Sociodemographic, environmental characteristics and comorbidities of older adults with schizophrenia who access community health service support: A national cross-sectional study. Aust N Z J Psychiatry 2019; 53:570-580. [PMID: 30754993 DOI: 10.1177/0004867419828480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Schizophrenia is a serious and chronic mental illness known to have broad ranging impacts for individuals across the lifespan, yet research on the disease in older adults is sparse. This study provides a profile of the sociodemographic, environmental and diagnostic characteristics of older community residents with schizophrenia using a national database. METHODS A cross-sectional sample of individuals who underwent community needs assessment using the standardised Home Care International Residential Assessment Instrument between 1 September 2012 and 31 January 2016 was utilised. Sociodemographic, diagnostic, and social and environmental variables were measured for individuals with a diagnosis of schizophrenia and compared to those without a diagnosis of schizophrenia. Statistical investigations employed bivariable and multivariable logistic regression models. RESULTS A total sample of 71,859 was eligible and 517 (0.7%) had a diagnosis of schizophrenia. The majority of the sociodemographic variables were statistically associated with schizophrenia in the adjusted analysis, except for ethnicity ( p = 0.35). Nearly all the measured social and environmental variables were adversely associated with having a diagnosis of schizophrenia, such as living in squalid conditions (adjusted odds ratio = 2.16; 95% confidence interval = [1.42, 3.28]). Participants with schizophrenia were significantly more likely to be diagnosed with all assessed psychiatric comorbidities ( p < 0.001) and diabetes mellitus ( p = 0.002), whereas coronary heart disease ( p = 0.001) and other physical comorbidities ( p = 0.001) were found at significantly lower rates. CONCLUSION The profile of schizophrenia found here suggests some subtle differences in the demographic profile and distribution of medical comorbidities in the older population with schizophrenia. The results also suggest that this group continues to experience social disadvantage into old age. This requires the attention of policy-makers to ensure that services are tailored to the high social needs of these individuals.
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Affiliation(s)
- Cameron Lacey
- 1 Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand.,2 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- 1 Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Philip J Schluter
- 3 School of Health Sciences, University of Canterbury, Christchurch, New Zealand.,4 Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Richard J Porter
- 2 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,5 Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Suzanne Pitama
- 1 Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Hamish A Jamieson
- 5 Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand.,6 Department of Medicine, University of Otago, Christchurch, New Zealand
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Temkin-Greener H, Cen X, Hasselberg MJ, Li Y. Preventable Hospitalizations Among Nursing Home Residents With Dementia and Behavioral Health Disorders. J Am Med Dir Assoc 2019; 20:1280-1286.e1. [PMID: 31043354 DOI: 10.1016/j.jamda.2019.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Nursing home (NH) residents with Alzheimer's disease/related dementias (ADRD) and/or behavioral health disorders (BHD) are at high risk of hospitalizations, many of which are potentially avoidable. Empirical evidence regarding potentially avoidable hospitalizations (PAHs) among these residents is quite sparse and mixed. The objectives of this study were to (1) examine the risk of PAH among residents with ADRD only, BHD only, ADRD and BHD compared to residents with neither and (2) identify associations between individual- and facility-level factors and PAH in these subgroups. DESIGN Retrospective, CY2014-2015. SETTING AND PARTICIPANTS Long-term residents age 65+ (N = 807,630) residing in 15,234 NHs. METHODS We employed the Minimum Data Set, MedPAR, Medicare beneficiary summary, and Nursing Home Compare. Hospitalization risk was the outcome of interest. Individual-level covariates were used to adjust for health conditions. Facility-level covariates and state dummies were included. Multinomial logistic regression models were fit to estimate the risk of PAH and non-potentially avoidable hospitalizations (N-PAH). RESULTS Compared to residents without ADRD or BHD, those with ADRD had at least a 10% lower relative risk ratio (RRR) of N-PAH and a significantly lower risk of PAH, at 16% (P < .0001). Residents with BHD only had a statistically higher, but clinically very modest (RRR = 1.03) risk of N-PAH, with no difference in the risk of PAH. Focusing on specific BHD conditions, we found no difference in N-PAH or PAH among residents with depression, lower PAH risk among those with schizophrenia/psychosis (RRR = 0.92), and an increased risk of both N-PAH (RRR = 1.15) and PAH (RRR = 1.09) among residents with bipolar disorders. CONCLUSIONS AND RELEVANCE We observed a lower risk of PAH and N-PAH among residents with ADRD, with the risk for residents with BHD varying by condition. Substantial variations in PAH and N-PAH were evident across states. Future research is needed to identify state-level modifiable factors that explain these variations.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Xi Cen
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Michael J Hasselberg
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Friedman C, VanPuymbrouck L. The relationship between disability prejudice and medicaid home and community-based services spending. Disabil Health J 2019; 12:359-365. [PMID: 30827830 DOI: 10.1016/j.dhjo.2019.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medicaid is one of the most important health care safety nets for people with disabilities in the United States. Yet, from the beginning Medicaid only covered long-term services and supports (LTSS) through institutional care. In 1981 changes to Medicaid allowed states to provide home and community-based services (HCBS) instead so people with disabilities could receive LTSS in their own homes or in the community. As a result of these changes, there has been a significant decline in institutionalization of people with disabilities in favor of HCBS in the United States. However, the priority of HCBS can be impacted by ideas about community living and disability attitudes, among others. How these attitudes may trickle down to impact Medicaid funding decisions is unknown. OBJECTIVE The aim of this study was to examine the relationship between HCBS and disability prejudice in the United States. METHODS We used secondary data about state LTSS expenditures from across the nation in fiscal year (FY) 2015, as well as disability prejudice data (Disability Attitudes Implicit Association Test) from 325,000 people residing in all 50 states and the District of Columbia. RESULTS Findings revealed regardless of the state size or wealth, states with more disability prejudice direct less of their LTSS funding towards HCBS. CONCLUSIONS Biases and prejudice in disability policy decision-making are obstacles to equality of opportunity and full participation in society, as promised by civil rights.
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Affiliation(s)
- Carli Friedman
- CQL, The Council on Quality and Leadership, 100 West Road, Suite 300, Towson, MD, 21204, United States.
| | - Laura VanPuymbrouck
- Department of Occupational Therapy, Rush University, 600 S. Paulina St., Chicago, IL, 60612, United States.
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van der Wolf E, van Hooren SAH, Waterink W, Lechner L. Well-being in elderly long-term care residents with chronic mental disorder: a systematic review. Aging Ment Health 2019; 23:287-296. [PMID: 29266972 DOI: 10.1080/13607863.2017.1408773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES One of the most important objectives of care for older long-term care residents with chronic mental disorders is to facilitate well-being. This review provides an overview of research literature on well-being in this population. METHOD A systematic review was conducted using Pubmed, PsycINFO and PsycARTICLES for all studies up until March 2016. Three reviewers independently assessed the eligibility of the publications and made a selection. RESULTS From a total of 720 unique search results, ten studies were deemed eligible. Specialized care, specifically the presence of mental health-workers was associated with increased well-being outcomes. Perceived amount of personal freedom was also related to higher well-being, whereas stigmatization and depression were related to reduced well-being. Size of residence, single or group-accommodation or moving to another locationdid not, however, seem to have an impact on well-being. CONCLUSION Specialized care, aimed at psychiatric disorders and extra attention for depressed residents are useful tools to promote well-being. Additionally, themes like personal freedom and stigmatization should be taken into consideration in the care for older long-term care residents with chronic mental disorder. However, as very little research has been conducted on this topic, conclusions should be interpreted with caution. More research is highly desirable.
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Affiliation(s)
- Elja van der Wolf
- a Laurens , Geriatric Residental Care Center 'De Oudelandse Hof' , Berkel en Rodenrijs , The Netherlands.,b Faculty of Psychology and Educational Sciences , Open University , Heerlen , The Netherlands
| | - Susan A H van Hooren
- b Faculty of Psychology and Educational Sciences , Open University , Heerlen , The Netherlands.,c Faculty of Healthcare , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,d KenVaK , Research Center for Arts Therapies , Heerlen , The Netherlands
| | - Wim Waterink
- b Faculty of Psychology and Educational Sciences , Open University , Heerlen , The Netherlands
| | - Lilian Lechner
- b Faculty of Psychology and Educational Sciences , Open University , Heerlen , The Netherlands
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Aggressive Behaviors Among Nursing Home Residents: Association With Dementia and Behavioral Health Disorders. J Am Med Dir Assoc 2018; 19:1104-1109.e4. [PMID: 30409493 DOI: 10.1016/j.jamda.2018.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We measured the prevalence and severity of aggressive behaviors (ABs) among nursing home (NH) residents and examined whether individuals with behavioral health disorders were more likely to exhibit aggressive behaviors than others. SETTING AND PARTICIPANTS The analytical sample included 3,270,713 first Minimum Data Set (MDS) assessments for residents in 15,706 NHs in 2015. MEASURES Individuals were identified as having (1) behavioral health disorders only (hierarchically categorized as schizophrenia/psychosis, bipolar disorder, personality disorder, substance abuse, depression/anxiety); (2) dementia only; (3) behavioral health disorders and dementia; or (4) neither. The Aggressive Behavior Scale (ABS) measured the degree of aggressive behaviors exhibited, based on 4 MDS items (verbal, physical, other behavioral symptoms, and rejection of care). The ABS scores ranged from 0 to 12 reflecting symptom severity as none (ABS score = 0), mild (ABS score = 1-2), moderate (ABS score = 3-5), and severe (ABS score = 6-12). Bivariate comparisons and multinomial logistic regressions were performed. RESULTS Residents with behavioral health disorders and dementia had the highest prevalence of ABs (23.1%), followed by dementia only (15.3%), behavioral health disorders only (9.3%), and neither (5.3%). After controlling for individual risk factors and facility covariates, the relative risk of exhibiting severe ABs was 2.47, 5.50, and 9.42 for residents with behavioral health disorders only, dementia only, and behavioral health disorders and dementia, respectively, with a similar pattern for moderate or mild ABs. CONCLUSIONS Residents with behavioral health disorders were less likely than residents with dementia to exhibit aggressive behaviors in nursing homes. Thus, anecdotally reported concerns that aggressive behaviors are primarily an issue for residents with behavioral health disorders, rather than those with dementia, were not empirically justified.
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Byers AL, Lui LY, Vittinghoff E, Covinsky KE, Ensrud KE, Taylor B, Yaffe K. Burden of Depressive Symptoms Over 2 Decades and Risk of Nursing Home Placement in Older Women. J Am Geriatr Soc 2018; 66:1895-1901. [PMID: 30094824 PMCID: PMC6181760 DOI: 10.1111/jgs.15496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/26/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the association between cumulative burden of depressive symptoms and risk of nursing home (NH) placement over 2 decades. DESIGN Prospective cohort study with data linked to Medicare claims files. SETTING Clinic sites in Baltimore, Maryland; Minneapolis, Minnesota; and the Monongahela Valley near Pittsburgh, Pennsylvania. PARTICIPANTS Initially community-dwelling women aged 65 and older (N=3,646). MEASUREMENTS Depressive symptom burden was determined using the Geriatric Depression Scale measured over 18 years to calculate accumulation of burden. NH placement was determined using Medicare claims data. RESULTS In Fine-Gray proportional hazards analyses including demographic characteristics, medical comorbidities, functional impairment, and recent depression exposure and accounting for competing risk of death, women with low depressive symptom burden were twice as likely to experience NH placement as those with minimal burden (hazard ratio (HR) = 1.92, 95% confidence interval (CI) = 1.16-3.20), women with moderate burden were more than twice as likely (HR = 2.62, 95% CI = 1.59-4.31), and women with high burden (HR = 3.08, 95% CI = 1.87-5.08) were three times as likely. The addition of antidepressant use to this model attenuated the risk only slightly. CONCLUSION In older women, cumulative burden of depressive symptoms over nearly 2 decades is associated with greater risk of transitioning from community-living to a NH irrespective of recent depression exposure, medical comorbidities, functional impairment, and the competing risk of death. This work supports the need for improving recognition, monitoring, and treatment of depressive symptoms early, which may reduce or delay NH placement.
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Affiliation(s)
- Amy L. Byers
- Department of Psychiatry, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, CA
| | - Li-Yung Lui
- Research Institute, California Pacific Medical Center, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kenneth E. Covinsky
- San Francisco VA Health Care System, San Francisco, CA
- Department of Medicine, Division of Geriatrics, University of California, San Francisco
| | - Kristine E. Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Minneapolis VA Health Care System, Minneapolis, MN
| | - Brent Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Minneapolis VA Health Care System, Minneapolis, MN
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
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Kang Y(S, Miller NA, Tzeng HM(HM, Zhang T. Race and mental health disorders’ impact on older patients’ nursing home admissions upon hospital discharge. Arch Gerontol Geriatr 2018; 78:269-274. [DOI: 10.1016/j.archger.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 11/16/2022]
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Brown MT, Wolf DA. Estimating the Prevalence of Serious Mental Illness and Dementia Diagnoses Among Medicare Beneficiaries in the Health and Retirement Study. Res Aging 2018; 40:668-686. [PMID: 28856968 PMCID: PMC6553879 DOI: 10.1177/0164027517728554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To estimate the prevalence of serious mental illness and dementia among Medicare beneficiaries in the Health and Retirement Study (HRS). METHODS This study utilizes HRS-linked Medicare claims data sets and inverse probability weighting to estimate overall and age-specific cumulative prevalence rates of dementia and serious mental illnesses among 18,740 Medicare beneficiaries. Two-way tabulations determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, and binary logistic regressions determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, controlling for covariates. RESULTS Weighted prevalence estimates for dementia, schizophrenia (SZP), bipolar disorder (BPD), and major depressive disorder (MDD) are similar to previous studies. Odds of dementia diagnosis are significantly greater for beneficiaries diagnosed with SZP, BPD, or MDD. CONCLUSIONS Co-occurring mental disabilities require further investigation, as in the near future increasing numbers of mentally ill older adults will need appropriate and affordable community-based services and supports.
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Affiliation(s)
| | - Douglas A Wolf
- 1 Aging Studies Institute, Syracuse University, Syracuse, NY, USA
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Temkin-Greener H, Campbell L, Cai X, Hasselberg MJ, Li Y. Are Post-Acute Patients with Behavioral Health Disorders Admitted to Lower-Quality Nursing Homes? Am J Geriatr Psychiatry 2018; 26:643-654. [PMID: 29576229 DOI: 10.1016/j.jagp.2018.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/15/2018] [Accepted: 02/17/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We measured the proportion of new post-acute nursing home admissions with behavioral health diagnoses and examined whether patients with these disorders (schizophrenia/psychosis, bipolar, depression/anxiety, personality disorder, and substance abuse) faced disparities in access to high quality facilities. SETTING/PARTICIPANTS The analytical sample included 3,729,282 admissions to 15,600 facilities nationwide for 2012-2014. MEASUREMENT Quality was measured for overall and staffing domains reported by the Centers for Medicare and Medicaid Services in the Five-Star Quality Rating System. Multinomial logistic regression models were used. The base model included the diagnostic groups of interest and state dummies. Patient sociodemographics, functional and cognitive status, and comorbid conditions were sequentially added to the base model to determine the independent effect of having a behavioral health diagnosis at admission. RESULTS Patients with these conditions experienced disparities accessing to high-quality homes compared to patients without. For example, patients with depression/anxiety had lower access to five-star homes, for the staffing quality domain (Model 3 ORs = 0.88, 0.93, 0.92 in years 1 through 3, respectively) compared to patients with no behavioral health diagnosis. Access disparities were faced not only by patients with serious mental illness, as previously demonstrated, but also patients with substance abuse and with depression/anxiety who account for one-third of all new admissions. CONCLUSIONS Our findings demonstrate persistence of disparities in access to high quality facilities over time and for patients with a broad range of behavioral health conditions. Further research is needed to understand the impact of these disparities on outcomes of patients with behavioral disorders.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | | | - Xuyea Cai
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Michael J Hasselberg
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
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van der Wolf E, van Hooren SAH, Waterink W, Lechner L. Measurement of Well-Being in Gerontopsychiatric Nursing Home Residents: Development of the Laurens Well-Being Inventory for Gerontopsychiatry. J Geriatr Psychiatry Neurol 2018; 31:136-148. [PMID: 29888647 DOI: 10.1177/0891988718781031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The gerontopsychiatric population consists of nursing home residents with combined psychiatric and physical disabilities. A validated measure to assess well-being among this population is currently not available. This article is a first step toward the development of a well-being instrument for the gerontopsychiatric population. METHODS Potential measurement items were gathered and selected with the help of both gerontopsychiatric residents and care professionals. A total of 295 residents and their primary professional caregivers were interviewed. Theoretical and data-driven considerations were applied in the methodological process of scale construction. RESULTS The final instrument comprised of 30 items within 3 dimensions of well-being (physical, social, and psychological well-being). Reliability and validity were found to be adequate for all dimensions and subscales. CONCLUSIONS The Laurens Well-Being Inventory for Gerontopsychiatry measures well-being in gerontopsychiatric nursing home residents. The first results regarding reliability and validity are promising. More research is needed especially to examine test-retest reliability and responsiveness to change.
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Affiliation(s)
- Elja van der Wolf
- 1 Laurens, Residential Care Center "De Oudelandse Hof," Berkel en Rodenrijs, the Netherlands.,2 Open University, Faculty of Psychology and Educational Sciences, DL, Heerlen, the Netherlands
| | - Susan A H van Hooren
- 2 Open University, Faculty of Psychology and Educational Sciences, DL, Heerlen, the Netherlands.,3 Zuyd University of Applied Sciences, Faculty of Healthcare, Heerlen, the Netherlands.,4 KenVaK, Research Centre for the Arts Therapies, Heerlen, the Netherlands
| | - Wim Waterink
- 2 Open University, Faculty of Psychology and Educational Sciences, DL, Heerlen, the Netherlands
| | - Lilian Lechner
- 2 Open University, Faculty of Psychology and Educational Sciences, DL, Heerlen, the Netherlands
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van den Brink AMA, Gerritsen DL, de Valk MMH, Mulder AT, Oude Voshaar RC, Koopmans RTCM. What do nursing home residents with mental-physical multimorbidity need and who actually knows this? A cross-sectional cohort study. Int J Nurs Stud 2018. [PMID: 29524680 DOI: 10.1016/j.ijnurstu.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Aging societies will bring an increase in the number of long-term care residents with mental-physical multimorbidity. To optimize care for these residents, it is important to study their care needs, since unmet needs lower quality of life. To date, knowledge about care needs of residents with mental-physical multimorbidity is limited. The aim of this study was to explore (un)met care needs of residents with mental-physical multimorbidity and determinants of unmet needs. METHODS Cross-sectional cohort study among 141 residents with mental-physical multimorbidity without dementia living in 17 geronto-psychiatric nursing home units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. The Camberwell Assessment of Need for the Elderly (CANE) was used to rate (un)met care needs from residents' and nursing staff's perceptions. Descriptive and multivariate regression analyses were conducted. RESULTS Residents reported a mean number of 11.89 needs (SD 2.88) of which 24.2% (n = 2.88, SD 2.48) were unmet. Nursing staff indicated a mean number of 14.73 needs (SD 2.32) of which 10.8% (n = 1.59, SD 1.61) were unmet. According to the residents, most unmet needs were found in the social domain as opposed to the psychological domain as reported by the nursing staff. Different opinions between resident and nursing staff about unmet needs was most common in the areas accommodation, company, and daytime activities. Further, nearly half of the residents indicated 'no need' regarding behavior while the nursing staff supposed that the resident did require some kind of support. Depression, anxiety and less care dependency were the most important determinants of unmet needs. CONCLUSIONS Systematic assessment of care needs showed differences between the perspectives of resident and nursing staff. These should be the starting point of a dialogue between them about needs, wishes and expectations regarding care. This dialogue can subsequently lead to the most optimal individually tailored care plan. To achieve this, nurses with effective communication and negotiation skills, are indispensable.
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Affiliation(s)
- Anne M A van den Brink
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Debby L Gerritsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Miranda M H de Valk
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands.
| | - Astrid T Mulder
- Gelre Hospital, Department of Geriatrics, Postbus 9014, 7300 DS, Apeldoorn, The Netherlands.
| | - Richard C Oude Voshaar
- University Medical Center Groningen, University of Groningen, University Center for Psychiatry and Interdisciplinary Center for Psychopathology of Emotion Regulation, Postbus 30.001, 9700 RB, Groningen, The Netherlands.
| | - Raymond T C M Koopmans
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
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Collet J, de Vugt ME, Schols JMGA, Engelen GJJA, Winkens B, Verhey FRJ. Well-being of nursing staff on specialized units for older patients with combined care needs. J Psychiatr Ment Health Nurs 2018; 25:108-118. [PMID: 29171899 DOI: 10.1111/jpm.12445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THE SUBJECT Working in long-term care is seen as a stressful, physically and mentally demanding occupation, and thus, nursing staff are at risk for work and stress-related diseases. In older patients, psychiatric illnesses often occur in combination with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nurses is unknown. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE Nursing staff working on specialized units for patients with combined care needs experience high levels of self-efficacy in combination with strong feelings of self-rated competence. Although levels of burnout are relatively low, mental healthcare nursing staff is more at risk for burnout when working in specialized settings for patients with combined care needs than nursing home staff working in specialized settings for these patients. Nursing staff characteristics, such as years of working experience and age, seem more important in relation to staff well-being than patient characteristics in specialized settings for combined care needs. WHAT ARE THE IMPLICATIONS FOR PRACTICE Staff well-being might benefit from specializing care, so that patients with similar care needs are placed together and care is focused. The presence of specialized care units for older patients with combined care needs can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. ABSTRACT Introduction In older patients, psychiatric illnesses frequently exist in tandem with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nursing staff is unknown. AIM To investigate whether care characteristics of patients with combined care needs are related to the mental well-being of nursing staff. METHOD Well-being of nursing staff was studied within a larger exploratory observational cross-sectional study that examined the differences and similarities of specialized combined care units in Dutch mental healthcare and nursing home settings. RESULTS Nursing staff across settings, with more than 5 years of work experience, felt competent in caring for patients with combined care needs. No significant effects of care characteristics of patients with combined care needs on the work-related well-being of nursing staff were shown. Both mental health nursing staff and older employees, however, were found to be more at risk for burnout. IMPLICATIONS/CONCLUSION Staff well-being might benefit from placing patients with combined care needs together, so care is focused. The presence of specialized care units can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training.
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Affiliation(s)
- J Collet
- Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Department of Family Medicine/Elderly Care Medicine and Department of Health Services Research, Maastricht University, Maastricht, Netherlands.,Department of Elderly, Mondriaan Mental Health Care, Heerlen, Netherlands
| | - M E de Vugt
- Alzheimer Center Limburg, School of Mental Health & Neurosciences, Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - J M G A Schols
- Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Department of Family Medicine/Elderly Care Medicine and Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - G J J A Engelen
- Department of Elderly, Mondriaan Mental Health Care, Heerlen, Netherlands
| | - B Winkens
- Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands
| | - F R J Verhey
- Alzheimer Center Limburg, School of Mental Health & Neurosciences, Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
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Collet J, de Vugt ME, Verhey FRJ, Engelen NJJA, Schols JMGA. Characteristics of double care demanding patients in a mental health care setting and a nursing home setting: results from the SpeCIMeN study. Aging Ment Health 2018; 22:33-39. [PMID: 27367644 DOI: 10.1080/13607863.2016.1202891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Older patients suffering from a combination of psychiatric disorders and physical illnesses and/or dementia are called Double Care Demanding patients (DCDs). Special wards for DCDs within Dutch nursing homes (NHs) and mental health care institutions (MHCIs) offer a unique opportunity to obtain insight into the characteristics and needs of this challenging population. METHODS This observational cross-sectional study collected data from 163 DCDs admitted to either a NH or a MHCI providing specialized care for DCDs. Similarities and differences between both DCD groups are described. RESULTS Neuropsychiatric symptoms were highly prevalent in all DCDs but significantly more in MHCI-DCDs. Cognitive disorders were far more present in NH-DCDs, while MHCI-DCDs often suffered from multiple psychiatric disorders. The severity of comorbidities and care dependency were equally high among all DCDs. NH-DCDs expressed more satisfaction in overall quality of life. CONCLUSIONS The institutionalized elderly DCD population is very heterogeneous. Specific care arrangements are necessary because the severity of a patient's physical illness and the level of functional impairment seem to be equally important as the patient's behavioural, psychiatric and social problems. Further research should assess the adequacy of the setting assignment and the professional skills needed to provide adequate care for elderly DCDs.
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Affiliation(s)
- Janine Collet
- a Department of Family Medicine/Elderly Care Medicine and Department Health Services Research, School for Public Health and Primary Care (CAPHRI) , Maastricht University , Maastricht , The Netherlands.,c Department of Elderly , Mondriaan Mental Health Care , Heerlen , The Netherlands
| | - Marjolein E de Vugt
- b Department of Psychiatry and Psychology, School of Mental Health and Neuroscience , Maastricht University Medical Centre+, Alzheimer Centre Limburg , Maastricht , The Netherlands
| | - Frans R J Verhey
- b Department of Psychiatry and Psychology, School of Mental Health and Neuroscience , Maastricht University Medical Centre+, Alzheimer Centre Limburg , Maastricht , The Netherlands
| | - Noud J J A Engelen
- c Department of Elderly , Mondriaan Mental Health Care , Heerlen , The Netherlands
| | - Jos M G A Schols
- a Department of Family Medicine/Elderly Care Medicine and Department Health Services Research, School for Public Health and Primary Care (CAPHRI) , Maastricht University , Maastricht , The Netherlands
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Murphy B, Bugeja L, Pilgrim J, Ibrahim JE. Deaths from Resident-to-Resident Aggression in Australian Nursing Homes. J Am Geriatr Soc 2017; 65:2603-2609. [DOI: 10.1111/jgs.15051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Briony Murphy
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Jennifer Pilgrim
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Joseph E. Ibrahim
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
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Allen C, Zarowitz B, O'Shea T, Peterson E, Yonan C, Waterman F. Identification of pseudobulbar affect symptoms in the nursing home setting: Development and assessment of a screening tool. Geriatr Nurs 2017; 39:54-59. [PMID: 28807457 DOI: 10.1016/j.gerinurse.2017.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 06/02/2017] [Accepted: 06/09/2017] [Indexed: 11/25/2022]
Abstract
Pseudobulbar Affect (PBA) is a neurologic condition characterized by involuntary outbursts of crying and/or laughing disproportionate to patient mood or social context. Although an estimated 9% of nursing home residents have symptoms suggestive of PBA, they are not routinely screened. Our goal was to develop an electronic screening tool based upon characteristics common to nursing home residents with PBA identified through medical record data. Nursing home residents with PBA treated with dextromethorphan hydrobromide/quinidine sulfate (n = 140) were compared to age-, gender-, and dementia-diagnosis-matched controls without PBA or treatment (n = 140). Comparative categories included diagnoses, medication use and symptom documentation. Using a multivariable regression and best decision rule analysis, we found PBA in nursing home residents was associated with chart documentation of uncontrollable crying, presence of a neurologic disorder (e.g., Parkinson's disease), or by the documented presence of at least 2 of the following: stroke, severe cognitive impairment, and schizophrenia. Based on these risk factors, an electronic screening tool was created.
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Affiliation(s)
- Carrie Allen
- Omnicare Senior Health Outcomes - a CVS Health Company, Cincinnati, OH, USA.
| | - Barbara Zarowitz
- Omnicare Senior Health Outcomes - a CVS Health Company, Cincinnati, OH, USA
| | - Terrence O'Shea
- Omnicare Senior Health Outcomes - a CVS Health Company, Cincinnati, OH, USA
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Characteristics and health conditions of a group of nursing home patients with mental-physical multimorbidity - the MAPPING study. Int Psychogeriatr 2017; 29:1037-1047. [PMID: 28260543 DOI: 10.1017/s1041610217000230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Long-term care facilities have partly taken over the traditional asylum function of psychiatric hospitals and house an increasing group of patients with mental-physical multimorbidity (MPM). Little is known about the characteristics, behavior, and care dependency of these patients. This paper aims to describe these aspects. METHODS Explorative, descriptive study among patients with MPM without dementia (n = 142), living in 17 geronto-psychiatric nursing home (NH) units across the Netherlands, stratified by those referred from mental healthcare services (MHS) and other healthcare services (OHS). Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. Patients referred from MHS (n = 58) and from OHS (n = 84) were compared by descriptive statistics. RESULTS Despite exclusion of patients with dementia, the majority of participants had cognitive impairment. Prevalence and severity of frontal impairment were high, as well as the number of patients with clinically relevant neuropsychiatric symptoms. MHS patients were younger, had more chronic psychiatric disorders, and more often used antipsychotics. Neuropsychiatric symptoms, domains of care dependency, physical conditions and concomitant medication use differed not significantly between the subgroups. CONCLUSIONS Both groups of patients with MPM showed heterogeneity in various aspects but differed not significantly regarding the consequences of their multimorbidity. In a variety of characteristics, this group seems to be different from other NH patient groups, which requires extra knowledge and skills of the staff. To uncover which knowledge and skills are necessary, the next step should be to investigate the specific care needs of NH patients with MPM without dementia.
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Mezuk B, Lohman M, Leslie M, Powell V. Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003-2011. Am J Public Health 2015; 105:1495-502. [PMID: 25973805 PMCID: PMC4463392 DOI: 10.2105/ajph.2015.302573] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. METHODS Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. RESULTS Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. CONCLUSIONS LTC may be an important point of engagement in suicide prevention.
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Affiliation(s)
- Briana Mezuk
- At the time of the study, Briana Mezuk and Matthew Lohman were with the Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond. Briana Mezuk is also with the Institute for Social Research, University of Michigan, Ann Arbor. Marc Leslie and Virginia Powell are with the Office of the Chief Medical Examiner, Virginia Department of Health, Richmond
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Viana BDM, Bicalho MAC, Moraes EN, Romano-Silva MA. Twenty-four-year demographic trends of a Brazilian long-term care institution for the aged. J Am Med Dir Assoc 2014; 16:174.e1-6. [PMID: 25533146 DOI: 10.1016/j.jamda.2014.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/14/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objectives of this study were to assess demographic trends of a long-term care institution (LTCI) for the aged throughout 24 years and to discuss the results considering regulations and demographic, socioeconomic, and epidemiological changes in Brazil during this period. METHODS We assessed administrative data of 394 residents of a Brazilian LTCI between January 1, 1990, and December 31, 2013. We calculated age at admission, age at death, length of stay (LOS), and median age of the residents on December 31 for each year from 1990 to 2013. Annual mortality index and total number of admissions and discharges also were analyzed. We used the Jonckheere-Terpstra trend test and 1-way ANOVA for statistical analysis. RESULTS We observed a significant statistical increased trend of the mean age at admission, of the median age of the residents, and of the median LOS throughout the period. There was no increased or decreased trend of the median age at death. CONCLUSIONS The increased trend of the mean age at admission and the median age of the residents may reflect improvements in health, socioeconomic status, life expectancy, and the development of protective regulations for older adults in Brazil. The increased trend of the median LOS may reflect the aforementioned improvements, but we expect a future inversion of this trend due to the admission of older, sicker, and more functionally dependent elderly individuals.
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Affiliation(s)
- Bernardo de Mattos Viana
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil; Núcleo de Geriatria e Gerontologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil.
| | - Maria Aparecida Camargos Bicalho
- Núcleo de Geriatria e Gerontologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil; Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil
| | - Edgar Nunes Moraes
- Núcleo de Geriatria e Gerontologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil; Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil
| | - Marco Aurélio Romano-Silva
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil; Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil
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Abstract
Although exact figures are lacking, many studies show that mental–physical multimorbidity is common in older people (van den Brink et al., 2013). Particularly, older patients with a chronic disease often have psychiatric disorders (Verdurmen et al., 2006). Conversely, medical comorbidity is common in psychiatric patients, especially cardiovascular, pulmonary, and neurological disorders and diabetes (Lyketsos et al., 2002).
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Meeks S, Van Haitsma K, Schoenbachler B, Looney SW. BE-ACTIV for depression in nursing homes: primary outcomes of a randomized clinical trial. J Gerontol B Psychol Sci Soc Sci 2014; 70:13-23. [PMID: 24691156 DOI: 10.1093/geronb/gbu026] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To report the primary outcomes of a cluster randomized clinical trial of Behavioral Activities Intervention (BE-ACTIV), a behavioral intervention for depression in nursing homes. METHOD Twenty-three nursing homes randomized to BE-ACTIV or treatment as usual (TAU); 82 depressed long-term care residents recruited from these nursing homes. BE-ACTIV participants received 10 weeks of individual therapy after a 2-week baseline. TAU participants received weekly research visits. Follow-up assessments occurred at 3- and 6-month posttreatment. RESULTS BE-ACTIV group participants showed better diagnostic recovery at posttreatment in intent-to-treat analyses adjusted for clustering. They were more likely to be remitted than TAU participants at posttreatment and at 3-month posttreatment but not at 6 months. Self-reported depressive symptoms and functioning improved in both groups, but there were no significant treatment by time interactions in these variables. DISCUSSION BE-ACTIV was superior to TAU in moving residents to full remission from depression. The treatment was well received by nursing home staff and accepted by residents. A large proportion of participants remained symptomatic at posttreatment, despite taking one or more antidepressants. The results illustrate the potential power of an attentional intervention to improve self-reported mood and functioning, but also the difficulties related to both studying and implementing effective treatments in nursing homes.
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Affiliation(s)
- Suzanne Meeks
- Department of Psychological and Brain Sciences, University of Louisville, Kentucky.
| | - Kimberly Van Haitsma
- Polisher Research Institute, Abramson Center for Jewish Life, North Wales, Pennsylvania
| | - Ben Schoenbachler
- Department of Psychiatry and Behavioral Science, University of Louisville, Kentucky
| | - Stephen W Looney
- Department of Biostatistics and Epidemiology, Georgia Regents University, Augusta
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Helvik AS, Skancke RH, Selbæk G, Engedal K. Nursing home admission during the first year after hospitalization - the contribution of cognitive impairment. PLoS One 2014; 9:e86116. [PMID: 24497936 PMCID: PMC3908879 DOI: 10.1371/journal.pone.0086116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The importance of cognitive and physical functioning for nursing home admission among medically hospitalized older patients is rarely studied in a one-year follow-up perspective. This study aims to explore the association between patient characteristics and nursing home admission within one year after hospitalization in persons 65 years or more. DESIGN A one-year longitudinal study. METHODS We included 463 (234 women) persons aged 65 years or more from internal medical wards in a rural area of Norway. Cognitive function was assessed using the Mini Mental State Examination; physical and instrumental functional status was assessed using the physical self-maintenance scale and instrumental activities of daily living scale of Lawton and Brody. Comorbidity was measured with the Charlson index. Admission to nursing home within one year (yes versus no) was analyzed using logistic regression analysis and Cox proportional hazard regression analysis. RESULTS The mean age of the sample was 80.5 (SD 7.4) years, mean Mini Mental State Examination score was 24.1 (SD 3.8) (maximum score is 30). In adjusted analysis participants with cognitive impairment (a Mini Mental State Examination score <25) or impaired physical functioning at baseline had higher risk of admission to nursing home within one year (OR 3.0, 95%CI 1.5-6.2 and OR 3.5, 95%CI 1.8-9.6, respectively). The time before admission was also associated with cognitive impairment and impaired physical functioning in the adjusted analysis (HR 2.6 95%CI 1.4-4.8 and HR 3.7, 95%CI 1.5-8.9, respectively). CONCLUSION Impaired cognitive and physical functioning increased the risk for nursing home admission within one year after hospitalization. However, putative regressors, such as education and social network were not included in the analysis.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St Olav's University Hospital, Trondheim, Norway
- Innlandet Hospital Trust, Division Tynset, Tynset, Norway
- * E-mail:
| | - Randi Helene Skancke
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Innlandet Hospital Trust, Division Tynset, Tynset, Norway
| | - Geir Selbæk
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Akershus University Hospital, Lørenskog, Norway
- The Norwegian Centre for Dementia Research, Oslo University Hospital, Ullevaal, Norway
| | - Knut Engedal
- The Norwegian Centre for Dementia Research, Oslo University Hospital, Ullevaal, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Residents with mental-physical multimorbidity living in long-term care facilities: prevalence and characteristics. A systematic review. Int Psychogeriatr 2013. [PMID: 23206307 DOI: 10.1017/s1041610212002025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Aging societies will be confronted with increased numbers of long-term care (LTC) residents with multimorbidity of physical and mental disorders other than dementia. Knowledge about the prevalence rates, medical and psychosocial characteristics, and care needs of this particular group of residents is mandatory for providing high-quality and evidence-based care. The purpose of this paper was to review the literature regarding these features. METHODS A systematic literature search was conducted in PubMed, EMBASE, PsycINFO, and CINAHL from January 1, 1988 to August 16, 2011. Two reviewers independently assessed eligibility of studies on pre-established inclusion criteria as well as methodological quality using standardized checklists. RESULTS Seventeen articles were included. Only one small study describes multimorbidity of a wide range of chronic psychiatric and somatic conditions in LTC residents and suggests that physical-mental multimorbidity is rather rule than exception. All other studies show prevalence rates of comorbid physical and mental illnesses (range, 0.5%-64.7%), roughly in line with reported prevalence rates among community-dwelling older people. LTC residents with mental-physical multimorbidity were younger than other LTC residents and had more cognitive impairment, no dementia, and problem behaviors. Care needs of these residents were not described. CONCLUSIONS Although exact figures are lacking, mental-physical multimorbidity is common in LTC residents. Given the specific characteristics of the pertaining residents, more knowledge of their specific care needs is essential. The first step now should be to perform research on symptoms and behavior, which seem more informative than diagnostic labels as well as care needs of LTC residents with mental-physical multimorbidity.
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Popejoy LL, Galambos C, Moylan K, Madsen R. Challenges to Hospital Discharge Planning for Older Adults. Clin Nurs Res 2012; 21:431-49. [DOI: 10.1177/1054773812436373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital discharge planning for older adults is an essential component to successful transitional care and will become increasingly important as hospitals face financial penalties for avoidable readmissions. This study reports a cross-sectional descriptive web-based survey study about challenges to discharge planning experienced by hospitals in the Midwestern state of Missouri. Problems identified by respondents included difficulties finding placement for patients requiring ventilator care, hemodialysis, chemotherapy, radiation therapy, wound vacuums, or who have mental health care needs. In general, urban hospitals reported more problems with finding postacute discharge destinations for patients than did rural hospitals. It is essential that nursing homes, residential care facilities, and home health agencies be adequately reimbursed to manage complex patients. It may be equally important to identify ways to develop critical assessment and care management skills that are needed in postacute staff to increase the likelihood that patients will be accepted at the time of hospital discharge.
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Blair Irvine A, Billow MB, Eberhage MG, Seeley JR, McMahon E, Bourgeois M. Mental illness training for licensed staff in long-term care. Issues Ment Health Nurs 2012; 33:181-94. [PMID: 22364430 PMCID: PMC3565566 DOI: 10.3109/01612840.2011.639482] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Licensed care staff working in long-term care facilities may be poorly prepared to work with residents with mental illness. This research reports on the program evaluation of Caring Skills: Working with Mental Illness, a training program delivered on the Internet. It was tested with a randomized treatment-control design, with an eight-week follow-up. The training provided video-based behavioral skills and knowledge training. Measures included video situations testing and assessment of psycho-social constructs including empathy and stigmatization. ANCOVA analysis at 4-weeks posttest showed significant positive effects with medium-large effect sizes, which were largely maintained at the 8-week follow-up. The training was well-received by the users.
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Bruce ML, Sheeran T, Raue PJ, Reilly CF, Greenberg RL, Pomerantz JC, Meyers BS, Weinberger MI, Johnston CL. Depression care for patients at home (Depression CAREPATH): intervention development and implementation, part 1. HOME HEALTHCARE NURSE 2011; 29:416-26. [PMID: 21716043 PMCID: PMC3520069 DOI: 10.1097/nhh.0b013e31821fe9f7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
High levels of depressive symptoms are common and contribute to poorer clinical outcomes even in geriatric patients who are already taking antidepressant medication. The Depression CARE for PATients at Home (Depression CAREPATH) intervention was designed for managing depression as part of ongoing care for medical and surgical patients. The intervention provides Home Health Agencies the resources needed to implement depression care management as part of routine clinical practice.
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Affiliation(s)
- Martha L Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA.
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Brown SHM, Abdelhafiz AH. Institutionalization of older people: prediction and prevention. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.10.88] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Expenditure on long-term care is likely to increase with the aging of the population and the increased need for institutionalization. Identifying risk factors for nursing home admission is of particular interest to develop predictive tools and intervention programs to reduce entry into nursing homes. Most of the patient-related risk factors leading to nursing home admission are based on an underlying decline in physical and/or cognitive functions. Interaction between caregiver and care recipient characteristics is also an important contributing factor. Structured preventive programs are more effective than individual counseling. Tailoring intervention programs to individual needs and preferences, continuous and comprehensive support of patients and their caregivers with access to a geriatrician is an important factor in the success of an intervention. Further research is still required to explore whether interventions at early stages of chronic diseases would delay physical and cognitive dysfunction and reduce the institutionalization of older people.
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Affiliation(s)
- Siobhan HM Brown
- Department of Elderly Medicine, Rotherham General Hospital, Moorgate Road, Rotherham,S60 2UD, UK
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